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. 2016 Sep 6:354:i4588.
doi: 10.1136/bmj.i4588.

Health outcomes during the 2008 financial crisis in Europe: systematic literature review

Divya Parmar  1 , Charitini Stavropoulou  2 , John P A Ioannidis  3
Affiliations

Health outcomes during the 2008 financial crisis in Europe: systematic literature review

Divya Parmar et al. BMJ. .

Abstract

Objective: To systematically identify, critically appraise, and synthesise empirical studies about the impact of the 2008 financial crisis in Europe on health outcomes.

Design: Systematic literature review.

Data sources: Structural searches of key databases, healthcare journals, and organisation based websites.

Review methods: Empirical studies reporting on the impact of the financial crisis on health outcomes in Europe, published from January 2008 to December 2015, were included. All selected studies were assessed for risk of bias. Owing to the heterogeneity of studies in terms of study design and analysis and the use of overlapping datasets across studies, studies were analysed thematically per outcome, and the evidence was synthesised on different health outcomes without formal meta-analysis.

Results: 41 studies met the inclusion criteria, and focused on suicide, mental health, self rated health, mortality, and other health outcomes. Of those studies, 30 (73%) were deemed to be at high risk of bias, nine (22%) at moderate risk of bias, and only two (5%) at low risk of bias, limiting the conclusions that can be drawn. Although there were differences across countries and groups, there was some indication that suicides increased and mental health deteriorated during the crisis. The crisis did not seem to reverse the trend of decreasing overall mortality. Evidence on self rated health and other indicators was mixed.

Conclusions: Most published studies on the impact of financial crisis on health in Europe had a substantial risk of bias; therefore, results need to be cautiously interpreted. Overall, the financial crisis in Europe seemed to have had heterogeneous effects on health outcomes, with the evidence being most consistent for suicides and mental health. There is a need for better empirical studies, especially those focused on identifying mechanisms that can mitigate the adverse effects of the crisis.

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Conflict of interest statement

All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: the study was financially supported by a pump priming scheme from the School of Health Sciences at City University London; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

Figures

None
Fig 1 PRISMA flow diagram of papers reporting on health outcomes during the financial crisis in Europe, published from January 2008 to December 2015
See this image and copyright information in PMC

Comment in

References

    1. Cylus J, Pearson M. The crisis and its implications for household financial security, government resources and health expenditure. In: Thomson S, Figueras J, Evetovits T, et al, eds. Economic crisis, health systems and health in Europe: impact and implications for policy.Open University Press, 2015.
    1. Quaglio G, Karapiperis T, Van Woensel L, Arnold E, McDaid D. Austerity and health in Europe. Health Policy 2013;113:13-9. 10.1016/j.healthpol.2013.09.005 pmid:24176290. - DOI - PubMed
    1. Kentikelenis A, Karanikolos M, Papanicolas I, Basu S, McKee M, Stuckler D. Health effects of financial crisis: omens of a Greek tragedy. Lancet 2011;378:1457-8. 10.1016/S0140-6736(11)61556-0 pmid:21988763. - DOI - PubMed
    1. Karanikolos M, Mladovsky P, Cylus J, et al. Financial crisis, austerity, and health in Europe. Lancet 2013;381:1323-31. 10.1016/S0140-6736(13)60102-6 pmid:23541059. - DOI - PubMed
    1. Stuckler D, Basu S, Suhrcke M, Coutts A, McKee M. The public health effect of economic crises and alternative policy responses in Europe: an empirical analysis. Lancet 2009;374:315-23. 10.1016/S0140-6736(09)61124-7 pmid:19589588. - DOI - PubMed

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