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      Trends in population mental health before and after the 2008 recession: a repeat cross-sectional analysis of the 1991–2010 Health Surveys of England

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          Abstract

          Objective

          To assess short-term differences in population mental health before and after the 2008 recession and explore how and why these changes differ by gender, age and socio-economic position.

          Design

          Repeat cross-sectional analysis of survey data.

          Setting

          England.

          Participants

          Representative samples of the working age (25–64 years) general population participating in the Health Survey for England between 1991 and 2010 inclusive.

          Main outcome measures

          Prevalence of poor mental health (caseness) as measured by the general health questionnaire-12 (GHQ).

          Results

          Age–sex standardised prevalence of GHQ caseness increased from 13.7% (95% CI 12.9% to 14.5%) in 2008 to 16.4% (95% CI 14.9% to 17.9%) in 2009 and 15.5% (95% CI 14.4% to 16.7%) in 2010. Women had a consistently greater prevalence since 1991 until the current recession. However, compared to 2008, men experienced an increase in age-adjusted caseness of 5.1% (95% CI 2.6% to 7.6%, p<0.001) in 2009 and 3% (95% CI 1.2% to 4.9%, p=0.001) in 2010, while no statistically significant changes were seen in women. Adjustment for differences in employment status and education level did not account for the observed increase in men nor did they explain the differential gender patterning. Over the last decade, socio-economic inequalities showed a tendency to increase but no clear evidence for an increase in inequalities associated with the recession was found. Similarly, no evidence was found for a differential effect between age groups.

          Conclusions

          Population mental health in men has deteriorated within 2 years of the onset of the current recession. These changes, and their patterning by gender, could not be accounted for by differences in employment status. Further work is needed to monitor recessionary impacts on health inequalities in response to ongoing labour market and social policy changes.

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          Most cited references16

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          Health effects of anticipation of job change and non-employment: longitudinal data from the Whitehall II study.

          To assess the effect of anticipating job change or non-employment on self reported health status in a group of middle aged male and female white collar civil servants. Longitudinal cohort study (Whitehall II study). Questionnaire data on self reported health status and health behaviour were obtained at initial screening and four years later, during the period when employees of the department facing privatisation were anticipating job change or job loss. London based office staff in 20 civil service departments. 666 members of one department threatened with early privatisation were compared with members of the 19 other departments. Self reported health status measures and health related behaviours, before and during anticipation of privatisation. In comparison to the remainder of the cohort, the profile of health related behaviours of cohort members who faced privatisation was more favourable, both before and during anticipation of privatisation. There were no significant differences in the changes in health behaviours between cohort members moving into a period of job insecurity and the remainder of the cohort. Self reported health status, however, tended to deteriorate among employees anticipating privatisation when compared with that of the rest of the cohort. The application of a longitudinal design, allowing the same individuals to be followed from job security into anticipation, provides more robust evidence than has previously been available that anticipation of job loss affects health even before employment status has changed.
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            Economic crisis and mental health.

            Literature from the past year was examined to learn whether economic recessions have an effect on mental disorders including depression and suicides. Economic recessions and crises have a context-dependent negative impact on mental health disorders. These appear in low-income and middle-income countries whereas some affluent countries are offering provisions that help unemployed persons to escape the detrimental consequences. The Asian economic crisis led to a sharp unemployment-related increase in suicide mortality in east Asian countries. In European Union countries rising unemployment was associated with significant short-term increases in premature deaths from intentional violence including suicides. It seems that active labour market programmes existing in some Organization for Economic Cooperation and Development countries can prevent some adverse health effects of economic downturns. As mental health consequences of economic crises are context dependent, the current situation needs monitoring. Enough services for those in need should be provided and advocacy for societal support measures is of great importance.
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              Economic downturns and population mental health: research findings, gaps, challenges and priorities.

              Prior research suggests that the current global economic crisis may be negatively affecting population mental health. In that context, this paper has several goals: (1) to discuss theoretical and conceptual explanations for how and why economic downturns might negatively affect population mental health; (2) present an overview of the literature on the relationship between economic recessions and population mental health; (3) discuss the limitations of existing empirical work; and (4) highlight opportunities for improvements in both research and practice designed to mitigate any negative impact of economic declines on the mental health of populations. Research has consistently demonstrated that economic crises are negatively associated with population mental health. How economic downturns influence mental health should be considered in policies such as social protection programs that aim to promote recovery.
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                Author and article information

                Journal
                BMJ Open
                BMJ Open
                bmjopen
                bmjopen
                BMJ Open
                BMJ Group (BMA House, Tavistock Square, London, WC1H 9JR )
                2044-6055
                2012
                2012
                21 September 2012
                : 2
                : 5
                : e001790
                Affiliations
                [1 ]Evaluation of Social Interventions Programme, MRC/CSO Social & Public Health Sciences Unit, Glasgow, UK
                [2 ]Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
                [3 ]Social Patterning of Health Over the Lifecourse, MRC/CSO Social & Public Health Sciences Unit, Glasgow, UK
                Author notes
                [Correspondence to ] Dr Srinivasa Vittal Katikireddi; vkatikireddi@ 123456sphsu.mrc.ac.uk
                Article
                bmjopen-2012-001790
                10.1136/bmjopen-2012-001790
                3488736
                23075569
                1e37e0b7-a426-4625-92e4-2eca3a83c377
                © 2012, Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

                This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/2.0/ and http://creativecommons.org/licenses/by-nc/2.0/legalcode.

                History
                : 11 July 2012
                : 28 August 2012
                Categories
                1612
                Public Health
                Research
                1506
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                Custom metadata
                press-release

                Medicine
                social medicine,mental health,epidemiology,public health
                Medicine
                social medicine, mental health, epidemiology, public health

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