How do income changes impact on mental health and wellbeing for working-age adults? A systematic review and meta-analysis

Thomson, R. M. , Igelström, E. , Purba, A. K., Shimonovich, M., Thomson, H. , McCartney, G. , Reeves, A., Leyland, A. , Pearce, A. and Katikireddi, S. V. (2022) How do income changes impact on mental health and wellbeing for working-age adults? A systematic review and meta-analysis. Lancet Public Health, 7(6), e515-e528. (doi: 10.1016/S2468-2667(22)00058-5) (PMID:35660213)

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Abstract

Background: Lower incomes are associated with poorer mental health and wellbeing, but the extent to which income has a causal effect is debated. We aimed to synthesise evidence from studies measuring the impact of changes in individual and household income on mental health and wellbeing outcomes in working-age adults (aged 16–64 years). Methods: For this systematic review and meta-analysis, we searched MEDLINE, Embase, Web of Science, PsycINFO, ASSIA, EconLit, and RePEc on Feb 5, 2020, for randomised controlled trials (RCTs) and quantitative non-randomised studies. We had no date limits for our search. We included English-language studies measuring effects of individual or household income change on any mental health or wellbeing outcome. We used Cochrane risk of bias (RoB) tools. We conducted three-level random-effects meta-analyses, and explored heterogeneity using meta-regression and stratified analyses. Synthesis without meta-analysis was based on effect direction. Critical RoB studies were excluded from primary analyses. Certainty of evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE). This study is registered with PROSPERO, CRD42020168379. Findings: Of 16 521 citations screened, 136 were narratively synthesised (12·5% RCTs) and 86 meta-analysed. RoB was high: 30·1% were rated critical and 47·1% serious or high. A binary income increase lifting individuals out of poverty was associated with 0·13 SD improvement in mental health measures (95% CI 0·07 to 0·20; n=42 128; 18 studies), considerably larger than other income increases (0·01 SD improvement, 0·002 to 0·019; n=216 509, 14 studies). For wellbeing, increases out of poverty were associated with 0·38 SD improvement (0·09 to 0·66; n=101 350, 8 studies) versus 0·16 for other income increases (0·07 to 0·25; n=62 619, 11 studies). Income decreases from any source were associated with 0·21 SD worsening of mental health measures (–0·30 to –0·13; n=227 804, 11 studies). Effect sizes were larger in low-income and middle-income settings and in higher RoB studies. Heterogeneity was high (I2=79–87%). GRADE certainty was low or very low. Interpretation: Income changes probably impact mental health, particularly where they move individuals out of poverty, although effect sizes are modest and certainty low. Effects are larger for wellbeing outcomes, and potentially for income losses. To best support population mental health, welfare policies need to reach the most socioeconomically disadvantaged. Funding: Wellcome Trust, Medical Research Council, Chief Scientist Office, and European Research Council.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Katikireddi, Professor Vittal and Thomson, Dr Hilary and PURBA, Amrit and Thomson, Dr Rachel and Shimonovich, Michal and Igelström, Erik and McCartney, Professor Gerard and Leyland, Professor Alastair and Pearce, Dr Anna
Authors: Thomson, R. M., Igelström, E., Purba, A. K., Shimonovich, M., Thomson, H., McCartney, G., Reeves, A., Leyland, A., Pearce, A., and Katikireddi, S. V.
College/School:College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > MRC/CSO SPHSU
Journal Name:Lancet Public Health
Publisher:Elsevier
ISSN:2468-2667
ISSN (Online):2468-2667
Published Online:01 June 2022
Copyright Holders:Copyright © 2022 The Authors
First Published:First published in Lancet Public Health 7(6): e515-e528
Publisher Policy:Reproduced under a Creative Commons License

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
306430Predicting the impacts of universal basic income on mental health inequalities in the UK population: a microsimulation modelRachel ThomsonWellcome Trust (WELLCOTR)218105/Z/19/ZHW - MRC/CSO Social and Public Health Sciences Unit
174091Improving life chances & reducing child health inequalities: harnessing the untapped potential of existing dataAnna PearceWellcome Trust (WELLCOTR)205412/Z/16/ZHW - MRC/CSO Social and Public Health Sciences Unit
172690Understanding the impacts of welfare policy on health: A novel data linkage studySrinivasa KatikireddiOffice of the Chief Scientific Adviser (CSO)SCAF/15/02HW - Public Health
3048231Inequalities in healthAlastair LeylandMedical Research Council (MRC)MC_UU_00022/2HW - MRC/CSO Social and Public Health Sciences Unit
3048231Inequalities in healthAlastair LeylandChief Scientist Office (CSO)SPHSU17HW - MRC/CSO Social and Public Health Sciences Unit
308851HEEDSrinivasa KatikireddiEuropean Research Council (ERC)949582HW - MRC/CSO Social and Public Health Sciences Unit