Interventions to reduce the impact of unemployment and economic hardship on mental health in the general population: a systematic review

Abstract

BackgroundJob loss, debt and financial difficulties are associated with increased risk of mental illness and suicide in the general population. Interventions targeting people in debt or unemployed might help reduce these effects.MethodWe searched MEDLINE, Embase, The Cochrane Library, Web of Science, and PsycINFO (January 2016) for randomized controlled trials (RCTs) of interventions to reduce the effects of unemployment and debt on mental health in general population samples. We assessed papers for inclusion, extracted data and assessed risk of bias.ResultsEleven RCTs (n = 5303 participants) met the inclusion criteria. All recruited participants were unemployed. Five RCTs assessed ‘job-club’ interventions, two cognitive behaviour therapy (CBT) and a single RCT assessed each of emotional competency training, expressive writing, guided imagery and debt advice. All studies were at high risk of bias. ‘Job club’ interventions led to improvements in levels of depression up to 2 years post-intervention; effects were strongest among those at increased risk of depression (improvements of up to 0.2–0.3 s.d. in depression scores). There was mixed evidence for effectiveness of group CBT on symptoms of depression. An RCT of debt advice found no effect but had poor uptake. Single trials of three other interventions showed no evidence of benefit.Conclusions‘Job-club’ interventions may be effective in reducing depressive symptoms in unemployed people, particularly those at high risk of depression. Evidence for CBT-type interventions is mixed; further trials are needed. However the studies are old and at high risk of bias. Future intervention studies should follow CONSORT guidelines and address issues of poor uptake.

Young Adult Unemployment and Later Depression and Anxiety: Does Childhood Neighborhood Matter?

“…The current study findings suggest that losing a job as a young person may disrupt a smooth developmental transition for young people and thus can jeopardize their future healthy development regardless of gender. Taken together, the current study findings indicate a needed shift in service profiles for unemployed young people—a comprehensive approach, such as “job–club” type interventions (Moore et al 2017) that not only facilitate reemployment but also address mental health needs to help them to cope with job loss. Further, the current study findings suggest that neighborhoods during childhood and adolescence, particularly their positive features, may represent concrete and malleable prevention targets that can curb mental health problems early in life.…”

Coping with Economic Stress: A Test of Deterioration and Stress-Suppressing Models

“…Lim et al (2014) found that college students with high financial self-efficacy were more likely to seek help from professionals when they were experiencing financial stress. A recent review of interventions used to negate the harm of debt and job loss on mental health (see Moore et al, 2017 review a discussion of interventions) found mixed results.…”

“…Interventions that focused on cognitive behavior therapy, consisting of "cognitive restructuring, behavior modification, and homework assignments" (Moore et al, 2017(Moore et al, , p. 1073 showed inconsistent results. Interventions that emphasized emotional competency training including techniques such as expressive writing, guided imagery about finding employment and relaxation strategies, and debt advice had no effect on depression.…”

Strengthening mental health systems to respond to economic crises

“…One analysis in European Union countries, suggested that each additional annual spend of $100 per head of population spent on active labour market programmes can reduce the effect of a 1% rise in the unemployment rate on suicides by 0.4% (35). Psychological support within active labour market programmes can also promote better mental health and wellbeing, as well as help increase re-employment rates (36)(37)(38).…”