Measuring Mental Health in a Cost-of-Living Crisis: a rapid review
Authors: England Clare , Jarrom David , Washington Jenni , Hasler Elise , Batten Leona , Lewis Ruth , Edwards Rhiannon Tudor , Davies Jacob , Collins Brendan , Cooper Alison , Edwards Adrian 
Published: July 2023

AbstractSince 2021 the UK has experienced a sharp rise in inflation. For many, wages and welfare payments have not kept up with rising costs, leading to a cost of living crisis. There is evidence indicating that economic crises are damaging to population mental health and that some groups are particularly vulnerable.The review aims to 1. Identify and appraise available population-level measures and methods for assessing the impact on mental health of any public health response to the cost-of-living crisis and 2. Review the appropriateness of the measures for specific, vulnerable populations.Study designs and mental health measurement toolsThese included secondary analyses of existing data, household panel surveys, repeated cross-sectional surveys; or used routine clinical data including medical records, prescribing data, or were ecological time-series studies using national or regional suicide death rates. 12 validated mental health measurement tools were identified. Four validated mental health measurement tools are embedded into UK population-level surveys.Vulnerable groups11 mental health measurement tools were used to identify population sub-groups whose mental health was most likely to be affected by an economic crisis. There is evidence that the mental health measurement tools and methods are suitable for measuring mental health in people with different socio-economic and financial situations. It was not possible to determine whether the methods and tools effectively captured data from people from minority ethnic groups.Policy and practice implicationsMany UK population-level surveys, include validated mental health tools and questions about financial security, providing data that can be used to explore population mental health. A quasi-experimental study design, using data from a household panel could be suitable for measuring the mental health impact of a specific public health initiative to tackle cost of living pressures. Reports and studies using population-level surveys or medical records should present data on ethnicity and, where possible, plan to stratify analyses by ethnicity.Economic considerationsPoorer households are more exposed to inflationary pressures. In the lead up to the cost of living crisis, Wales had the highest proportion of working age adults and pensioners in relative income poverty out of the UK nations. 28% of children in Wales were living in relative poverty. Given that over half of all mental health problems start by age 14 (and 75% by age 18) and poverty being a risk factor for psychological illnesses, there is likely to be a long shadow of mental health continuing into future generations stemming from the cost-of-living crisis. Mental Health problems cost the Welsh economy 4.8 billion (UK pounds) per annum. In a recent survey of Welsh participants, 60% of respondents agreed that rising costs of living negatively affected their quality of life.Funding statementHealth Technology Wales was funded for this work by the Health and Care Research Wales Evidence Centre, itself funded by Health and Care Research Wales on behalf of Welsh GovernmentEXECUTIVE SUMMARYWhat is a Rapid Review?Our rapid reviews use a variation of the systematic review approach, abbreviating or omitting some components to generate the evidence to inform stakeholders promptly whilst maintaining attention to bias.Who is this summary for?The intended audience are stakeholders needing to measure mental health outcomes who are seeking evidence for appropriate methods and tools, which are applicable to the UK or relating to Wales.Background / Aim of Rapid ReviewSince 2021, the UK has experienced a sharp rise in inflation. For most people, wages and welfare payments have not kept up with rising costs, leading to a cost-of-living crisis. There is evidence drawn from longitudinal epidemiological studies indicating that economic crises are damaging to population mental health and that some groups are particularly vulnerable. Consequently, public health responses to the cost-of-living crisis should be able to assess the impact of the policies on mental health. The aims of the review are to 1) identify and appraise available population-level measures and methods for assessing the impact on mental health of any public health response to the cost-of-living crisis and 2) review the appropriateness of the measures for specific, vulnerable populations.Key FindingsFour systematic reviews, one scoping review, one clinical guidance, one rapid review, nine peer-reviewed primary studies and two reports from grey literature were included. Most evidence come from before and after the 2008/2009 economic crisis, which is also called the Great Recession.Study designs and mental health measurement tools▪Study designs included secondary analyses of existing data drawn from national or regional cohort studies, household panel surveys, repeated cross-sectional surveys; or used routine clinical data including medical records, prescribing data, or were ecological time-series studies using national or regional suicide death rates.▪Two quasi-experimental studies used data from a household panel survey to examine the impact of the introduction of specific welfare policies on mental health.▪Seven UK studies used data from the “Understanding Society: The UK Household Longitudinal Study” (UKHLS), one used the “Scottish Longitudinal Study” (SLS), one used the “Welsh Health Survey” (now “National Survey for Wales”), and one used the Office for National Statistics (ONS) “Opinions and Lifestyle Survey”.▪Twelve brief validated mental health measurement tools, which were self-administered, or administered by an interviewer, were identified (section 6, table 4).▪Four validated mental health measurement tools are embedded into UK population-level surveys. The four tools are: 12-item General Health Questionnaire (used in UKHLS); Short form 12 Mental Health Component Summary (used in UKHLS); Warwick-Edinburgh Mental Well-being Scale (used in UKHLS and the “National Survey for Wales”) and Patient Health Questionnaire depression scale (used in the “Opinions and Lifestyle Survey”)Vulnerable groups▪Eleven of the twelve mental health measurement tools were used to identify population sub-groups whose mental health was most likely to be affected by an economic crisis.▪The reviews and studies did not comment on the suitability of the mental health measurement tools for measuring mental health among vulnerable groups.▪There is evidence that the identified mental health measurement tools and methods are suitable for measuring mental health in people with different socio-economic and financial situations, including those who are financially insecure and from men and women and from people of different ages.▪It was not possible to determine whether the identified methods and tools effectively captured data from people from minority ethnic groups.Policy and practice implications▪The UK has many population-level surveys, which include validated mental health tools and questions about financial security, providing rich data that can be used to explore the mental health of the population.▪A quasi-experimental study design, using data from a household panel survey such as the UKHLS, could be suitable for measuring the mental health impact of a specific public health initiative to tackle cost-of-living pressures, and which has a clear roll-out date.▪Reports and studies using population-level surveys or medical records should present data on ethnicity and, where possible, plan to stratify analyses by ethnicity.Economic considerations▪The impacts of the cost of living crisis have not been felt equally. Poorer households are more exposed to inflationary pressures as they spend a greater proportion of their income on items such as food and energy that have seen considerable inflation.▪In the lead up to the cost of living crisis, Wales had the highest proportion of working age adults (21%) and pensioners (18%) in relative income poverty out of the UK nations. 28% of children in Wales were living in relative poverty. Given that over half of all mental health problems start by age 14 (and 75% by age 18) and poverty being a known risk factor for psychological illnesses, there is likely to be a long shadow of mental health continuing into future generations stemming from the cost of living crisis.▪Mental Health problems cost the Welsh economy £4.8 billion per annum.▪In a survey of 2,000 Welsh participants covering the period November 2022 to January 2023, 60% of respondents agreed that rising costs of living negatively affected their quality of life (25% strongly agreed). 87% reported ‘worrying’ around the cost of living, with 38% reporting ‘worrying a lot’.