@article{cordoba-dona_how_2016,
title = {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.},
author = {Juan Antonio Córdoba-Doña and Antonio Escolar-Pujolar and Miguel San Sebastián and Per E Gustafsson},
doi = {10.1186/s12889-016-2934-z},
issn = {1471-2458},
year = {2016},
date = {2016-01-01},
journal = {BMC public health},
volume = {16},
number = {1},
abstract = {BACKGROUND: Despite an increasing number of studies on the factors mediating the impact of the economic recession on mental health, research beyond the individual employment status is scarce. Our objectives were to investigate in which ways the mental health of employed and unemployed populations is differently affected by the current economic recession along the educational scale and to examine whether financial strain and social support explain these effects of the crisis.$textbackslashbackslash$n$textbackslashbackslash$nMETHODS: A repeated cross-sectional study, using two waves of the Andalusian Health Survey in 2007 (pre-crisis) and 2011-2012 (crisis). A population aged between 19 and 64 years was selected. The dependent variable was the Mental Component Summary of the SF-12 questionnaire. We performed Poisson regression models stratified by working status, with period, educational level, financial strain and social support as independent variables. We examined interactions between period and educational level. Age, sex, main earner, cohabitation and partner's working status were considered as covariates.$textbackslashbackslash$n$textbackslashbackslash$nRESULTS: The study included 3210 individuals (1185 women) in 2007 and 3633 individuals (1486 women) in 2011-2012. In working individuals the prevalence of poor mental health increased for secondary and complete primary studies groups during crisis compared to the pre-crisis period, while it decreased significantly in the university study group (PR = 0.76, 95 % CI: 0.58-0.99). However, in unemployed individuals prevalence ratios for poor mental health increased significantly only in the secondary studies group (PR = 1.73, 95 % CI: 1.06-2.83). Financial strain and social support yielded consistent associations with mental health in all subgroups. Only financial strain could partly explain the crisis effect on mental health among the unemployed.$textbackslashbackslash$n$textbackslashbackslash$nCONCLUSIONS: Our study supports the finding that current economic recession is associated with poorer mental health differentially according to labour market status and educational level. Those with secondary studies may be at risk in times of economic recession. In connection with this, emerging educational inequalities in mental health among the employed population were observed. Our research also suggests a partial mediating role of financial strain for the effects of crisis on poor mental health among the unemployed. Good social support appears to buffer poor mental health in all subgroups but not specifically during crisis period.},
keywords = {Crisi Econòmica, Espanya, Salut Mental, Treball},
pubstate = {published},
tppubtype = {article}
}

@article{bosmans_explaining_2016,
title = {Explaining the relation between precarious employment and mental well-being. A qualitative study among temporary agency workers},
author = {Kim Bosmans and Stefan Hardonk and Nele De Cuyper and Christophe Vanroelen},
doi = {10.3233/WOR-152136},
issn = {10519815},
year = {2016},
date = {2016-01-01},
journal = {Work},
volume = {53},
number = {2},
abstract = {BACKGROUND: From an employee-perspective, temporary agency employment can be considered in two ways. According to the first perspective, agency jobs are associated with job characteristics that adversely affect (mental) health: job insecurity, low wages, a lack of benefits, little training, poorer prospects for the future, high working time flexibility, minimal trade union representation and problematic triadic employment relations. The other perspective underlines that flexibility, learning opportunities and freedom in agency employment enable workers to build the career of their choice, which may positively affect health and well-being. OBJECTIVE: This article aims at interpreting and explaining these conflicting perspectives. In particular, we discuss the role of coping resources (control, support, trust and equity) in the stress pathway between characteristics of temporary agency employment and mental well-being. METHODS: Semi-structured interviews with 12 Belgian temporary agency workers were conducted and analysed from a phenomenological perspective. RESULTS: The results reveal mainly how a lack of coping resources plays a key role in how (precarious) characteristics of temporary agency employment affect employees' mental well-being. CONCLUSIONS: This study illustrates one of the earlier assumed pathways, in which coping resources play an intermediary as well as a moderating role.},
keywords = {Salut Mental, Treball},
pubstate = {published},
tppubtype = {article}
}

@article{cordoba-dona_economic_2014,
title = {Economic crisis and suicidal behaviour: the role of unemployment, sex and age in Andalusia, Southern Spain},
author = {Juan Córdoba-Doña and Miguel San Sebastián and Antonio Escolar-Pujolar and Jesús Martínez-Faure and Per E Gustafsson},
doi = {10.1186/1475-9276-13-55},
issn = {1475-9276},
year = {2014},
date = {2014-01-01},
journal = {International Journal for Equity in Health},
volume = {13},
number = {1},
abstract = {INTRODUCTION: Although suicide rates have increased in some European countries in relation to the current economic crisis and austerity policies, that trend has not been observed in Spain. This study examines the impact of the economic crisis on suicide attempts, the previously neglected endpoint of the suicidal process, and its relation to unemployment, age and sex.$textbackslashbackslash$n$textbackslashbackslash$nMETHODS: The study was carried out in Andalusia, the most populated region of Spain, and which has a high level of unemployment. Information on suicide attempts attended by emergency services was extracted from the Health Emergencies Public Enterprise Information System (SIEPES). Suicide attempts occurring between 2003 and 2012 were included, in order to cover five years prior to the crisis (2003-2007) and five years after its onset (2008-2012). Information was retrieved from 24,380 cases (11,494 men and 12,886 women) on sex, age, address, and type of attention provided. Age-adjusted suicide attempt rates were calculated. Excess numbers of attempts from 2008 to 2012 were estimated for each sex using historical trends of the five previous years, through time regression models using negative binomial regression analysis. To assess the association between unemployment and suicide attempts rates, linear regression models with fixed effects were performed.$textbackslashbackslash$n$textbackslashbackslash$nRESULTS: A sharp increase in suicide attempt rates in Andalusia was detected after the onset of the crisis, both in men and in women. Adults aged 35 to 54 years were the most affected in both sexes. Suicide attempt rates were associated with unemployment rates in men, accounting for almost half of the cases during the five initial years of the crisis. Women were also affected during the recession period but this association could not be specifically attributed to unemployment.$textbackslashbackslash$n$textbackslashbackslash$nCONCLUSIONS: This study enhances our understanding of the potential effects of the economic crisis on the rapidly increasing suicide attempt rates in women and men, and the association of unemployment with growing suicidal behaviour in men. Research on the suicide effects of the economic crisis may need to take into account earlier stages of the suicidal process, and that this effect may differ by age and sex.},
keywords = {Crisi Econòmica, Espanya, Salut Mental},
pubstate = {published},
tppubtype = {article}
}

@article{bartoll_evolution_2014,
title = {The evolution of mental health in Spain during the economic crisis},
author = {Xavier Bartoll and Laia Pal??ncia and Davide Malmusi and Marc Suhrcke and Carme Borrell},
doi = {10.1093/eurpub/ckt208},
issn = {1464360X},
year = {2014},
date = {2014-01-01},
journal = {European Journal of Public Health},
volume = {24},
number = {3},
abstract = {We analyse how mental health and socioeconomic inequalities in the Spanish population aged 16-64 years have changed between 2006-2007 and 2011-2012. We observed an increase in the prevalence of poor mental health among men (prevalence ratio = 1.15, 95% CI 1.04-1.26], especially among those aged 35-54 years, those with primary and secondary education, those from semi-qualified social classes and among breadwinners. None of these associations remained after adjusting for working status. The relative index of inequality by social class increased for men from 1.02 to 1.08 (P = 0.001). We observed a slight decrease in the prevalence of poor mental health among women (prevalence ratio = 0.92, 95% CI 0.87-0.98), without any significant change in health inequality.},
keywords = {Espanya, Salut Mental},
pubstate = {published},
tppubtype = {article}
}

@article{vives_employment_2013,
title = {Employment precariousness and poor mental health: Evidence from spain on a new social determinant of health},
author = {Alejandra Vives and Marcelo Amable and Montserrat Ferrer and Salvador Moncada and Clara Llorens and Carles Muntaner and Fernando G Benavides and Joan Benach},
doi = {10.1155/2013/978656},
issn = {16879805},
year = {2013},
date = {2013-01-01},
journal = {Journal of Environmental and Public Health},
volume = {2013},
abstract = {BACKGROUND: Evidence on the health-damaging effects of precarious employment is limited by the use of one-dimensional approaches focused on employment instability. This study assesses the association between precarious employment and poor mental health using the multidimensional Employment Precariousness Scale.$textbackslashbackslash$n$textbackslashbackslash$nMETHODS: Cross-sectional study of 5679 temporary and permanent workers from the population-based Psychosocial Factors Survey was carried out in 2004-2005 in Spain. Poor mental health was defined as SF-36 mental health scores below the 25th percentile of the Spanish reference for each respondent's sex and age. Prevalence proportion ratios (PPRs) of poor mental health across quintiles of employment precariousness (reference: 1st quintile) were calculated with log-binomial regressions, separately for women and men.$textbackslashbackslash$n$textbackslashbackslash$nRESULTS: Crude PPRs showed a gradient association with poor mental health and remained generally unchanged after adjustments for age, immigrant status, socioeconomic position, and previous unemployment. Fully adjusted PPRs for the 5th quintile were 2.54 (95% CI: 1.95-3.31) for women and 2.23 (95% CI: 1.86-2.68) for men.$textbackslashbackslash$n$textbackslashbackslash$nCONCLUSION: The study finds a gradient association between employment precariousness and poor mental health, which was somewhat stronger among women, suggesting an interaction with gender-related power asymmetries. Further research is needed to strengthen the epidemiological evidence base and to inform labour market policy-making.},
keywords = {Crisi Econòmica, Espanya, Salut Mental},
pubstate = {published},
tppubtype = {article}
}

@article{gili_mental_2013,
title = {The mental health risks of economic crisis in Spain: Evidence from primary care centres, 2006 and 2010},
author = {Margalida Gili and Miquel Roca and Sanjay Basu and Martin McKee and David Stuckler},
doi = {10.1093/eurpub/cks035},
issn = {11011262},
year = {2013},
date = {2013-01-01},
journal = {European Journal of Public Health},
volume = {23},
number = {1},
abstract = {BACKGROUND: Nearly all European countries have been affected by the economic crisis that began in 2007, but the consequences have been among the worst in Spain. We investigated the associations of the recession on the frequency of mood, anxiety, somatoform, alcohol-related and eating disorders among those visiting Spanish primary care settings. METHODS: Primary care physicians selected randomized samples of patients attending primary care centres representing Spain's consulting populations. A total of 7940 patients in 2006-07 and 5876 in 2010-11 were administered the Primary Care Evaluation of Mental Disorders (PRIME-MD) instrument to diagnose mental disorders. Multivariate logistic regression models were used to quantify overall changes in the frequency of mental disorders, adjusting for potential socio-demographic differences in consulting populations unrelated to economic factors. RESULTS: Compared with the pre-crisis period of 2006, the 2010 survey revealed substantial and significant increases in the proportion of patients with mood (19.4% in major depression), anxiety (8.4% in generalized anxiety disorder), somatoform (7.3%) and alcohol-related disorders (4.6% in alcohol dependence), all significant at P textbackslashtextless 0.001, but not in eating disorders (0.15%},
keywords = {Crisi Econòmica, Espanya, Salut Mental},
pubstate = {published},
tppubtype = {article}
}

@article{lopez_bernal_effect_2013,
title = {The effect of the late 2000s financial crisis on suicides in Spain: An interrupted time-series analysis},
author = {James A Lopez Bernal and Antonio Gasparrini and Carlos M Artundo and Martin McKee},
doi = {10.1093/eurpub/ckt083},
issn = {11011262},
year = {2013},
date = {2013-01-01},
journal = {European Journal of Public Health},
volume = {23},
number = {5},
abstract = {BACKGROUND: The current financial crisis is having a major impact on European economies, especially that of Spain. Past evidence suggests that adverse macro-economic conditions exacerbate mental illness, but evidence from the current crisis is limited. This study analyses the association between the financial crisis and suicide rates in Spain. METHODS: An interrupted time-series analysis of national suicides data between 2005 and 2010 was used to establish whether there has been any deviation in the underlying trend in suicide rates associated with the financial crisis. Segmented regression with a seasonally adjusted quasi-Poisson model was used for the analysis. Stratified analyses were performed to establish whether the effect of the crisis on suicides varied by region, sex and age group. RESULTS: The mean monthly suicide rate in Spain during the study period was 0.61 per 100 000 with an underlying trend of a 0.3% decrease per month. We found an 8.0% increase in the suicide rate above this underlying trend since the financial crisis (95% CI: 1.009-1.156; P = 0.03); this was robust to sensitivity analysis. A control analysis showed no change in deaths from accidental falls associated with the crisis. Stratified analyses suggested that the association between the crisis and suicide rates is greatest in the Mediterranean and Northern areas, in males and amongst those of working age. CONCLUSIONS: The financial crisis in Spain has been associated with a relative increase in suicides. Males and those of working age may be at particular risk of suicide associated with the crisis and may benefit from targeted interventions.},
keywords = {Crisi Econòmica, Salut Mental},
pubstate = {published},
tppubtype = {article}
}

@article{roca_economic_2013,
title = {Economic crisis and mental health in Spain},
author = {Miquel Roca and Margarita Gili and Javier Garcia-Campayo and Mauro García-Toro},
doi = {10.1016/S0140-6736(13)62650-1},
issn = {01406736},
year = {2013},
date = {2013-01-01},
journal = {The Lancet},
volume = {382},
number = {9909},
abstract = {Many agree that economic crisis, unemployment, and low incomes are associated with poor health; and this might be particularly relevant for mental health.1 The economic crisis in Europe is particularly severe in Greece, Portugal, and Spain, and controversies have arisen around the consequences of the financial crisis on health and suicides rates. Fountoulakis and colleagues2 argued that there is no evidence to support a causal link between the financial crisis and suicide, questioning the reliability of the Greek official data on suicide rates. It is important to note that suicide rates in south European countries are lower than those in other European countries.3 Between 1997 and 2007, Spain's economy was one of the fastest growing in Europe. At present, 25% of Spanish people of working age are unemployed, the highest rate in Europe. According to the Spanish National Institute of Statistics suicide rates in Spain (table) decreased between 2008 and 2011. However, Lopez-Bernal and colleagues noted an increase of suicide in working-age men.4},
keywords = {Crisi Econòmica, Espanya, Salut Mental},
pubstate = {published},
tppubtype = {article}
}

@article{vives_employment_2011,
title = {Employment Precariousness in Spain: Prevalence, Social Distribution, and Population-Attributable Risk Percent of Poor Mental Health},
author = {Vives, Alejandra and Vanroelen, Christophe and Amable, Marcelo and Ferrer, Montserrat and Moncada, Salvador and Llorens, Clara and Muntaner, Carles and Benavides, Fernando G. and Benach, Joan},
url = {http://journals.sagepub.com/doi/10.2190/HS.41.4.b},
doi = {10.2190/HS.41.4.b},
issn = {0020-7314},
year = {2011},
date = {2011-01-01},
journal = {International Journal of Health Services},
volume = {41},
number = {4},
pages = {625--646},
keywords = {Salut, Salut Mental, Treball},
pubstate = {published},
tppubtype = {article}
}

@article{perez-rodriguez_demand_2006,
title = {Demand for psychiatric emergency services and immigration. Findings in a Spanish hospital during the year 2003},
author = {Perez-Rodriguez, M Mercedes and Baca-Garcia, Enrique and Quintero-Gutierrez, Francisco J and Gonzalez, Gloria and Saiz-Gonzalez, Dolores and Botillo, Carlota and Basurte-Villamor, Ignacio and Sevilla, Juncal and Gonzalez de Rivera, Jose L},
url = {https://academic.oup.com/eurpub/article-lookup/doi/10.1093/eurpub/ckl021},
doi = {10.1093/eurpub/ckl021},
year = {2006},
date = {2006-01-01},
journal = {The European Journal of Public Health},
volume = {16},
number = {4},
pages = {383--387},
abstract = {BACKGROUND: The aim of this study is to investigate differences among immigrants and natives regarding access and pathways to psychiatric care, psychiatric admission rates, length of stay, continuity of care, and main diagnoses. METHODS: Psychiatric emergency visits (1511) and hospitalizations (410) were registered in a Spanish Hospital with a catchment area of 280 000 people (19.3% immigrants) during the year 2003. Motives for demanding emergency psychiatric care, pathways to care, admission rates, length of stay, continuity of care, and main diagnoses were compared among natives and immigrants. RESULTS: Immigrants accounted for 13.0% of consultations to the psychiatric emergency room (15.9% of patients) and 11.0% of admissions to the psychiatric hospitalization unit (13.5% of patients). The pathways to care were different for immigrants and natives. Immigrants had a lower rate of readmission to the psychiatric emergency room. Motives for consultation and hospitalization were also different among immigrants and natives. Immigrants showed more self-aggressive behaviours and neuroses, and lower rates of affective disorders and psychoses. CONCLUSIONS: Immigrants under-used psychiatric emergency and hospitalization services in comparison with natives. They did not consult because of psychoses or affective disorders, but mainly because of reactive conditions related to the stress of migration.},
keywords = {Accés Serveis de Salut, Salut, Salut Mental},
pubstate = {published},
tppubtype = {article}
}