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Abstract
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
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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.
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