Skip to main content
×
Home
    • Aa
    • Aa

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

  • T. H. M. Moore (a1) (a2), N. Kapur (a3), K. Hawton (a4), A. Richards (a1) (a2), C. Metcalfe (a1) and D. Gunnell (a1) (a2)...
Abstract
Background

Job 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.

Method

We 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.

Results

Eleven 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.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Interventions to reduce the impact of unemployment and economic hardship on mental health in the general population: a systematic review
      Available formats
      ×
      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your Dropbox account. Find out more about sending content to Dropbox.

      Interventions to reduce the impact of unemployment and economic hardship on mental health in the general population: a systematic review
      Available formats
      ×
      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your Google Drive account. Find out more about sending content to Google Drive.

      Interventions to reduce the impact of unemployment and economic hardship on mental health in the general population: a systematic review
      Available formats
      ×
Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Corresponding author
* Address for correspondence: Professor D. Gunnell, School of Social and Community Medicine, University of Bristol, 39 Whatley Road, Bristol BS8 2PS, UK. (Email: d.j.gunnell@bristol.ac.uk)
Linked references
Hide All

This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

J Adams , M White , S Moffatt , D Howel , J Mackintosh (2006). A systematic review of the health, social and financial impacts of welfare rights advice delivered in healthcare settings. BMC Public Health 6, 28.

SS Audhoe , JL Hoving , JK Sluiter , MH Frings-Dresen (2010). Vocational interventions for unemployed: effects on work participation and mental distress. A systematic review. Journal of Occupational Rehabilitation 20, 113.

NH Azrin , T Flores , SJ Kaplan (1975). Job-finding club: a group-assisted program for obtaining employment. Behaviour Research and Therapy 13, 1727.

K Baicker , SL Taubman , HL Allen , M Bernstein , JH Gruber , JP Newhouse , EC Schneider , BJ Wright , AM Zaslavsky , AN Finkelstein , Oregon Health Study G, M Carlson , T Edlund , C Gallia , J Smith (2013). The Oregon experiment-effects of medicaid on clinical outcomes. New England Journal of Medicine 368, 17131722.

MC Barnes , D Gunnell , R Davies , K Hawton , N Kapur , J Potokar , JL Donovan (2016). Understanding vulnerability to self-harm in times of economic hardship and austerity: a qualitative study. BMJ Open bmjopen-2015-010131.

J Burke-Miller , LA Razzano , DD Grey , CR Blyler , JA Cook (2012). Supported employment outcomes for transition age youth and young adults. Psychiatric Rehabilitation Journal 35, 171179.

RD Caplan , AD Vinokur , RH Price , M van Ryn (1989). Job seeking, reemployment, and mental health: a randomized field experiment in coping with job loss. Journal of Applied Psychology 74, 759769.

S-S Chang , D Stuckler , P Yip , D Gunnell (2013). Impact of 2008 global economic crisis on suicide: time trend study in 54 countries. British Medical Journal BMJ 2013;347:f5239.

J Connor , A Rodgers , P Priest (1999). Randomised studies of income supplementation: a lost opportunity to assess health outcomes. Journal of Epidemiology & Community Health 53, 725730.

C Coope , J Donovan , C Wilson , M Barnes , C Metcalfe , W Hollingworth , N Kapur , K Hawton , D Gunnell (2015). Characteristics of people dying by suicide after job loss, financial difficulties and other economic stressors during a period of recession (2010–2011): a review of coroners’ records. Journal of Affective Disorders 183, 98105.

P Corcoran , E Griffin , E Arensman , AP Fitzgerald , IJ Perry (2015). Impact of the economic recession and subsequent austerity on suicide and self-harm in Ireland: an interrupted time series analysis. International Journal of Epidemiology 10.1093/ije/dyv058. pp. 969977.

P Craig , P Dieppe , S Macintyre , S Michie , I Nazareth , M Petticrew (2008). Developing and evaluating complex interventions: the new Medical Research Council guidance. British Medical Journal BMJ 2008;337:a1655.

J Cylus , MM Glymour , M Avendano (2014). Do generous unemployment benefit programs reduce suicide rates? A state fixed-effect analysis covering 1968–2008. American Journal of Epidemiology 180, 4552.

LR Derogatis , RS Lipman , K Rickels , EH Uhlenhuth , L Covi (1974). The Hopkins Symptom Checklist (HSCL): a self-report symptom inventory. Behavioral Science 19, 115.

LC Fernald , R Hamad , D Karlan , EJ Ozer , J Zinman (2008). Small individual loans and mental health: a randomized controlled trial among South African adults. BMC Public Health 8, 409.

A Finkelstein , S Taubman , B Wright , M Bernstein , J Gruber , JP Newhouse , H Allen , K Baicker , Or , Oregon Health Study Group (2012). The Oregon health insurance experiment: evidence from the first year. Quarterly Journal of Economics 127, 10571106.

C Fitch , S Hamilton , P Bassett , R Davey (2011). The relationship between personal debt and mental health: a systematic review. Mental Health Review Journal 16, 153166.

MS Forgatch , DS DeGarmo (2007). Accelerating recovery from poverty: prevention effects for recently separated mothers. Journal of Early and Intensive Behavior Intervention 4, 681702.

DP Goldberg , R Gater , N Sartorius , TB Ustun , M Piccinelli , O Gureje , C Rutter (1997). The validity of two versions of the GHQ in the WHO study of mental illness in general health care. Psychological Medicine 27, 191197.

D Gray (1983). A job club for older job seekers: an experimental evaluation. Journal of Gerontology 38, 363368.

E Harris , J Lum , V Rose , M Morrow , E Comino , M Harris (2002). Are CBT interventions effective with disadvantaged job-seekers who are long-term unemployed? Psychology, Health and Medicine 7, 401410.

C Haw , K Hawton , D Gunnell , S Platt (2015). Economic recession and suicidal behaviour: possible mechanisms and ameliorating factors. International Journal of Social Psychiatry 61, 7381.

S Hodzic , P Ripoll , C Bernal , F Zenasni (2015 a). The effects of emotional competences training among unemployed adults: a longitudinal study. Applied Psychology. Health and Well-being 7, 275292.

S Hodzic , P Ripoll , E Lira , F Zenasni (2015 b). Can intervention in emotional competences increase employability prospects of unemployed adults? Journal of Vocational Behavior 88, 2837.

R Jagannathan , MJ Camasso , U Sambamoorthi (2010). Experimental evidence of welfare reform impact on clinical anxiety and depression levels among poor women. Social Science & Medicine 71, 152160.

LM Joseph , MA Greenberg (2001). The effects of a career transition program on reemployment success in laid-off professionals. Consulting Psychology Journal: Practice & Research Summer 53, 169181.

SV Katikireddi , CL Niedzwiedz , F Popham (2012). Trends in population mental health before and after the 2008 recession: a repeat cross-sectional analysis of the 1991–2010 Health Surveys of England. BMJ Open 2 bmjopen-2012–001790.

SM Kneipp , JA Kairalla , BJ Lutz , D Pereira , AG Hall , J Flocks , L Beeber , T Schwartz (2011). Public health nursing case management for women receiving temporary assistance for needy families: a randomized controlled trial using community-based participatory research. American Journal of Public Health 101, 17591768.

I Kotsou , D Nelis , J Gregoire , M Mikolajczak (2011). Emotional plasticity: conditions and effects of improving emotional competence in adulthood. Journal of Applied Psychology 96, 827839.

M Kukla , GR Bond (2009). The working alliance and employment outcomes for people with severe mental illness enrolled in vocational programs. Rehabilitation Psychology 54, 156163.

A Liberati , DG Altman , J Tetzlaff , C Mulrow , PC Gøtzsche , JPA Ioannidis , M Clarke , PJ Devereaux , J Kleijnen , D Moher (2009). The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. British Medical Journal 339. http://www.bmj.com/content/339/bmj.b2700

S Liu , JL Huang , M Wang (2014). Effectiveness of job search interventions: a meta-analytic review. Psychological Bulletin July 140, 10091041.

PA Morris , R Hendra (2009). Losing the safety net: how a time-limited welfare policy affects families at risk of reaching time limits. Developmental Psychology 45, 383400.

K Nieuwenhuijsen , B Faber , JH Verbeek , A Neumeyer-Gromen , HL Hees , AC Verhoeven , CM van der Feltz-Cornelis , U Bültmann (2014). Interventions to improve return to work in depressed people. Cochrane Database of Systematic Reviews 2014, Issue 12. CD006237. DOI: 10.1002/14651858.CD006237.pub3..

T Norström , H Grönqvist (2014). The great Recession, unemployment and suicide. Journal of Epidemiology and Community Health 69, 110116.

P Pleasence (2008). Trials and tribulations: conducting randomized experiments in a socio-legal setting. Journal of Law and Society 35, 829.

P Pleasence , NJ Balmer (2007). Changing fortunes: results from a randomized trial of the offer of debt advice in England and wales. Journal of Empirical Legal Studies 4, 651673.

RH Price , M Van Ryn , AD Vinokur (1992). Impact of a preventive job search intervention on the likelihood of depression among the unemployed. Journal of Health & Social Behavior 33, 158167.

J Proudfoot , D Guest , J Carson , G Dunn , J Gray (1997). Effect of cognitive-behavioural training on job-finding among long-term unemployed people. Lancet 350, 96100.

JC Rife , JR Belcher (1994). Assisting unemployed older workers to become reemployed: an experimental evaluation. Research on Social Work Practice 4, 313.

RA-S Salman , E Beller , J Kagan , E Hemminki , RS Phillips , J Savulescu , M Macleod , J Wisely , I Chalmers (2014). Increasing value and reducing waste in biomedical research regulation and management. Lancet 383, 176185.

KF Schulz , DG Altman , D Moher (2010). CONSORT 2010 Statement: updated guidelines for reporting parallel group randomized trials. Annals of Internal Medicine 152, 726732.

SP Spera , ED Buhrfeind , JW Pennebaker (1994). Expressive writing and coping with job loss. Academy of Management Journal 37, 722733.

D Stuckler , S Basu , M Suhrcke , A Coutts , M McKee (2009). The public health effect of economic crises and alternative policy responses in Europe: an empirical analysis. Lancet 374, 315323.

HW Tsang , KM Fung , AY Leung , SM Li , WM Cheung (2010). Three year follow-up study of an integrated supported employment for individuals with severe mental illness. Australian & New Zealand Journal of Psychiatry 44, 4958.

L Turner , L Shamseer , DG Altman , L Weeks , J Peters , T Kober , S Dias , KF Schulz , AC Plint , D Moher (2012). Consolidated standards of reporting trials (CONSORT) and the completeness of reporting of randomised controlled trials (RCTs) published in medical journals. Cochrane Database of Systematic Reviews 11. doi:10.1002/14651858.MR000030.pub2

M Vanryn , AD Vinokur (1992). How did it work - An examination of the mechanisms through which an intervention for the unemployed promoted job-search behavior. American Journal of Community Psychology 20, 577597.

AD Vinokur , RH Price , RD Caplan (1996). Hard times and hurtful partners: how financial strain affects depression and relationship satisfaction of unemployed persons and their spouses. Journal of Personality & Social Psychology 71, 166179.

AD Vinokur , RH Price , RD Caplan , M van Ryn , J Curran (1995 a). The Jobs I preventive intervention for unemployed individuals: short- and long-term effects on reemployment and mental health. In Job Stress Interventions, pp. 125138. American Psychological Association: Washington, DC, USA.

AD Vinokur , RH Price , Y Schul (1995 b). Impact of the JOBS intervention on unemployed workers varying in risk for depression. American Journal of Community Psychology 23, 3974.

AD Vinokur , Y Schul (1997). Mastery and inoculation against setbacks as active ingredients in the JOBS intervention for the unemployed. Journal of Consulting & Clinical Psychology 65, 867877.

AD Vinokur , Y Schul , J Vuori , RH Price (2000). Two years after a job loss: long-term impact of the JOBS program on reemployment and mental health. Journal of Occupational Health Psychology 5, 3247.

AD Vinokur , M van Ryn , EM Gramlich , RH Price (1991 b). Long-term follow-up and benefit-cost analysis of the Jobs Program: a preventive intervention for the unemployed. Journal of Applied Psychology 76, 213219.

J Vuori , J Silvonen (2005). The benefits of a preventive job search program on re-employment and mental health at 2-year follow-up. Journal of Occupational and Organizational Psychology 78, 4352.

J Vuori , J Silvonen , AD Vinokur , RH Price (2002). The Tyohon job search program in Finland: benefits for the unemployed with risk of depression or discouragement. Journal of Occupational Health Psychology 7, 519.

J Vuori , AD Vinokur (2005). Job-search preparedness as a mediator of the effects of the tyohon job search Intervention on re-employment and mental health. Journal of Organizational Behavior 26, 275291.

D Watson , J Pennebaker (1989). Health complaints, stress and distress. Psychological Review 96, 234254.

Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Psychological Medicine
  • ISSN: 0033-2917
  • EISSN: 1469-8978
  • URL: /core/journals/psychological-medicine
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Keywords:

Type Description Title
WORD
Supplementary Materials

Moore supplementary material
Appendices

 Word (79 KB)
79 KB

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 157
Total number of PDF views: 683 *
Loading metrics...

Abstract views

Total abstract views: 2189 *
Loading metrics...

* Views captured on Cambridge Core between 15th December 2016 - 21st September 2017. This data will be updated every 24 hours.