Trends in mental health inequalities in England during a period of recession, austerity and welfare reform 2004 to 2013

doi:10.1016/j.socscimed.2015.11.009

Social Science & Medicine

Volume 147, December 2015, Pages 324-331

https://doi.org/10.1016/j.socscimed.2015.11.009 Get rights and content

Highlights

•
The prevalence of mental health problems in England increased markedly since 2008.
•
Increases were greatest in people with less education and people out of work.
•
These increases were partly explained by trends in unemployment and wages.
•
Welfare policies and austerity measures may have contributed to this increase.

Abstract

Several indicators of population mental health in the UK have deteriorated since the financial crisis, during a period when a number of welfare reforms and austerity measures have been implemented. We do not know which groups have been most affected by these trends or the extent to which recent economic trends or recent policies have contributed to them.

We use data from the Quarterly Labour Force Survey to investigate trends in self reported mental health problems by socioeconomic group and employment status in England between 2004 and 2013. We then use panel regression models to investigate the association between local trends in mental health problems and local trends in unemployment and wages to investigate the extent to which these explain increases in mental health problems during this time.

We found that the trend in the prevalence of people reporting mental health problems increased significantly more between 2009 and 2013 compared to the previous trends. This increase was greatest amongst people with low levels of education and inequalities widened. The gap in prevalence between low and high educated groups widened by 1.29 percentage points for women (95% CI: 0.50 to 2.08) and 1.36 percentage points for men (95% CI: 0.31 to 2.42) between 2009 and 2013. Trends in unemployment and wages only partly explained these recent increases in mental health problems. The trend in reported mental health problems across England broadly mirrored the pattern of increases in suicides and antidepressant prescribing.

Welfare policies and austerity measures implemented since 2010 may have contributed to recent increases in mental health problems and widening inequalities. This has led to rising numbers of people with low levels of education out of work with mental health problems. These trends are likely to increase social exclusion as well as demand for and reliance on social welfare systems.

Section snippets

Background

In England the onset of the recession in 2008 and subsequent rises in unemployment were associated with an upturn in suicides (Barr, B. et al., 2012) and an increase in other adverse mental health outcomes (Hawton et al., 2015, Spence et al., 2014). Whilst a deterioration in mental health during recessions has been reported in many studies, these trends have tended to reverse once unemployment levels have fallen (Biddle et al., 2008). This has not, however, been the case in England in recent

Data sources and measures

We analysed trends in the prevalence of mental health problems using the Quarterly Labour Force survey (QLFS). The QLFS is made up of a rolling panel with each household interviewed for 5 consecutive quarters, the first wave of the QLFS is face-to-face while waves 2–5 are by telephone (ONS, 2011). We included all respondents aged between 18 and 59 from England who were in each of the quarterly surveys between the first quarter of 2004 and the first quarter of 2013. We did not include data from

Trends in mental health problems

Fig. 2 shows the overall quarterly trend in the prevalence of mental health problems between 2004 and 2013 along with the fitted results from the segmented regression model.

The segmented regression analysis indicated that there was a significant break in the trend between the last quarter of 2008 and the first quarter of 2009. From this point to the first quarter of 2013 the increase in mental health problems was significantly greater than the trend between the first quarter of 2004 and the

Discussion

We found that there was a significant increase in the trend in reported mental health problems since 2008 and that inequalities between people with high versus low levels of education widened since this time. Increases have been greatest amongst people out of work. Overall trends in unemployment and declines in wages explained 36% of this increase. However as declines in wages only had a small effect and unemployment did not increase markedly after 2009 these economic trends did not explain why

References (42)

C. Coope et al.
Suicide and the 2008 economic recession: who is most at risk? Trends in suicide rates in England and Wales 2001–2011
Soc. Sci. Med.
(2014)
B. Barr et al.
Suicides associated with the 2008-2010 recession in the UK: a time-trend analysis
BMJ
(2012)
B. Baumberg et al.
Benefits Stigma in Britain
(2012)
T. Bell et al.
Factors associated with being a false positive on the General Health Questionnaire
Soc. Psychiatry Psychiatr. Epidemiol.
(2005)
L. Biddle et al.
Suicide rates in young men in England and Wales in the 21st century: time-trend study
BMJ
(2008)
D. Blane et al.
GP Experience of the Impact of Austerity on Patients and General Practices in Very Deprived Areas
(2012)
K. Cooper et al.
Does Money in Adulthood Affect Adult Outcomes?
(2015)
R. Crawford et al.
Local Government Spending: Where Is the Axe Falling?
(2012)
M.J. Crawley
The R Book
(2007)
DCLG
The Fiscal Case for Working with Troubled Families: Analysis and Evidence on the Costs of Troubled Families to Government
(2013)

P. De Agostini et al.

Were we really all in it together? the distributional effects of the UK Coalition government's tax-benefit policy changes

Soc. Policy Cold Clim.

(November 2014)

M. Duncan et al.

Severe and Multiple Disadvantage a Review of Key Texts

(2012)

P. Dwyer et al.

Universal Credit, ubiquitous conditionality and its implications for social citizenship

J. Poverty Soc. Justice

(2014)

W. Elming et al.

An Assessment of the Potential Compensation Provided by the New “National Living Wage” for the Personal Tax and Benefit Measures Announced for Implementation in the Current Parliament

(2015)

L. Friedli et al.

Positive affect as coercive strategy: conditionality, activation and the role of psychology in UK government workfare programmes

Med. Humanit.

(2015)

K. Hawton et al.

The Multicentre Study of Self-harm in England

(2015)

HSCIC

The Health and Social Care Inforamtion Centre (HSCIC) Indicator Portal

(2014)

HSCIC

Prescribing by GP Practice – Health & Social Care Information Centre

(2014)

HSCIC

Quality and Outcomes Framework Achievement, Prevalence and Exceptions Data, 2012/13

(2013)

G. Iacobucci

GPs' workload climbs as government austerity agenda bites

BMJ

(2014)

ILO

Key Indicators of the Labour Market (KILM)

(2011)

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Trends in mental health inequalities in England during a period of recession, austerity and welfare reform 2004 to 2013

Highlights

Abstract

Section snippets

Background

Data sources and measures

Trends in mental health problems

Discussion

Soc. Sci. Med.

Suicides associated with the 2008-2010 recession in the UK: a time-trend analysis

BMJ

Benefits Stigma in Britain

Factors associated with being a false positive on the General Health Questionnaire

Soc. Psychiatry Psychiatr. Epidemiol.

Suicide rates in young men in England and Wales in the 21st century: time-trend study

BMJ

GP Experience of the Impact of Austerity on Patients and General Practices in Very Deprived Areas

Does Money in Adulthood Affect Adult Outcomes?

Local Government Spending: Where Is the Axe Falling?

The R Book

The Fiscal Case for Working with Troubled Families: Analysis and Evidence on the Costs of Troubled Families to Government

Were we really all in it together? the distributional effects of the UK Coalition government's tax-benefit policy changes

Soc. Policy Cold Clim.

Severe and Multiple Disadvantage a Review of Key Texts

Universal Credit, ubiquitous conditionality and its implications for social citizenship

J. Poverty Soc. Justice

An Assessment of the Potential Compensation Provided by the New “National Living Wage” for the Personal Tax and Benefit Measures Announced for Implementation in the Current Parliament

Positive affect as coercive strategy: conditionality, activation and the role of psychology in UK government workfare programmes

Med. Humanit.

The Multicentre Study of Self-harm in England

The Health and Social Care Inforamtion Centre (HSCIC) Indicator Portal

Prescribing by GP Practice – Health & Social Care Information Centre

Quality and Outcomes Framework Achievement, Prevalence and Exceptions Data, 2012/13

GPs' workload climbs as government austerity agenda bites

BMJ

Key Indicators of the Labour Market (KILM)