title: How economic crises affect alcohol consumption and alcohol-related health problems: a realist systematic review.
abstract: Economic crises are complex events that affect behavioral patterns (including alcohol consumption) via opposing mechanisms. With this realist systematic review, we aimed to investigate evidence from studies of previous or ongoing crises on which mechanisms (How?) play a role among which individuals (Whom?). Such evidence would help understand and predict the potential impact of economic crises on alcohol consumption. Medical, psychological, social, and economic databases were used to search for peer-reviewed qualitative or quantitative empirical evidence (published January 1, 1990-May 1, 2014) linking economic crises or stressors with alcohol consumption and alcohol-related health problems. We included 35 papers, based on defined selection criteria. From these papers, we extracted evidence on mechanism(s), determinant, outcome, country-level context, and individual context. We found 16 studies that reported evidence completely covering two behavioral mechanisms by which economic crises can influence alcohol consumption and alcohol-related health problems. The first mechanism suggests that psychological distress triggered by unemployment and income reductions can increase drinking problems. The second mechanism suggests that due to tighter budget constraints, less money is spent on alcoholic beverages. Across many countries, the psychological distress mechanism was observed mainly in men. The tighter budget constraints mechanism seems to play a role in all population subgroups across all countries. For the other three mechanisms (i.e., deterioration in the social situation, fear of losing one's job, and increased non-working time), empirical evidence was scarce or absent, or had small to moderate coverage. This was also the case for important influential contextual factors described in our initial theoretical framework. This realist systematic review suggests that among men (but not among women), the net impact of economic crises will be an increase in harmful drinking. Such a different net impact between men and women could potentially contribute to growing gender-related health inequalities during a crisis.
authors.affiliation: Department of Public Health, Academic Medical Center (AMC) - University of Amsterdam, PO Box 22660, 1100 DD Amsterdam, The Netherlands. Electronic address: m.c.degoeij@amc.uva.nl.
authors.forename: Moniek C M
authors.initials: MC
authors.lastname: de Goeij
authors.affiliation: Health Economics Group, Norwich Medical School, University of East Anglia, Norwich, Norfolk NR4 7TJ, United Kingdom; United Kingdom Clinical Research Collaboration (UKCRC) Centre for Diet and Activity Research (CEDAR), Institute of Public Health, Cambridge CB2 0SR, United Kingdom; Centre for Health Economics, University of York, Heslington, York YO10 5DD, United Kingdom.
authors.forename: Marc
authors.initials: M
authors.lastname: Suhrcke
authors.affiliation: Health Economics Group, Norwich Medical School, University of East Anglia, Norwich, Norfolk NR4 7TJ, United Kingdom.
authors.forename: Veronica
authors.initials: V
authors.lastname: Toffolutti
authors.affiliation: IVO Addiction Research Institute, Heemraadssingel 194, 3021 DM Rotterdam, The Netherlands; Erasmus MC - University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands; Maastricht University, Department of Health Promotion, PO Box 616, 6200 MD Maastricht, The Netherlands.
authors.forename: Dike
authors.initials: D
authors.lastname: van de Mheen
authors.affiliation: IVO Addiction Research Institute, Heemraadssingel 194, 3021 DM Rotterdam, The Netherlands; Erasmus MC - University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands.
authors.forename: Tim M
authors.initials: TM
authors.lastname: Schoenmakers
authors.affiliation: Department of Public Health, Academic Medical Center (AMC) - University of Amsterdam, PO Box 22660, 1100 DD Amsterdam, The Netherlands.
authors.forename: Anton E
authors.initials: AE
authors.lastname: Kunst
mesh_terms: D000428:Alcohol Drinking / Q000009:adverse effects / Q000453:epidemiology* / Q000523:psychology*; D019973:Alcohol-Related Disorders / Q000453:epidemiology* / Q000523:psychology*; D003430:Cross-Sectional Studies; D057172:Economic Recession / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D013315:Stress, Psychological / Q000150:complications
keywords: Alcohol consumption; Alcohol-related health problems; Economic crisis; Realist systematic review