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The Evolution of Mental Health in the Context of Transitory Economic Changes

  • Original Research Article
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Abstract

Background

Mental health disorders are highly prevalent across countries. They increase over time and impose a severe burden on individuals and societies.

Objective

This paper examines the evolution of mental health over a period of 15 years, paying special attention on the impact of the most recent economic downturn and subsequent recovery, in Spain.

Method

We use data coming from the National Health Surveys of 2006/2007, 2011/2012 and 2016/2017. Mental health is proxied by two measures, doctor-diagnosed mental disorder and psychological distress (based on the 12-item General Health Questionnaire). To account for the relationship between the two mental health indicators, we estimate a bivariate probit model. The potential endogeneity of unemployment status is considered.

Results

We observe different patterns of the two mental health indicators over time. Psychological distress in men increased during recession years, but slightly decreased among women. Diagnosed mental disorders declined during the peak years of the crisis. Unemployment is a major risk factor for mental distress. Irrespective of the economic conditions, belonging to a higher social class acts as a buffer against psychological distress for women, but not for men. The remaining determinants acted as expected. Women declared worse psychological health than men, and were also more often diagnosed with mental disorders. Having a partner had a protective impact, while providing intensive care to a dependent relative exerted the opposite effect. Education acted as buffer against the onset of psychological distress in women.

Conclusion

Even though the need for mental healthcare increased during the recession, the fact that fewer people were diagnosed suggests that barriers to accessing mental healthcare may be aggravated during the crisis. Policies aiming to tackle the challenges posed by the high prevalence of mental disorders have to be particularly attentive to changes in individuals’ socioeconomic situation, including education, unemployment and social class.

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Data Availability

The data that support the findings of this study are available from the National Statistical Institute website http://www.ine.es. The software codes will be provided upon request.

Notes

  1. See Catalano et al. [6] and Bellés-Orero and Vall Castelló [7], for comprehensive reviews.

  2. A drop in living standards may lead to readjustment of consumption patterns, such as cuts in spending on quality food and healthcare [27].

  3. Unemployment can lead to lower self-esteem, loss of social contacts, feelings of hopelessness, etc.

  4. Volunteering may improve mental health. See Jenkinson et al [48], for a review.

  5. Following the WHO definition of mental health [57], we use the terms mental health and mental/psychological well-being interchangeably throughout the paper.

  6. Individuals with GHQ-12 scores of at least 3 are considered at “risk of psychiatric morbidity”.

  7. We also constructed alternative indicators of psychological distress, namely GHQ-12 ≥ 5 and GHQ-12 ≥ 8, which we used as robustness checks. The interpretation of the results remains unchanged.

  8. Social class is used as proxy for socioeconomic status (SES). The two terms are used interchangeably throughout the paper.

  9. Income is an alternative indicator of SES. However, the SNHS measures income as a categorical variable with eight response levels. As in previous work [68], we employ an interval regression model based on information of the head of the household (age, gender, education, occupation and region of residence) to obtain a continuous household income variable. The Oxford equivalence scale [69] is used to adjust the predicted disposable monthly income for differences in household composition.

  10. Detailed data on the distribution of the two mental health indicators by autonomous region of residence are shown in the Appendix Table 7.

  11. The estimations control for the region of residence, although these results are not shown to make tables more readable.

  12. We use the adjusted Wald test to assess differences in the effects pairwise (see Table 8 in the Appendix) and across all periods.

  13. As a robustness check, we estimated our models using alternative socioeconomic indicators: social class of the household head, natural logarithm of income and income quartiles. The impact of the other covariates is similar in all models. The results presented in Table 6 are derived from the models with income quartiles as SES indicator. The Appendix Tables 9 and 10 contain the estimates of this model.

  14. In 2015 men were main breadwinners in two-thirds of all Spanish households [78].

  15. Higher GDP is shown to be associated with an increased demand for mental healthcare [102].

  16. Unmet needs for specialised care [103] or no change in use despite increase in referrals [104] point in that direction.

  17. It seems the most plausible explanation for Spain. There are no official data. However, one can get an idea of the evolution of the number of mental health professionals and services by regions from the data (corresponding to 2004, 2007, 2010 and 2014) published by the Observatory for Mental Health of the Spanish Neuropsychiatric Association [105].

  18. Mental health care is included in the comprehensive set of services provided (free at the point of use) by the National Health System. However, the long waiting times in the public sector may force those most in need to seek private care, fully paid out-of-pocket.

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Acknowledgements

We thank seminar participants at the Universidad de Las Palmas de Gran Canarias, Jornadas AES 2019 in Albacete, and Raquel Andrés for helpful comments and suggestions.

Author information

Authors and Affiliations

  1. Department of Economics, Faculty of Economics and Business Administration, Universitat de Barcelona, BEAT and CAEPS, 08034, Barcelona, Spain

    Alexandrina Stoyanova

  2. Department of Quantitative Methods in Economics, Universidad de Las Palmas de Gran Canaria, 35017, Las Palmas de Gran Canaria, Spain

    Jaime Pinilla

Authors
  1. Alexandrina Stoyanova
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  2. Jaime Pinilla
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Contributions

AS and JP conceived the research. Both authors contributed to analyse the data and interpret the results. Both authors wrote the first draft of the manuscript, critically reviewed and revised it and approved the final version.

Corresponding author

Correspondence to Alexandrina Stoyanova.

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Funding

A Stoyanova acknowledges financial support from the Fundación Ramón Areces project “Envejecimiento y sistema sanitario y social. El gasto público y sus efectos en igualdad, dependencia y aseguramiento en España” (162PR19693); and the project “Desarrollo económico, transición demográfica y estado del bienestar en un entorno de globalización”, Ministerio de Economía y Competitividad, Gobierno de España (ECO2016-78991-R).

Conflict of interest

Alexandrina Stoyanova and Jaime Pinilla have no conflict of interest to declare.

Appendix

Appendix

See Tables 7, 8, 9 and 10.

Table 7 Diagnosed mental disorders and psychological distress by gender and autonomous region of residence (%)
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Table 8 Differential impact of main socioeconomic variables on mental health outcomes by gender across time [adjusted Wald \(X^{2}\) (Prob > \(X^{2}\))]
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Table 9 Bivariate probit models for diagnosed mental disorder and psychological distress—men
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Table 10 Bivariate probit models for diagnosed mental disorder and psychological distress—women
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Stoyanova, A., Pinilla, J. The Evolution of Mental Health in the Context of Transitory Economic Changes. Appl Health Econ Health Policy 18, 203–221 (2020). https://doi.org/10.1007/s40258-019-00537-9

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