suicideThe 2008 recession in Europe was associated with adverse health outcomes, particularly for suicides and mental health problems, according to a review of studies.

However, the authors of the review, published in The BMJ, warn that most published studies on this topic had a substantial risk of bias and therefore results need to be cautiously interpreted.

In 2008, the global economic downturn caused a period of financial crisis in Europe. While interest in the impact of the crisis on the health of populations is growing, the evidence so far has been fragmented.

So a team of researchers at City University in London and Stanford University in California analysed studies reporting on the impact of the European financial crisis on health outcomes, published from January 2008 to December 2015.

Forty-one studies met the inclusion criteria and were analysed, the vast majority focused on Spain and Greece – two counties hardest hit by the 2008 recession. The main health outcomes that these studies explored were suicides and mental health.

All studies were assessed for risk of bias. Of these, 29 (73%) were deemed to be at high risk of bias, nine (23%) at moderate risk of bias, and only two at low risk of bias, limiting the conclusions that could be drawn.

Although there were differences across countries and groups, there was some indication that suicides increased during the financial crisis, particularly among men.

Studies looking at mental health found similar increases, but these results were more mixed. Women seemed to be more affected by mental health problems than men.

Studies focusing on mortality seemed to show a different picture, with overall mortality not being affected or even declining during the crisis years. It has been argued in previously published studies that, among other reasons, this is probably due to healthier lifestyles during years of economic difficulties.

There was also some evidence that the health of immigrants, especially those who had illegal status and lacked social security, deteriorated much more during the crisis than that of natives.

These results need to be interpreted with caution, say the authors, but overall, the financial crisis in Europe seems to have had mixed effects on health outcomes, with the evidence being most consistent for suicides and mental health.

“There is a need for better empirical studies, especially those focused on identifying mechanisms that can mitigate the adverse effects of the crisis,” they conclude.

In a linked editorial, researchers at the University of Liverpool, agree that recessions can harm health, but argue that a government’ response can exacerbate the damage. “It is therefore critical to distinguish between the health effects of recessions and the effect of different policy responses to recession,” they write.

And they call on doctors “to advocate for social and welfare policies that are informed by the evidence available and evaluated for their health effects, so that they protect people during crisis rather than creating further health problems.”