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Effectiveness of community interventions for protecting and promoting the mental health of working-age adults experiencing financial uncertainty: a systematic review
  1. Michael McGrath1,2,
  2. Fiona Duncan3,
  3. Kate Dotsikas1,
  4. Cleo Baskin4,
  5. Liam Crosby5,
  6. Shamini Gnani4,
  7. Rachael Maree Hunter5,
  8. Eileen Kaner6,
  9. James Bowes Kirkbride1,
  10. Louise Lafortune7,
  11. Caroline Lee7,8,
  12. Emily Oliver3,
  13. David P Osborn1,9,
  14. Kate R Walters5,
  15. Jennifer Dykxhoorn1,5
  16. School for Public Health Research Public Mental Health Programme
  1. 1 Division of Psychiatry, University College London, London, UK
  2. 2 Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
  3. 3 Department of Sport and Exercise Sciences, Durham University, Durham, UK
  4. 4 Department of Primary Care and Public Health, Imperial College London, London, UK
  5. 5 Department of Primary Care and Population Health, University College London, London, UK
  6. 6 Institute of Health and Society, Newcastle University, Newcastle, UK
  7. 7 Cambridge Public Health, University of Cambridge, Cambridge, UK
  8. 8 Cambridge Institute for Sustainability Leadership, Cambridge, UK
  9. 9 Camden and Islington NHS Foundation Trust, London, UK
  1. Correspondence to Dr Jennifer Dykxhoorn, Division of Psychiatry, University College London, London W1T 7NF, UK; j.dykxhoorn{at}


Background The COVID-19 pandemic has created a period of global economic uncertainty. Financial strain, personal debt, recent job loss and housing insecurity are important risk factors for the mental health of working-age adults. Community interventions have the potential to attenuate the mental health impact of these stressors. We examined the effectiveness of community interventions for protecting and promoting the mental health of working-age adults in high-income countries during periods of financial insecurity.

Methods Eight electronic databases were systematically screened for experimental and observational studies published since 2000 measuring the effectiveness of community interventions on mental health outcomes. We included any non-clinical intervention that aimed to address the financial, employment, food or housing insecurity of participants. A review protocol was registered on the PROSPERO database (CRD42019156364) and results are reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

Results From 2326 studies screened, 15 met our inclusion criteria. Five categories of community intervention were identified: advice services colocated in healthcare settings; link worker social prescribing; telephone debt advice; food insecurity interventions; and active labour market programmes. In general, the evidence for effective and cost-effective community interventions delivered to individuals experiencing financial insecurity was lacking. From the small number of studies without a high risk of bias, there was some evidence that financial insecurity and associated mental health problems were amenable to change and differences by subpopulations were observed.

Conclusion There is a need for well-controlled studies and trials to better understand effective ingredients and to identify those interventions warranting wider implementation.

  • inequalities
  • mental health
  • psychosocial factors
  • public health
  • systematic reviews

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See:

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  • Contributors DPO, EO and KRW were responsible for the study design. MM, FD and KD performed the screening and quality assessment. MM conducted the data extraction and synthesis and wrote the initial draft. MM, FD, KD, CB, LC, JD, SG, RMH, EK, JBK, LL, CL, EO, KRW and DPO contributed to the interpretation of results, critically reviewed the manuscript and approved the final submission.

  • Funding This study was funded by the National Institute for Health Research (NIHR) School for Public Health Research (grant reference: BH154142). The NIHR School for Public Health Research is a partnership between the Universities of Sheffield, Bristol, Cambridge, Imperial; and University College London; the London School for Hygiene & Tropical Medicine; LiLaC—a collaboration between the Universities of Liverpool and Lancaster; and Fuse—the Centre for Translational Research in Public Health, a collaboration between Newcastle, Durham, Northumbria, Sunderland and Teesside Universities. MM, JD, JBK and DPO are supported by the NIHR Biomedical Research Centre at University College London Hospitals. DPO is also supported by the NIHR Applied Research Collaboration North Thames. EK is supported by an NIHR Senior Investigator Award and the NIHR Applied Research Collaboration North East and North Cumbria.

  • Disclaimer The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.