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Eur Arch Psychiatry Clin Neurosci. 2016 Mar;266(2):89-124. doi: 10.1007/s00406-016-0681-x. Epub 2016 Feb 13.

EPA guidance on mental health and economic crises in Europe.

Author information

Institute of Psychiatric Research, Mª Josefa Recio Foundation (Hospitaller Sisters), Bilbao, Spain.
Centro de Investigación en Red Salud Mental (CIBERSAM), Madrid, Spain.
Clinica Padre Menni, Department of Psychiatry, Joaquin Beunza, 45, 31014, Pamplona, Spain.
Health Service and Population Research Department, Institute of Psychiatry, King's College London, De Crespigny Park, London, UK.
PSSRU, London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, UK.
Collaborative Antwerp Psychiatric Research Institute, Antwerp University, 2610, Wilrijk, Belgium.
University of Nottingham, Nottingham, UK.
Department of Psychiatry, Pomeranian Medical University, Szczecin, Poland.
Institute of Psychiatric Research, Mª Josefa Recio Foundation (Hospitaller Sisters), Bilbao, Spain.
Department of Pharmacology, Institute of Psychiatry and Neurology, Warsaw, Poland.
Centro de Investigación en Red Salud Mental (CIBERSAM), Madrid, Spain.
University of Valencia, Valencia, Spain.
Portuguese Society of Psychiatry and Mental Health, Beatriz Ângelo Hospital, Lisbon, Portugal.
National Centre for Suicide Research and Prevention of Mental Health, Karolinska Institute, Stockholm, Sweden.


This European Psychiatric Association (EPA) guidance paper is a result of the Working Group on Mental Health Consequences of Economic Crises of the EPA Council of National Psychiatric Associations. Its purpose is to identify the impact on mental health in Europe of the economic downturn and the measures that may be taken to respond to it. We performed a review of the existing literature that yields 350 articles on which our conclusions and recommendations are based. Evidence-based tables and recommendations were developed through an expert consensus process. Literature dealing with the consequences of economic turmoil on the health and health behaviours of the population is heterogeneous, and the results are not completely unequivocal. However, there is a broad consensus about the deleterious consequences of economic crises on mental health, particularly on psychological well-being, depression, anxiety disorders, insomnia, alcohol abuse, and suicidal behaviour. Unemployment, indebtedness, precarious working conditions, inequalities, lack of social connectedness, and housing instability emerge as main risk factors. Men at working age could be particularly at risk, together with previous low SES or stigmatized populations. Generalized austerity measures and poor developed welfare systems trend to increase the harmful effects of economic crises on mental health. Although many articles suggest limitations of existing research and provide suggestions for future research, there is relatively little discussion of policy approaches to address the negative impact of economic crises on mental health. The few studies that addressed policy questions suggested that the development of social protection programs such as active labour programs, social support systems, protection for housing instability, and better access to mental health care, particularly at primary care level, is strongly needed.


Depression; Economic crisis; Europe; Mental health; Psychiatric care; Suicide; Unemployment; Welfare system

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