4 January 2017
Job clubs seem to be effective in reducing depression in people who lose their jobs, particularly those at high risk of depression, an NIHR-funded study has found. But evidence for other types of support for people during times of financial hardship, including cognitive behavioural therapy (CBT) and debt advice, is limited.
University of Bristol researchers from the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) looked at the findings from ‘randomised controlled trials’, where different forms of support were compared with each other. They wanted to understand the effectiveness of the support available for people, other than visiting a GP and taking anti-depressants and other drugs.
The review, published in Psychological Medicine, found that there was some evidence to suggest that job clubs are effective, but that overall the evidence that job club, CBT or debt advice interventions work is very limited. More research is needed to identify the best approach to support people who lose their jobs or experience financial hardship.
Reducing the effect of job loss and debt on mental health should be an important element of policy response to periods of recession. Research shows that government spending on active labour market programmes and unemployment protection schemes can counter the effect of recession on suicide rates. But austerity measures, such as reassessing whether people are eligible for benefits, have the opposite effect.
Studies have shown that mental health in men deteriorated within two years of the 2008 recession. Suicide and self-harm rates have increased following the economic crisis, particularly in men.
Professor David Gunnell, who led the study, said:
“During economic recession more people are out of work, home repossessions and debt increase, people still in work may also feel that it’s harder to cope financially, and welfare benefits reduce. Financial difficulties can lead to relationship strain too. All of these can make people feel depressed and anxious over a long period of time and some people contemplate or attempt self-harm and suicide.
“We were interested in understanding what support could be offered to people during times of economic hardship, beyond taking drugs or other more medical interventions. Our findings suggest that job clubs are effective, especially for those at high risk of depression. But the evidence for other types of interventions is very weak. With more public funding cuts ahead, we’re likely to see more and more people falling on hard times, and it’s vital that we understand how we can help them cope.”
Recession and economic hardship are also responsible for further entrenching health inequalities, disproportionately affecting people who have already experienced difficulties that can seem insurmountable.
Professor Gunnell has recently published another study in BMJ Open looking at the events and experiences that lead people who are experiencing economic hardship to self-harm. That study found that financial hardship resulting from the recession and austerity measures accumulated over time, or acted as a ‘final straw’, triggering self-harm. These people tend to have already experienced many damaging life-experiences, including abuse, neglect, bullying, domestic violence, mental health problems, relationship difficulties, bereavements and low self-esteem.
Interventions to reduce the impact of unemployment and economic hardship on mental health in the general population: a systematic review
Moore THM, Kapur N, Hawton K, Richards A, Metcalfe C, Gunnell D