Interventions to mitigate the effects of poverty and inequality on mental health



To review psychosocial and policy interventions which mitigate the effects of poverty and inequality on mental health.


Systematic reviews, controlled trials and realist evaluations of the last 10 years are reviewed, without age or geographical restrictions.


Effective psychosocial interventions on individual and family level, such as parenting support programmes, exist. The evidence for mental health impact of broader community-based interventions, e.g. community outreach workers, or service-based interventions, e.g. social prescribing and debt advice is scarce. Likewise, the availability of evidence for the mental health impact of policy level interventions, such as poverty alleviation or youth guarantee, is quite restricted.


The social, economic, and physical environments in which people live shape mental health and many common mental disorders. There are effective early interventions to promote mental health in vulnerable groups, but it is necessary to both initiate and facilitate a cross-sectoral approach, and to form partnerships between different government departments, civic society organisations and other stakeholders. This approach is referred to as Mental Health in All Policies and it can be applied to all public policy levels from local policies to supranational.

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  1. 1.

    World Health Organization and Calouste Gulbenkian Foundation (2014) Social determinants of mental health. World Health Organization, Geneva

  2. 2.

    Wilkinson R, Marmot M (2003) Social determinants of health: the solid facts, 2nd edn. World Health Organization Regional Office for Europe, Copenhagen

  3. 3.

    Koh HH, Oppenheimer SC, Massin-Short S, Emmons KM, Geller AC, Viswanath K (2010) Translating research evidence into practice to reduce health disparities: a social determinants approach. Am J Public Health 100(Suppl 1):S72–S80

  4. 4.

    Bell R, Donkin A, Marmot M (2013) Tackling structural and social issues to reduce inequities in children’s outcomes in low-to middle-income countries. Office of Research Discussion Paper No. 2013–02. UNICEF Office of Research, Florence

  5. 5.

    World Health Organization (2007) Breaking the vicious cycle between mental ill-health and poverty. Mental Health Core to Development Information Sheet. Accessed Oct 2016

  6. 6.

    Iemmi V, Bantjes J, Coast E, Channer K, Leone T, McDaid D, Palfreyman A, Stephens B, Lund C (2016) Suicide and poverty in low-income and middle-income countries: a systematic review. Lancet Psychiatry 3(8):774–783

  7. 7.

    Lund C, Breen A, Flisher AJ, Kakuma R, Corrigall J, Joska JA, Swartz L, Patel V (2010) Poverty and common mental disorders in low and middle income countries: a systematic review. Soc Sci Med 71(3):517–528

  8. 8.

    Lund C, De Silva M, Plagerson S, Cooper S, Chisholm D, Das JJ, Knapp M, Patel V (2011) Poverty and mental disorders: breaking the cycle in low-income and middle-income countries. Lancet 378:1502–1514

  9. 9.

    Thornicroft G (2006) Shunned. Discrimination against people with mental illness. Oxford University Press, Oxford

  10. 10.

    Mangalore R, Knapp M, Jenkins R (2007) Income-related inequality in mental health in Britain: the concentration index approach. Psychol Med 37:1037–1045

  11. 11.

    Saraceno B (2004) Mental health: scarce resources need new paradigms. World Psychiatry 3(1):3–5

  12. 12.

    EUROSTAT Statistics Explained. People at risk of poverty or social exclusion. Accessed 31 Oct 2016

  13. 13.

    Rutter M, Quinton D (1984) Parental psychiatric disorder: effects on children. Psychol Med 14(4):853–880

  14. 14.

    OECD (2012) Sick on the job?: myths and realities about mental health and work, OECD Publishing, Paris

  15. 15.

    Birdsall N, Levine R, Ibrahim A (2005) Towards universal primary education: investments, incentives, and institutions. Eur J Educ 40:337–349

  16. 16.

    WHO Regional Office for Europe. Risk factors of ill health among older people. Accessed 31 Oct 2016

  17. 17.

    Lloyd-Sherlock P (2010) Population ageing and international development: from generalisation to evidence. Policy Press, Bristol

  18. 18.

    United Nations, Department of Economic and Social Affairs, Population Division (2013) World Population Ageing. ST/ESA/SER.A/348

  19. 19.

    Fitch C, Hamilton S, Bassett P, Ryan Davey R (2011) The relationship between personal debt and mental health: a systematic review. Ment Health Rev J 16(4):153–166

  20. 20.

    Jenkins R, Bhugra D, Bebbington P, Brugha T, Farrell M, Coid J, Fryers T, Weich S, Singleton N, Meltzer H (2008) Debt, income and mental disorder in the general population. Psychol Med 38(10):1485–1493

  21. 21.

    Solantaus T, Leinonen J, Punamaki RL (2004) Children’s mental health in times of economic recession: replication and extension of the family economic stress model in Finland. Dev Psychol 40(3):412–429

  22. 22.

    Dooley D, Catalano R, Wilson G (1994) Depression and unemployment: panel findings from the Epidemiologic Catchment Area study. Am J Community Psychol 22:745–765

  23. 23.

    Jenkins R, Minoletti A (2013) Promoting mental health: a crucial component of all public policy. In: Leppo K et al (eds) Health in all policies: seizing opportunities, implementing policies. Ministry of Social Affairs and Health, Helsinki

  24. 24.

    EU Directorate General for Health and Food Safety (2015) Joint action on mental health and well-being. Mental Health in all Policies—situation analysis and recommendations for action. Accessed 15 Oct 2016

  25. 25.

    Wahlbeck K (2015) Public mental health: the time is ripe for translation of evidence into practice. World Psychiatry 14:36–42

  26. 26.

    Marchal B, Van Belle S, Van Olmen J, Hoerée T, Kegels G (2012) Is realist evaluation keeping its promise? A review of published empirical studies in the field of health systems research. Evaluation 18(2):192–212

  27. 27.

    Reijneveld SA, de Meer G, Wiefferink CH, Crone MR (2008) Parents’ concerns about children are highly prevalent but often not confirmed by child doctors and nurses. BMC Public Health 8:124

  28. 28.

    Barlow J, Bergman H, Kornør H, Wei Y, Bennett C (2016) Group-based parent training programmes for improving emotional and behavioural adjustment in young children. Cochrane Database Syst Rev (8):Art CD003680

  29. 29.

    Gross D, Garvey C, Julion W, Fogg L, Tucker S, Mokros H (2009) Efficacy of the Chicago parent program with low-income African American and Latino parents of young children. Prev Sci 10:54–65

  30. 30.

    Webster-Stratton C (1998) Preventing conduct problems in Head Start children: strengthening parenting competencies. J Consult Clin Psychol 66(5):715–730

  31. 31.

    Kelly Y, Sacker A, Del BE, Francesconi M, Marmot M (2011) What role for the home learning environment and parenting in reducing the socioeconomic gradient in child development? Findings from the Millennium Cohort Study. Arch Dis Child 96(9):832–837

  32. 32.

    Stewart-Brown SL, Schrader-McMillan A (2011) Parenting for mental health: what does the evidence say we need to do? Report of Workpackage 2 of the DataPrev project. Health Promot Int 26(Suppl. 1):i10–i28

  33. 33.

    Reyno S, McGrath P (2006) Predictors of parent training efficacy for child externalizing behavior problem: a meta-analytic review. J Child Psychol Psychiatry 47:99–111

  34. 34.

    Cooper PJ, Tomlinson M, Swartz L et al (2009) Improving the quality of the mother-infant relationship and infant attachment in a socio-economically deprived community in a South African context: a randomised controlled trial. BMJ 338:b974

  35. 35.

    Olds DL (2002) Prenatal and infancy home visiting by nurses: from randomized trials to community replication. Prev Sci 3:1153–1172

  36. 36.

    Olds DL, Henderson CRJ, Chamberlin R, Tatelbaum R (1986) Preventing child abuse and neglect: a randomized trial of nurse home visitation. Pediatrics 78(1):65–78

  37. 37.

    Olds DL, Kitzman H, Cole R, Robinson J, Sidora K, Luckey DW, Henderson CRJ, Hanks C, Bondy J, Holmberg J (2004) Effects of nurse home-visiting on maternal life course and child development: age 6 follow-up results of a randomized trial. Pediatrics 114(6):1550–1559

  38. 38.

    Olds D, Henderson CRJ, Cole R, Eckenrode J, Kitzman H, Luckey D, Pettitt L, Sidora K, Morris P, Powers J (1998) Long-term effects of nurse home visitation on behavior—15-year follow-up of a randomized controlled trial. JAMA 280(14):1238–1244

  39. 39.

    Karoly LA, Greenwood PW, Everingham SS, Hoube J, Kilburn RM, Rydell CP, Sanders M, Chiesa J (1998) Investing in our children what we know and don’t know about the costs and benefits of early childhood interventions. The RAND Corporation, Santa Monica

  40. 40.

    Weare K (2010) Mental health and social and emotional learning: evidence, principles, tensions, balances. Adv School Ment Health Promot 3:5–17

  41. 41.

    Stewart-Brown S (2006) What is the evidence on school health promotion in improving health or preventing disease and, specifically, what is the effectiveness of the health promoting schools approach? WHO Regional Office for Europe, Copenhagen

  42. 42.

    Weare K, Nind M (2011) Mental health promotion and problem prevention in schools: what does the evidence say? Health Promot Int 26(Suppl 1):29–69

  43. 43.

    Adi Y, Killoran A, Janmohamed K, Stewart-Brown S (2007) Systematic review of the effectiveness of interventions to promote mental wellbeing in primary schools: universal approaches which do not focus on violence or bullying. National Institute for Clinical Excellence, London

  44. 44.

    Forsman AK, Nordmyr J, Wahlbeck K (2011) Psychosocial interventions for the promotion of mental health and the prevention of depression among older adults. Health Promot Int 26(Suppl. 1):i85–i107

  45. 45.

    NICE (2015) Older people: independence and mental wellbeing: what are the most effective ways to improve or protect the mental wellbeing and/or independence of older people?. Accessed 30 Oct 2016

  46. 46.

    Miret M, Cabello M, Marchena C, Mellor-Marsá B, Caballero FF, Obradors-Tarragó C, Haro JM, Ayuso-Mateos JL (2015) The state of the art on European well-being research within the area of mental health. Int J Clin Health Psychol 15:171–179

  47. 47.

    Gibson M, Petticrew M, Bambra C, Sowden AJ, Wright KE, Whiteheade M (2011) Housing and health inequalities: a synthesis of systematic reviews of interventions aimed at different pathways linking housing and health. Health Place 17(1):175–184

  48. 48.

    Sanbonmatsu L, Potter NA, Adam E, Duncan GJ, Katz LF, Kessler RC, Ludwig J, Marvakov J, Yang F, Congdon WJ, Gennetian LA, Kling JR, Lindau ST, McDade TW (2012) The long-term effects of moving to opportunity on adult health and economic self-sufficiency. Cityscape 14(2):109–136

  49. 49.

    Thomson H, Thomas S, Sellstrom E, Petticrew M (2013) Housing improvements for health and associated socio-economic outcomes. Cochrane Database Syst Rev Issue (2):CD008657. doi:10.1002/14651858.CD008657.pub2

  50. 50.

    Tsemberis S, Eisenberg RF (2000) Pathways to housing: supported housing for street-dwelling homeless individuals with psychiatric disabilities. Psychiatr Serv 51:487–493

  51. 51.

    Newman S, Goldman H (2008) Putting Housing First, making housing last: housing policy for persons with severe mental illness. Am J Psychiatry 165:10

  52. 52.

    Patterson M, Moniruzzaman A, Palepu A, Zabkiewicz D, Frankish CJ, Krausz M, Somers JM (2013) Housing first improves subjective quality of life among homeless adults with mental illness: 12-month findings from a randomized controlled trial in Vancouver, British Columbia. Soc Psychiatry Psychiatr Epidemiol 48:1245–1259

  53. 53.

    Aubry T, Nelson G, Tsemberis S (2015) Housing First for people with severe mental illness who are homeless: a review of the research and findings from the AtHome–Chez soi demonstration project. Can J Psychiatry 60(11):467–474

  54. 54.

    Rezansoff SN, Moniruzzaman A, Fazel S, McCandless L, Procyshyn R, Somers JM (2016) Housing first improves adherence to antipsychotic medication among formerly homeless adults with schizophrenia: results of a randomized controlled trial. Schizophr Bull sbw 136. doi:10.1093/schbul/sbw136

  55. 55.

    Proudfoot J, Guest D, Carson J et al (1997) Effect of cognitive–behavioural training on job-finding among long-term unemployed people. Lancet 350:96–100

  56. 56.

    Vuori J, Silvonen J, Vinokur A, Price R (2002) The Työhön Job Search Program in Finland: benefits for the unemployed with risk of depression or discouragement? J Occup Health Psychol 7:5–19

  57. 57.

    Vinokur AD et al (2000) Two years after a job loss: long-term impact of the JOBS program on reemployment and mental health. J Occup Health Psychol 5:32–47

  58. 58.

    Vuori J, Silvonen J (2005) The benefits of a preventive job search program on re-employment and mental health at two years follow-up. J Occup Organ Psychol 78:43–52

  59. 59.

    Vinokur AD, van Ryn M, Gramlich EM, Price RH (1991) Long-term follow-up and benefit-cost analysis of the Jobs Program: a preventive intervention for the unemployed. J Appl Psychol 76:213–219

  60. 60.

    Anaf J, Baum F, Newman L, Ziersch A, Jolley G (2013) The interplay between structure and agency in shaping the mental health consequences of job loss. BMC Public Health 13:110

  61. 61.

    Heffernan J, Pilkington P (2011) Supported employment for persons with mental illness: systematic review of the effectiveness of individual placement and support in the UK. J Ment Health (Lond) 20:4

  62. 62.

    Kinoshita Y, Furukawa TA, Kinoshita K, Honyashiki M, Omori IM, Marshall M, Bond GR, Huxley P, Amano N, Kingdon D (2013) Supported employment for adults with severe mental illness. Cochrane Database Syst Rev (9):CD008297. doi:10.1002/14651858.CD008297.pub2

  63. 63.

    Michon H, van Busschbach JT, Stant AD, van Vugt MD, van Weeghel J, Kroon H (2014) Effectiveness of individual placement and support for people with severe mental illness in the Netherlands: a 30-month randomized controlled trial. Psychiat Rehabil J 37(2):129–136

  64. 64.

    Huber M, Stanciole A, Bremner J, Wahlbeck K (2008) Quality in and equallity of access to healthcare services. European Commision, Directorate-General for Employment, Social Affairs and Equal Opportunities, Brussels

  65. 65.

    Anderson LM, Adeney KL, Shinn C, Safranek S, Buckner-Brown J, Krause LK (2015) Community coalition-driven interventions to reduce health disparities among racial and ethnic minority populations. Cochrane Database Syst Rev (6):CD009905

  66. 66.

    Anderson K, Laxhman N, Priebe S (2015) Can mental health interventions change social networks? A systematic review. BMC Psychiatry 15:297

  67. 67.

    Castelein S, Bruggeman R, Van Busschbach JT, Van Der Gaag M, Stant AD, Knegtering H et al (2008) The effectiveness of peer support groups in psychosis: a randomized controlled trial. Acta Psychiatr Scand 118:64–72

  68. 68.

    Villalta-Gil V, Roca M, Gonzalez N, Domènec E, Escanilla A, Asensio MR et al (2009) Dog-assisted therapy in the treatment of chronic schizophrenia inpatients. Anthrozoos A Multidiscip J Interact People Anim 22:149–159

  69. 69.

    White D (2016) Digital Participation and Social Justice in Scotland, Carnegie UK Trust. Accessed Nov 2016

  70. 70.

    Wise S (2013) Trying to connect—Telecommunications access and affordability among people experiencing financial hardship, Anglicare Victoria. Accessed 4 Nov 2016

  71. 71.

    Ginossar T, Nelson S (2010) Reducing the health and digital divides: a model for using community-based participatory research approach to e-health interventions in low-income Hispanic communities. J Computer-Mediated Comm 15:530–551

  72. 72.

    Bramesfeld A, Klippel U, Seidel G, Schwartz F, Dierks ML (2007) How do patients expect the mental health service system to act? Testing the WHO responsiveness concept for its appropriateness in mental health care. Soc Sci Med 65:880–889

  73. 73.

    Butler M, McCreedy E, Schwer N, Burgess D, Call K, Przedworski J, Rosser S, Larson S, Allen M, Fu S, Kane RL (2016) Improving cultural competence to reduce health disparities. Agency for Healthcare Research and Quality (US), Rockville (MD)

  74. 74.

    Aggarwal NK, Pieh MC, Dixon L, Guarnaccia P, Alegría M, Lewis-Fernández R (2016) Clinician descriptions of communication strategies to improve treatment engagement by racial/ethnic minorities in mental health services: a systematic review. Patient Educ Couns 99(2):198–209

  75. 75.

    Cawston P (2011) Social prescribing in very deprived areas. Br J Gen Pract 61:350

  76. 76.

    Thomson LJ, Camic PM, Chatterjee HJ (2015) A review of community referral schemes. University College London, London

  77. 77.

    Wilson P, Booth A (2015) Evidence to inform the commissioning of social prescribing. University of York, York. Centre for Reviews and Dissemination.

  78. 78.

    Gusi N, Reyes MC, Gonzalez-Guerrero JL, Herrera E, Garcia JM (2008) Cost-utility of a walking programme for moderately depressed, obese, or overweight elderly women in primary care: a randomised controlled trial. BMC Public Health 8:231

  79. 79.

    Murphy S, Raisanen L, Moore G, Edwards R, Linck P, Williams N et al (2010) A pragmatic randomised controlled trial of the Welsh National Exercise Referral Scheme: protocol for trial and integrated economic and process evaluation. BMC Public Health 10:352

  80. 80.

    Jenkins R, Fitch C, Hurlston M, Walker F (2009) Recession, debt and mental health: challenges and solutions. Ment Health Fam Med 6:85–90

  81. 81.

    Declaration of Alma-Ata, International Conference on Primary Health Care, Alma-Ata, USSR, 6–12 September, 1978.

  82. 82.

    Wang PS, Aguilar-Gaxiola S, Alonso J, Angermeyer MC, Borges G, Bromet EJ et al (2007) Use of mental health services for anxiety, mood, and substance disorders in 17 countries in the WHO world mental health surveys. Lancet 370(9590):841–850

  83. 83.

    Kessler RC, Demler O, Frank RG, Olfson M, Pincus HA, Walters EE et al (2005) Prevalence and treatment of mental disorders, 1990 to 2003. N Engl J Med 352(24):2515–2523

  84. 84.

    Yates R (2009) Universal health care and the removal of user fees. Lancet 373:2078–2081

  85. 85.

    Syed S, Gerber B, Sharp L (2013) Traveling towards disease: transportation barriers to health care access. J Community Health 38(5):976–993

  86. 86.

    Lasalvia A, Zoppei S, Van Bortel T, Bonetto C, Cristofalo D, Wahlbeck K, Vasseur Bacle S, Van Audenhove C, van Weeghel J, Reneses B, Germanavicius A, Economou M, Lanfredi M, Ando S, Sartorius N, Lopez-Ibor J, Thornicroft G, the ASPEN/INDIGO Study Group (2013) Global pattern of experienced and anticipated discrimination reported by people with major depressive disorder: a cross-sectional survey. Lancet 381:55–62

  87. 87.

    Mitchell RJ, Richardson EA, Shortt NK, Pearce JR (2015) Neighborhood environments and socioeconomic inequalities in mental well-being. Am J Prev Med 49(1):80–84

  88. 88.

    Völker S, Kistemann T (2015) Developing the urban blue: comparative health responses to blue and green urban open spaces in Germany. Health Place 35:196–205

  89. 89.

    Stuckler D, Basu S, Suhrcke M, Coutts A, McKee M (2009) The public health effect of economic crises and alternative policy responses in Europe: an empirical analysis. Lancet 2009; 374:315–323

  90. 90.

    Word Health Organisation Regional Office for Europe (2011) Impact of economic crises on mental health. WHO Regional Office for Europe, Copenhagen

  91. 91.

    Hämäläinen K, Hämäläinen U, Tuomala J (2014) The labour market impacts of a youth guarantee: lessons for Europe?, Government Institute for Economic Research, Finland. Accessed 4 Nov 2016

  92. 92.

    Hall A-M (2013) The Youth Guarantee—a lifeline for European youth? Experiences from the EU-28. European Commission Thematic Paper. DG Employment, Social Affairs and Inclusion

  93. 93.

    Fernald L, Gertler P, Neufeld L (2009) 10-year effect of Oportunidades, Mexico’s conditional cash transfer programme, on child growth, cognition, language, and behaviour: a longitudinal follow-up study. Lancet 374:1997–2005

  94. 94.

    Fernald LCH, Gertler PJ, Neufeld LM (2008) Role of cash in conditional cash transfer programmes for child health, growth, and development: an analysis of Mexico’s Oportunidades. Lancet 371:828–837

  95. 95.

    Paxson C, Schady N (2007) Does money matter? The effects of cash transfers on child health and development in rural Ecuador. Policy Research Working Paper Series: 4226. The World Bank, Washington, DC

  96. 96.

    Fernald L, Hamad R, Karlan D, Ozer E, Zinman J (2008) Small individual loans and mental health: a randomized controlled trial among South African adults. BMC Public Health 8:409–423

  97. 97.

    Ssewamala FM, Han CK, Neilands TB (2009) Asset ownership and health and mental health functioning among AIDS-orphaned adolescents: findings from a randomized clinical trial in rural Uganda. Soc Sci Med 69:191–198

  98. 98.

    Costello E, Compton S, Keeler G, Angold A (2003) Relationship between poverty and psychopathology: a natural experiment. JAMA 290:2023–2029

  99. 99.

    Rojas Y, Stenberg SÃ (2016) Evictions and suicide: a follow-up study of almost 22,000 Swedish households in the wake of the global financial crisis. J Epidemiol Community Health 70(4):409–413

  100. 100.

    Wahlbeck K, McDaid D (2012) Actions to alleviate the mental health impact of the economic crisis. World Psychiatry 11:139–145

  101. 101.

    Holl M, van den Dries L, Wolf JRLM (2016) Interventions to prevent tenant evictions: a systematic review. Health Soc Care Community 24(5):532–546

  102. 102.

    Jenkins R, Minoletti A (2013) Promoting mental health: a crucial component of all public policy. In: Leppo K et al (eds) Health in all policies: seizing opportunities, implementing policies. Ministry of Social Affairs and Health, Finland

  103. 103.

    Chisholm D, Flisher AJ, Lund C et al (2007) Scale up services for mental disorders: a call for action. Lancet 370:1241–1252

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Correspondence to Kristian Wahlbeck.

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Wahlbeck, K., Cresswell-Smith, J., Haaramo, P. et al. Interventions to mitigate the effects of poverty and inequality on mental health. Soc Psychiatry Psychiatr Epidemiol 52, 505–514 (2017) doi:10.1007/s00127-017-1370-4

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  • Poverty
  • Social inequality
  • Mental health
  • Interventions
  • Social policy