Effectiveness of community interventions for protecting and promoting the mental health of working-age adults experiencing financial uncertainty: a systematic review

Michael McGrath; Fiona Duncan; Kate Dotsikas; Cleo Baskin; Liam Crosby; Shamini Gnani; Rachael Maree Hunter; Eileen Kaner; James Bowes Kirkbride; Louise Lafortune; Caroline Lee; Emily Oliver; David P Osborn; Kate R Walters; Jennifer Dykxhoorn; School for Public Health Research Public Mental Health Programme

doi:10.1136/jech-2020-215574

Effectiveness of community interventions for protecting and promoting the mental health of working-age adults experiencing financial uncertainty: a systematic review

J Epidemiol Community Health. 2021 Jul;75(7):665-673. doi: 10.1136/jech-2020-215574. Epub 2021 Apr 30.

Authors

Michael McGrath^{1

2}, Fiona Duncan³, Kate Dotsikas¹, Cleo Baskin⁴, Liam Crosby⁵, Shamini Gnani⁴, Rachael Maree Hunter⁵, Eileen Kaner⁶, James Bowes Kirkbride¹, Louise Lafortune⁷, Caroline Lee^{7

8}, Emily Oliver³, David P Osborn^{1

9}, Kate R Walters⁵, Jennifer Dykxhoorn^{10

5}; School for Public Health Research Public Mental Health Programme

Affiliations

¹ Division of Psychiatry, University College London, London, UK.
² Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK.
³ Department of Sport and Exercise Sciences, Durham University, Durham, UK.
⁴ Department of Primary Care and Public Health, Imperial College London, London, UK.
⁵ Department of Primary Care and Population Health, University College London, London, UK.
⁶ Institute of Health and Society, Newcastle University, Newcastle, UK.
⁷ Cambridge Public Health, University of Cambridge, Cambridge, UK.
⁸ Cambridge Institute for Sustainability Leadership, Cambridge, UK.
⁹ Camden and Islington NHS Foundation Trust, London, UK.
¹⁰ Division of Psychiatry, University College London, London, UK j.dykxhoorn@ucl.ac.uk.

Abstract

Background: The COVID-19 pandemic has created a period of global economic uncertainty. Financial strain, personal debt, recent job loss and housing insecurity are important risk factors for the mental health of working-age adults. Community interventions have the potential to attenuate the mental health impact of these stressors. We examined the effectiveness of community interventions for protecting and promoting the mental health of working-age adults in high-income countries during periods of financial insecurity.

Methods: Eight electronic databases were systematically screened for experimental and observational studies published since 2000 measuring the effectiveness of community interventions on mental health outcomes. We included any non-clinical intervention that aimed to address the financial, employment, food or housing insecurity of participants. A review protocol was registered on the PROSPERO database (CRD42019156364) and results are reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

Results: From 2326 studies screened, 15 met our inclusion criteria. Five categories of community intervention were identified: advice services colocated in healthcare settings; link worker social prescribing; telephone debt advice; food insecurity interventions; and active labour market programmes. In general, the evidence for effective and cost-effective community interventions delivered to individuals experiencing financial insecurity was lacking. From the small number of studies without a high risk of bias, there was some evidence that financial insecurity and associated mental health problems were amenable to change and differences by subpopulations were observed.

Conclusion: There is a need for well-controlled studies and trials to better understand effective ingredients and to identify those interventions warranting wider implementation.

Keywords: inequalities; mental health; psychosocial factors; public health; systematic reviews.

Publication types

Review