title: The mental health risks of economic crisis in Spain: evidence from primary care centres, 2006 and 2010.
abstract: BACKGROUND
  Nearly all European countries have been affected by the economic crisis that began in 2007, but the consequences have been among the worst in Spain. We investigated the associations of the recession on the frequency of mood, anxiety, somatoform, alcohol-related and eating disorders among those visiting Spanish primary care settings.
  
  
  METHODS
  Primary care physicians selected randomized samples of patients attending primary care centres representing Spain's consulting populations. A total of 7940 patients in 2006-07 and 5876 in 2010-11 were administered the Primary Care Evaluation of Mental Disorders (PRIME-MD) instrument to diagnose mental disorders. Multivariate logistic regression models were used to quantify overall changes in the frequency of mental disorders, adjusting for potential socio-demographic differences in consulting populations unrelated to economic factors.
  
  
  RESULTS
  Compared with the pre-crisis period of 2006, the 2010 survey revealed substantial and significant increases in the proportion of patients with mood (19.4% in major depression), anxiety (8.4% in generalized anxiety disorder), somatoform (7.3%) and alcohol-related disorders (4.6% in alcohol dependence), all significant at P < 0.001, but not in eating disorders (0.15%, P = 0.172). Independent of observed risks of unemployment [odds ratio (OR) = 1.72, P < 0.001], we observed a significantly elevated risk of major depression associated with mortgage repayment difficulties (OR = 2.12, P < 0.001) and evictions (OR = 2.95, P < 0.001). About one-third of the overall risk in the consulting population's attendance with mental health disorders could be attributed to the combined risks of household unemployment and mortgage payment difficulties.
  
  
  CONCLUSIONS
  Recession has significantly increased the frequency of mental health disorders and alcohol abuse among primary care attendees in Spain, particularly among families experiencing unemployment and mortgage payment difficulties.
authors.affiliation: Institut Universitari d'Investigació en Ciències de la Salut (IUNICS), University of Balearic Islands, 07122 Palma de Mallorca, Spain. mgili@uib.es
authors.forename: Margalida
authors.initials: M
authors.lastname: Gili
authors.forename: Miquel
authors.initials: M
authors.lastname: Roca
authors.forename: Sanjay
authors.initials: S
authors.lastname: Basu
authors.forename: Martin
authors.initials: M
authors.lastname: McKee
authors.forename: David
authors.initials: D
authors.lastname: Stuckler
mesh_terms: D000328:Adult; D019973:Alcohol-Related Disorders / Q000453:epidemiology / Q000523:psychology; D001008:Anxiety Disorders / Q000453:epidemiology / Q000523:psychology; D003430:Cross-Sectional Studies; D003863:Depression / Q000453:epidemiology / Q000523:psychology; D057172:Economic Recession; D001068:Feeding and Eating Disorders / Q000453:epidemiology / Q000523:psychology; D005260:Female; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis* / Q000453:epidemiology* / Q000523:psychology; D008603:Mental Health; D008875:Middle Aged; D019964:Mood Disorders / Q000453:epidemiology / Q000523:psychology; D009017:Morbidity; D016017:Odds Ratio; D011320:Primary Health Care / Q000191:economics* / Q000706:statistics & numerical data; D011569:Psychiatric Status Rating Scales; D012307:Risk Factors; D012959:Socioeconomic Factors; D013001:Somatoform Disorders / Q000453:epidemiology / Q000523:psychology; D013030:Spain / Q000453:epidemiology; D011795:Surveys and Questionnaires