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The impact of the great economic Crisis 2008 on mental health care in Italy

The economic crisis in 2008 has affected the welfare of the population in many countries. This paper investigates the impact of the economic crisis on hospital admissions for severe mental disorder at small geographic levels in Italy, and assesses whether there are heterogeneous effects across areas with distinct levels of income. This project has received funding from the European Union’s Horizon 2020 research and innovation programme under the Marie Skłodowska-Curie Grant Agreement No 721402.

Health

The advent of the global financial crisis in 2008 and its economic consequences prompted a revival of this stream of literature, which subsequently assesses the relationship between macroeconomic conditions and mental health outcomes. In Italy, the crisis has had profound implications on the population. The systematic rise in unemployment rates and the worsening labour conditions have given rise to substantial inequalities and social tensions. Also, the generally pessimistic outlook of the economy could have posed additional severe mental health challenges due to the widespread insecurity. Although the literature on the association between economic crisis and mental health and health care utilisation is plentiful, the research in the Italian context has investigated the issue either using longitudinal survey data with subjective measurement of mental health or looking at the correlation between mental disorder and crisis period at the aggregated level. To establish the socioeconomic determinants of mental health outcomes, we need to look into multi-disciplinary works for deeper understandings of how adverse conditions act as psychological stressors and how such conditions can have implications on the health care system. Our analysis has shown strong evidence for the impact of the economic crisis on admissions for affective disorders for the entire population in Italy. The effect is significant for all the different models that we tested, even though the magnitude is moderate. We argue that since we observe only inpatient admissions, not outpatient interventions, the actual impact could be even more severe. Our study uniquely contributes to the stream of literature on the socioeconomic determinants of mental illness by establishing the causal impact of rising unemployment during the economic crisis on severe mental disorder admissions in the context of universal coverage. The linear and dynamic panel models that we tested all point to the same conclusion—higher unemployment increases admission for affective disorder. However, inequality did not play a contributing role. When we analyse the socioeconomic gradient of the impact, we have found that areas with the lowest levels of income per capita are the most affected population. The result shows how people who belong to the more economically vulnerable segment of the society can experience adverse episodes due to their mental distress towards the deteriorating economic environment. Behind this effect, two mechanisms may be at play: (i) for the unemployed, worsening labour market conditions could have induced the onsets of affective disorders; (ii) for the employed, the social diffusion of job insecurity has raised the anxiety level that potentially led to affective disorder. The recent COVID-19 outbreak has brought another heavy storm to harm the mental health of the population in Italy. With increased social isolation, the general sense of grief and fear, alongside the grim economic prospects, we can reasonably expect anxiety, stress, and potential mental illness to escalate. An estimated 970 million people around the world suffer from mental distress, and the prevalence of, for instance, depression has risen more than 40% over the past 30 years. The overwhelming phenomenon reflects a combination of the rising needs and the increasing awareness to seek treatment. How society perceives mental illness patients and how health care systems allocate resources to treatment and social policies will be a long-lasting debate. We hope that our study can bring to light the importance of adequate policy responses to address the psychological aspects of large-scale socioeconomic shocks in the long term.

Keywords

health, mental health, economic crisis