The Evolution of Mental Health in the Context of Transitory Economic Changes

  • Alexandrina StoyanovaEmail author
  • Jaime Pinilla
Original Research Article



Mental health disorders are highly prevalent across countries. They increase over time and impose a severe burden on individuals and societies.


This paper examines the evolution of mental health over a period of 15 years, paying special attention on the impact of the most recent economic downturn and subsequent recovery, in Spain.


We use data coming from the National Health Surveys of 2006/2007, 2011/2012 and 2016/2017. Mental health is proxied by two measures, doctor-diagnosed mental disorder and psychological distress (based on the 12-item General Health Questionnaire). To account for the relationship between the two mental health indicators, we estimate a bivariate probit model. The potential endogeneity of unemployment status is considered.


We observe different patterns of the two mental health indicators over time. Psychological distress in men increased during recession years, but slightly decreased among women. Diagnosed mental disorders declined during the peak years of the crisis. Unemployment is a major risk factor for mental distress. Irrespective of the economic conditions, belonging to a higher social class acts as a buffer against psychological distress for women, but not for men. The remaining determinants acted as expected. Women declared worse psychological health than men, and were also more often diagnosed with mental disorders. Having a partner had a protective impact, while providing intensive care to a dependent relative exerted the opposite effect. Education acted as buffer against the onset of psychological distress in women.


Even though the need for mental healthcare increased during the recession, the fact that fewer people were diagnosed suggests that barriers to accessing mental healthcare may be aggravated during the crisis. Policies aiming to tackle the challenges posed by the high prevalence of mental disorders have to be particularly attentive to changes in individuals’ socioeconomic situation, including education, unemployment and social class.



We thank seminar participants at the Universidad de Las Palmas de Gran Canarias, Jornadas AES 2019 in Albacete, and Raquel Andrés for helpful comments and suggestions.

Author Contributions

AS and JP conceived the research. Both authors contributed to analyse the data and interpret the results. Both authors wrote the first draft of the manuscript, critically reviewed and revised it and approved the final version.

Compliance with Ethical Standards


A Stoyanova acknowledges financial support from the Fundación Ramón Areces project “Envejecimiento y sistema sanitario y social. El gasto público y sus efectos en igualdad, dependencia y aseguramiento en España” (162PR19693); and the project “Desarrollo económico, transición demográfica y estado del bienestar en un entorno de globalización”, Ministerio de Economía y Competitividad, Gobierno de España (ECO2016-78991-R).

Conflict of interest

Alexandrina Stoyanova and Jaime Pinilla have no conflict of interest to declare.


  1. 1.
    National Statistical Institute. Contabilidad Nacional (PIB). 2019. Accessed 15 Mar 2019.
  2. 2.
    Eurostat. Statistical Data. Labour Force Survey. 2019. Accessed 4 Feb 2019.
  3. 3.
    Eurostat. EU-SILC Survey data. Gini coefficient of equivalised disposable income. 2018. Accessed 20 Mar 2019.
  4. 4.
    Eurostat. EU-SILC Survey data. S80/S20 income quintile share ratio. 2019. Accessed 20 Mar 2019.
  5. 5.
    Gené-Badia J, Gallo P, Hernández-Quevedo C, García-Armesto S. Spanish health care cuts: Penny wise and pound foolish? Health Policy. 2012;106(1):23–8.PubMedCrossRefGoogle Scholar
  6. 6.
    Catalano R, Goldman-Mellor S, Saxton K, et al. The health effects of economic decline. Annu Rev Public Health. 2011;32:431–50.PubMedCrossRefGoogle Scholar
  7. 7.
    Bellés-Obrero C, Vall Castello J. The Business Cycle and Health. Oxford Research Encyclopedia of Economics and Finance. Ed. 2018. Accessed 28 Mar 2019.
  8. 8.
    Ruhm C. Are recessions good for your health? Q J Econ. 2000;115:617–50.CrossRefGoogle Scholar
  9. 9.
    Neumayer E. Recessions lower (some) mortality rates: evidence from Germany. Soc Sci Med. 2004;58(6):1037–47.PubMedCrossRefPubMedCentralGoogle Scholar
  10. 10.
    Tapia Granados JA. Recessions and mortality in Spain, 1980–1997. Eur J Popul. 2005;21(4):393–422.CrossRefGoogle Scholar
  11. 11.
    Gerdtham UG, Ruhm CJ. Deaths rise in good economic times: evidence from the OECD. Econ Hum Biol. 2006;4(3):298–316.PubMedCrossRefPubMedCentralGoogle Scholar
  12. 12.
    Buchmueller T, Grignon M, Jusot F. Unemployment and mortality in France, 1982–2002. Centre for Health Economics and Policy Analysis (CHEPA), McMaster University. CHEPA Working Paper 2007; 0704.Google Scholar
  13. 13.
    Lin SJ. Economic fluctuations and health outcome: a panel analysis of Asia-Pacific countries. Appl Econ. 2009;41(4):519–30.CrossRefGoogle Scholar
  14. 14.
    McInerney M, Mellor JM. Recessions and seniors’ health, health behaviors, and healthcare use: analysis of the medicare current beneficiary survey. J Health Econ. 2012;31(5):744–51.PubMedCrossRefPubMedCentralGoogle Scholar
  15. 15.
    Stevens AH, Miller DL, Page ME, Filipski M. The best of times, the worst of times: understanding pro-cyclical mortality. Am Econ J Econ Policy. 2015;7(4):279–311.PubMedPubMedCentralCrossRefGoogle Scholar
  16. 16.
    Lam JP, Piérard E. The time-varying relationship between mortality and business cycles in the USA. Health Econ. 2017;26(2):164–83.PubMedCrossRefPubMedCentralGoogle Scholar
  17. 17.
    Ruhm C. Recessions, healthy no more? J Health Econ. 2015;42:17–28.PubMedCrossRefPubMedCentralGoogle Scholar
  18. 18.
    Theodossiou I. The effects of low-pay and unemployment on psychological well-being: a logistic regression approach. J Health Econ. 1998;17(1):85–104.PubMedCrossRefPubMedCentralGoogle Scholar
  19. 19.
    Paul KI, Moser K. Unemployment impairs mental health: meta-analyses. J Vocat Behav. 2009;74(3):264–82.CrossRefGoogle Scholar
  20. 20.
    Goldman-Mellor SJ, Saxton KB, Catalano RC. Economic contraction and mental health. Int J Ment Health. 2010;39(2):6–31.CrossRefGoogle Scholar
  21. 21.
    Gili M, Roca M, Basu S, McKee M, Stuckler D. The mental health risks of economic crisis in Spain: evidence from primary care centres, 2006 and 2010. Eur J Public Health. 2013;23(1):103–8.PubMedCrossRefPubMedCentralGoogle Scholar
  22. 22.
    Bartoll X, Palencia L, Malmusi D, Suhrcke M, Borrel C. The evolution of mental health in Spain during the economic crisis. Eur J Public Health. 2014;24(3):415–8.PubMedCrossRefPubMedCentralGoogle Scholar
  23. 23.
    Latif E. The impact of economic downturn on mental health in Canada. Int J Soc Econ. 2015;42(1):33–46.CrossRefGoogle Scholar
  24. 24.
    Urbanos-Garrido RM, Lopez-Valcarcel BG. The influence of the economic crisis on the association between unemployment and health: an empirical analysis for Spain. Eur J Health Econ. 2015;16(2):175–84.PubMedCrossRefPubMedCentralGoogle Scholar
  25. 25.
    Ruiz-Pérez I, Bermúdez-Tamayo C, Rodríguez-Barranco M. Socio-economic factors linked with mental health during the recession: a multilevel analysis. Int J Equity Health. 2017;16(1):45.PubMedPubMedCentralCrossRefGoogle Scholar
  26. 26.
    Basterra V. Evolución de la prevalencia de alto riesgo de trastornos mentales en población adulta española: 2006–2012. Gac Sanit. 2017;31(4):324–6.PubMedCrossRefPubMedCentralGoogle Scholar
  27. 27.
    Farré L, Fasani F, Mueller H. Feeling useless: the effect of unemployment on mental health in the Great Recession. IZA J Labor Econ. 2018;7:8. Scholar
  28. 28.
    Stuckler D, Basu S, Suhrcke M, Coutts A, McKee M. The public health effect of economic crises and alternative policy responses in Europe: an empirical analysis. Lancet. 2009;374(9686):315–23.PubMedCrossRefPubMedCentralGoogle Scholar
  29. 29.
    Lopez Bernal JA, Gasparrini A, Artundo CM, McKee M. The effect of the late 2000s financial crisis on suicides in Spain: an interrupted time-series analysis. Eur J Public Health. 2013;23(5):732–6.PubMedCrossRefPubMedCentralGoogle Scholar
  30. 30.
    Córdoba-Doña JA, San Sebastián M, Escolar-Pujolar A, Martínez-Faure JE, Gustafsson PE. Economic crisis and suicidal behaviour: the role of unemployment, sex and age in Andalusia, Southern Spain. Int J Equity Health. 2014;13:55. Scholar
  31. 31.
    Alameda-Palacios J, Ruiz-Ramos M, García-Robredo B. Suicidio, prescripción de antidepresivos y desempleo en Andalucía. Gac Sanit. 2014;28(4):309–12.PubMedCrossRefPubMedCentralGoogle Scholar
  32. 32.
    Toffolutti V, Suhrcke M. Assessing the short term health impact of the Great Recession in the European Union: a cross-country panel analysis. Prev Med. 2014;64:54–62.PubMedCrossRefGoogle Scholar
  33. 33.
    Tekin E, McClellan C, Minyard KJ. Health and health behaviors during the worst of times: Evidence from the great recession. NBER Working Paper: 19234; 2013.Google Scholar
  34. 34.
    Pascual N, Rodríguez I. Effects of unemployment on self-assessed health and mental health: empirical evidence for Catalonia (2006–2012). Masters Project. Masters in Health Economics and Policy, Barcelona Graduate School of Economics; 2013.Google Scholar
  35. 35.
    Paling T, Vall Castelló J. Business cycle impacts on substance use of adolescents: a multi-country analysis. Econ Hum Biol. 2017;27:1–11.PubMedCrossRefGoogle Scholar
  36. 36.
    Clark AE, Frijters P, Shields MA. Relative income, happiness, and utility: an explanation for the Easterlin paradox and other puzzles. J Econ Lit. 2008;46(1):95–144.CrossRefGoogle Scholar
  37. 37.
    Murphy GC, Athanasou JA. The effect of unemployment on mental health. J Occup Organ Psychol. 1999;72(1):83–99.CrossRefGoogle Scholar
  38. 38.
    McInerney M, Mellor JM, Nicholas LH. Recession depression: mental health effects of the 2008 stock market crash. J Health Econ. 2013;32(6):1090–104.PubMedCrossRefGoogle Scholar
  39. 39.
    Charles KK, DeCicca P. Local labor market fluctuations and health: is there a connection and for whom? J Health Econ. 2008;27(6):1532–50.PubMedCrossRefPubMedCentralGoogle Scholar
  40. 40.
    Asgeirsdottir T, Corman H, Noonan K, Olafsdottir P, Reichmann N. Are recessions good for your health behaviours? Impacts of the economic crisis in Iceland. NBER Working Paper: 18233; 2012.Google Scholar
  41. 41.
    Xu X. The business cycle and health behaviors. Soc Sci Med. 2013;77:126–36.PubMedCrossRefPubMedCentralGoogle Scholar
  42. 42.
    Catalano R, Dooley D, Rook K. A test of reciprocal risk between undesirable economic and noneconomic life events. Am J Community Psychol. 1987;15(5):633–51.PubMedCrossRefPubMedCentralGoogle Scholar
  43. 43.
    Goldsmith AH, Veum JR, Darity W. The impact of labor force history on self-esteem and its component parts, anxiety, alienation and depression. J Econ Psychol. 1996;17(2):183–220.CrossRefGoogle Scholar
  44. 44.
    Ferrie JE. Is job insecurity harmful to health? J R Soc Med. 2001;94(2):71–6.PubMedPubMedCentralCrossRefGoogle Scholar
  45. 45.
    Ferrie JE, Shipley MJ, Stansfeld SA, Marmot MG. Effects of chronic job insecurity and change in job security on self-reported health, minor psychiatric morbidity, physiological measures, and health related behaviours in British civil servants: the Whitehall II study. J Epidemiol Commun Health. 2002;56(6):450–4.CrossRefGoogle Scholar
  46. 46.
    Prause J, Doodley D, Huh J. Income volatility and psychological depression. Am J Community Psychol. 2009;43(1–2):57–70.PubMedCrossRefPubMedCentralGoogle Scholar
  47. 47.
    Prentice C, McKillop D, French D. How financial strain affects health: evidence from the Dutch National Bank Household Survey. Soc Sci Med. 2017;178:127–35.PubMedCrossRefPubMedCentralGoogle Scholar
  48. 48.
    Jenkinson CE, Dickens AP, Jones K, Thompson-Coon J, Taylor RS, Rogers M, Bambra CL, Lang I, Richards SH. Is volunteering a public health intervention? A systematic review and meta-analysis of the health and survival of volunteers. BMC Public Health. 2013;13:773. Scholar
  49. 49.
    Ruhm CJ. Healthy living in hard times. J Health Econ. 2005;24(2):341–63.PubMedCrossRefPubMedCentralGoogle Scholar
  50. 50.
    Mossakowski KN. Is the duration of poverty and unemployment risk factor for heavy drinking? Soc Sci Med. 2008;67:947–55.PubMedCrossRefPubMedCentralGoogle Scholar
  51. 51.
    Dávalos ME, Fang H, French MT. Easing the pain of an economic downturn: macroeconomic conditions and excessive alcohol consumption. Health Econ. 2012;21(11):1318–35.PubMedCrossRefPubMedCentralGoogle Scholar
  52. 52.
    Dave DM, Kelly IR. How does the business cycle affect eating habits? Soc Sci Med. 2012;74(2):254–62.PubMedCrossRefPubMedCentralGoogle Scholar
  53. 53.
    Colman G, Dave D. Exercise, physical activity, and exertion over the business cycle. Soc Sci Med. 2013;93:11–20.PubMedCrossRefPubMedCentralGoogle Scholar
  54. 54.
    Martin Bassols N, Vall Castelló J. Effects of the great recession on drugs consumption in Spain. Econ Hum Biol. 2016;22:103–16.PubMedCrossRefPubMedCentralGoogle Scholar
  55. 55.
    Carpenter CS, McClellan CB, Rees DI. Economic conditions, illicit drug use, and substance use disorders in the United States. J Health Econ. 2017;52:63–73.PubMedCrossRefPubMedCentralGoogle Scholar
  56. 56.
    Jansen M, Jiménez-Marín S, Gorjón L. The legacy of the crisis: The Spanish Labour Market in the Aftermath of the Great Recession. FEDEA Estudios sobre Economía Española. 2016/10. Accessed 3 Oct 2019.
  57. 57.
    World Health Organization. Mental health: a state of well-being. WHO web page: (Updated August 2014). Accessed 8 Aug 2019.
  58. 58.
    Heckman J. Dummy endogenous variables in a simultaneous equation system. Econometrica. 1978;46(4):931–59.CrossRefGoogle Scholar
  59. 59.
    Rodríguez M, Stoyanova A. Changes in the demand for private medical insurance following a shift in tax incentives. Health Econ. 2008;17(2):185–202.PubMedCrossRefPubMedCentralGoogle Scholar
  60. 60.
    Giammanco MD, Gitto L. Coping, uncertainty and health-related quality of life as determinants of anxiety and depression on a sample of hospitalized cardiac patients in Southern Italy. Qual Life Res. 2016;25(11):2941–56.PubMedCrossRefPubMedCentralGoogle Scholar
  61. 61.
    Bhattacharya J, Goldman D, McCaffrey D. Estimating probit models with self-selected treatments. Stat Med. 2006;25(3):389–413.PubMedCrossRefPubMedCentralGoogle Scholar
  62. 62.
    National Statistical Institute. Spanish Labour Force Survey. 2019. Accessed 25 July 2019.
  63. 63.
    Roodman D. Fitting fully observed recursive mixed-process models with CMP. Stata J. 2011;11(2):159–206.CrossRefGoogle Scholar
  64. 64.
    StataCorp. Stata statistical software: release 10. College Station: StataCorp LP; 2017.Google Scholar
  65. 65.
    National Statistical Institute. Spanish National Health Survey (Encuesta Nacional de Salud). 2018. Accessed 3 Sept 2018.
  66. 66.
    Solon G, Haider SJ, Wooldridge JM. What are we weighting for? J Hum Resour. 2015;50(2):301–16.CrossRefGoogle Scholar
  67. 67.
    Spanish Ministry of Health, Consumer Affairs and Social Welfare. Key indicators of the National Health System. 2016. Accessed 8 Aug 2019.
  68. 68.
    Rodríguez M, Stoyanova A. The effect of private insurance access on the choice of GP/Specialist and public/private provider in Spain. Health Econ. 2004;13(7):689–703.PubMedCrossRefPubMedCentralGoogle Scholar
  69. 69.
    OOECD. The OECD list of social indicators. In: The OECD Social Indicator Development Programme (book 5). Paris: OECD Publications and Information Center; 1982.Google Scholar
  70. 70.
    Wahlbeck K, McDaid D. Actions to alleviate the mental health impact of the economic crisis. World Psychiatry. 2012;11(2):139–45.PubMedPubMedCentralCrossRefGoogle Scholar
  71. 71.
    Frasquilho D, Gaspar Matos M, Salonna F, Guerreiro D, Storti CC, Gaspar T, Caldas-de-Almeida JM. Mental health outcomes in times of economic recession: a systematic literature review. BMC Public Health. 2016. Scholar
  72. 72.
    McDonough O, Walters V. Gender and health: reassessing patterns and explanations. Soc Sci Med. 2001;52(4):547–59.PubMedCrossRefGoogle Scholar
  73. 73.
    Kudielka BM, Buske-Kirschbaum A, Hellhammer DH, Kirschbaum C. Differential heart rate reactivity and recovery after psychosocial stress (TSST) in healthy children, younger adults, and elderly adults: the impact of age and gender. Int J Behav Med. 2004;11:116–21.PubMedCrossRefPubMedCentralGoogle Scholar
  74. 74.
    Chopra KK, Ravindran A, Kennedy SH, Meckenzie B, Matthews S, Anisman H. Sex differences in hormonal responses to a social stressor in chronic major depression. Psychoneuroendocrinology. 2009;2009(34):1235–41.CrossRefGoogle Scholar
  75. 75.
    Katikireddi SV, Niedzwiedz CL, Popham F. Trends in population mental health before and after the 2008 recession: a repeat cross-sectional analysis of the 1991–2010 Health Surveys of England. BMJ Open. 2012;2(5):e001790. Scholar
  76. 76.
    Hauksdottir A, McClure C, Jonsson SH, Olafsson O, Valdimarsdóttir UA. Increased stress among women following an economic collapse: a prospective cohort study. Am J Epidemiol. 2013;177(9):979–88.PubMedCrossRefPubMedCentralGoogle Scholar
  77. 77.
    Economou M, Angelopoulos E, Peppou LE, Souliotis K, Tzavara C, Kontoangelos K, Madianos M, Stefanis C. Enduring financial crisis in Greece: prevalence and correlates of major depression and suicidality. Soc Psychiatry Psychiatr Epidemiol. 2016;51(7):1015–24.PubMedCrossRefGoogle Scholar
  78. 78.
    National Statistical Institute. Encuesta de Presupuestas Familiares. 2015. Accessed 25 July 2019.
  79. 79.
    Taylor SE, Klein LC, Lewis BP, Gruenewald TL, Gurung RA, Updegraff JA. Biobehavioral responses to stress in females: tend-and-befriend, not fight-or-flight. Psychol Rev. 2000;107(3):411–29.PubMedCrossRefGoogle Scholar
  80. 80.
    Blanchflower DG, Oswald AJ. Is well-being U-shaped over the life cycle? Soc Sci Med. 2008;66(8):1733–49.PubMedCrossRefPubMedCentralGoogle Scholar
  81. 81.
    Colombo F, Mercier J. Help wanted? Fair and sustainable financing of long-term care services. Appl Econ Perspect P. 2012;34(2):316–32.CrossRefGoogle Scholar
  82. 82.
    DePasquale N, Davis KD, Zarit SH, et al. Combining formal and informal caregiving roles: the psychosocial implications of double-and triple-duty care. J Gerontol B Psychol Sci Soc Sci. 2016;71(2):201–11.PubMedCrossRefPubMedCentralGoogle Scholar
  83. 83.
    Horwitz AV, White HR, Howell-White S. Becoming married and mental health: a longitudinal study of a cohort of young adults. J Marriage Fam. 1996;58(4):895–907.CrossRefGoogle Scholar
  84. 84.
    Brown SL. The effect of union type on psychological well-being: depression among cohabitors versus marrieds. J Health Soc Behav. 2000;41(3):241–55.PubMedCrossRefPubMedCentralGoogle Scholar
  85. 85.
    Kim HK, McKenry PC. The relationship between marriage and psychological well-being: a longitudinal analysis. J Fam Issues. 2002;23(8):885–911.CrossRefGoogle Scholar
  86. 86.
    Simon RW. Revisiting the relationships among gender, marital status and mental health. Am J Sociol. 2002;107(4):1065–96.PubMedCrossRefPubMedCentralGoogle Scholar
  87. 87.
    Lamb KA, Lee GR, DeMaris A. Union formation and depression: selection and relationship effects. J Marriage Fam. 2003;65(4):953–62.CrossRefGoogle Scholar
  88. 88.
    Williams K. Has the future of marriage arrived? A contemporary examination of gender, marriage, and psychological well-being. J Health Soc Behav. 2003;44(4):470–87.PubMedPubMedCentralCrossRefGoogle Scholar
  89. 89.
    Marcussen K. Explaining differences in mental health between married and cohabiting individuals. Soc Psychol Quart. 2005;68(3):239–57.CrossRefGoogle Scholar
  90. 90.
    Simon RW, Barrett AE. Nonmarital romantic relationships and mental health in early adulthood: does the association differ for women and men? J Health Soc Behav. 2010;51(2):168–82.PubMedCrossRefPubMedCentralGoogle Scholar
  91. 91.
    Chevalier A, Feinstein L. Sheepskin or Prozac: the causal effect of education on mental health. Working Papers: 15, Geary Institute, University College Dublin; 2007.Google Scholar
  92. 92.
    Crespo L, López-Noval B, Mira P. Compulsory schooling, education, depression and memory: new evidence from SHARELIFE. Econ Educ Rev. 2014;43(C):36–46.CrossRefGoogle Scholar
  93. 93.
    Johansson E, Böckerman P, Martelin T, Pirkola S, Poikolainen K. Does education shield against common mental disorders? The Research Institute of the Finnish Economy. Discussion Paper: 1202; 2009.Google Scholar
  94. 94.
    Córdoba-Doña JA, Escolar-Pujolar A, San Sebastián M, Gustafsson PE. How are the employed and unemployed affected by the economic crisis in Spain? Educational inequalities, life conditions and mental health in a context of high unemployment. BMC Public Health. 2016;16:267. Scholar
  95. 95.
    Riumallo-Herl C, Basu S, Stuckler D, Courtin E, Avendano M. Job loss, wealth and depression during the Great Recession in the USA and Europe. Int J Epidemiol. 2014;43(5):1508–17.PubMedPubMedCentralCrossRefGoogle Scholar
  96. 96.
    Grayson JP. Health, physical activity level, and employment status in Canada. Int J Health Serv. 1993;23(4):743–61.PubMedCrossRefPubMedCentralGoogle Scholar
  97. 97.
    Fagan P, Shavers V, Lawrence D, Gibson JT, Ponder P. Cigarette smoking and quitting behaviors among unemployed adults in the United States. Nicotine Tob Res. 2007;9(2):241–8.PubMedCrossRefPubMedCentralGoogle Scholar
  98. 98.
    Karjalainen K, Lintonen T, Impinen A, Lillsunde P, Mäkelä P, Rahkonen O, Haukka J, Ostamo A. Socio-economic determinants of drugged driving—a register-based study. Addiction. 2011;106(8):1448–59.PubMedCrossRefPubMedCentralGoogle Scholar
  99. 99.
    Harhay MO, Bor J, Basu S, McKee M, Mindell JS, Shelton NJ. Differential impact of the economic recession on alcohol use among white British adults, 2004–2010. Eur J Public Health. 2014;24(3):410–5.PubMedCrossRefPubMedCentralGoogle Scholar
  100. 100.
    Gili M, López-Navarro E, Castro A, Homan C, Navarro C, García-Toro M, García-Campayo J, Roca M. Gender differences in mental health during the econòmic crisis. Psicothema. 2016;28(4):407–13.PubMedPubMedCentralGoogle Scholar
  101. 101.
    Artazcoz L, Benach J, Borrell C, Cortès I. Unemployment and mental health: understanding the interactions among gender, family roles, and social class. Am J Public Health. 2004;94(1):82–8.PubMedPubMedCentralCrossRefGoogle Scholar
  102. 102.
    Urbanos R, Puig-Junoy J. Políticas de austeridad y cambios en las pautas de uso de los servicios sanitarios. Informe SESPAS 2014. Gac Sanit. 2014;28(1):81–8.CrossRefGoogle Scholar
  103. 103.
    Buffel V, van de Straat V, Bracke P. Employment status and mental health care use in times of economic contraction: a repeated cross-sectional study in Europe, using a three-level model. Int J Equity Health. 2015;14:29. Scholar
  104. 104.
    Sicras-Mainar A, Navarro-Artieda R. Use of antidepressants in the treatment of major depressive disorder in primary care during a period of economic crisis. Neuropsychiatr Dis Treat. 2015;12:29–40.PubMedPubMedCentralCrossRefGoogle Scholar
  105. 105.
    Observatorio de Salud Mental de la Asociación Española de Neuropsiquiatría. Datos. Generador de estadísticas. Accessed 7 Oct 2019.
  106. 106.
    Silva M, Resurrección D, Antunes A, Frasquilho D, Cardoso G. Impact of economic crises on mental health care: a systematic review. Epidemiol Psychiatr Sci. 2018. Scholar
  107. 107.
    Martin-Carrasco M, Evans-Lacko S, Dom G, Christodoulou NG, Samochowiec J, Gonzalez-Fraile E, Bienkowski P, Gómez-Beneyto M, Dos Santos MJ, Wasserman D. EPA guidance on mental health and economic crises in Europe. Eur Arch Psychiatry Clin Neurosci. 2016;266(2):89–124.PubMedCrossRefPubMedCentralGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of Economics, Faculty of Economics and Business AdministrationUniversitat de Barcelona, BEAT and CAEPSBarcelonaSpain
  2. 2.Department of Quantitative Methods in EconomicsUniversidad de Las Palmas de Gran CanariaLas Palmas de Gran CanariaSpain

Personalised recommendations