title: Mental health outcomes in times of economic recession: a systematic literature review.
abstract: BACKGROUND
  Countries in recession experience high unemployment rates and a decline in living conditions, which, it has been suggested, negatively influences their populations' health. The present review examines the recent evidence of the possible association between economic recessions and mental health outcomes.
  
  
  METHODS
  Literature review of records identified through Medline, PsycINFO, SciELO, and EBSCO Host. Only original research papers, published between 2004 and 2014, peer-reviewed, non-qualitative research, and reporting on associations between economic factors and proxies of mental health were considered.
  
  
  RESULTS
  One-hundred-one papers met the inclusion criteria. The evidence was consistent that economic recessions and mediators such as unemployment, income decline, and unmanageable debts are significantly associated with poor mental wellbeing, increased rates of common mental disorders, substance-related disorders, and suicidal behaviours.
  
  
  CONCLUSIONS
  On the basis of a thorough analysis of the selected investigations, we conclude that periods of economic recession are possibly associated with a higher prevalence of mental health problems, including common mental disorders, substance disorders, and ultimately suicidal behaviour. Most of the research is based on cross-sectional studies, which seriously limits causality inferences. Conclusions are summarised, taking into account international policy recommendations concerning the cost-effective measures that can possibly reduce the occurrence of negative mental health outcomes in populations during periods of economic recession.
authors: Medical School, CMDT, Nova University Lisbon, Lisbon, Portugal.
authors: Diana
authors: D
authors: Frasquilho
authors: Faculty of Human Kinetics, ISAMB, University of Lisbon, Lisbon, Portugal.
authors: Margarida Gaspar
authors: MG
authors: Matos
authors: Institute of Active Lifestyle, Faculty of Physical Culture, Palacky University Olomouc, Olomouc, Czech Republic. ferdinand.salonna@upol.cz.
authors: Ferdinand
authors: F
authors: Salonna
authors: Psychiatry Department, Faculty of Medicine, University of Lisbon, Lisbon, Portugal.
authors: Diogo
authors: D
authors: Guerreiro
authors: European Monitoring Centre for Drugs and Drug Addiction, Lisbon, Portugal.
authors: Cláudia C
authors: CC
authors: Storti
authors: Aventura Social/ISAMB, University of Lisbon and Lisbon Lusíada University, Lisbon, Portugal.
authors: Tânia
authors: T
authors: Gaspar
authors: Department of Mental Health, Medical School, Nova University Lisbon, Lisbon, Portugal.
authors: José M
authors: JM
authors: Caldas-de-Almeida
mesh_terms: D003430:Cross-Sectional Studies; D057172:Economic Recession / Q000706:statistics & numerical data*; D006801:Humans; D007182:Income; D001523:Mental Disorders / Q000453:epidemiology; D008603:Mental Health / Q000706:statistics & numerical data*; D013405:Suicide; D014478:Unemployment / Q000523:psychology