title: Trends in mental health inequalities in England during a period of recession, austerity and welfare reform 2004 to 2013.
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.
authors.affiliation: Department of Public Health and Policy, Institute of Psychology, Health and Society, University of Liverpool, Whelan Building, Liverpool, L69 3GB, UK. Electronic address: b.barr@liverpool.ac.uk.
authors.forename: Ben
authors.initials: B
authors.lastname: Barr
authors.affiliation: Department of Psychological Sciences, University of Liverpool, UK.
authors.forename: Peter
authors.initials: P
authors.lastname: Kinderman
authors.affiliation: Department of Public Health and Policy, University of Liverpool, UK.
authors.forename: Margaret
authors.initials: M
authors.lastname: Whitehead
mesh_terms: D000293:Adolescent; D000328:Adult; D057172:Economic Recession / Q000706:statistics & numerical data* / Q000639:trends; D004651:Employment / Q000191:economics / Q000523:psychology / Q000706:statistics & numerical data; D004739:England; D005260:Female; D054625:Healthcare Disparities / Q000191:economics* / Q000639:trends; D006801:Humans; D008297:Male; D008605:Mental Health Services / Q000191:economics* / Q000706:statistics & numerical data / Q000639:trends; D008875:Middle Aged; D012946:Social Welfare / Q000191:economics / Q000523:psychology; D012959:Socioeconomic Factors; D014478:Unemployment / Q000523:psychology / Q000706:statistics & numerical data
keywords: Austerity; Employment; Health inequalities; Mental health; Recession; Unemployment; Welfare reform