Mental health and unemployment: A systematic review and meta-analysis of interventions to improve depression and anxiety outcomes

Andrew F Arena; Sophia Mobbs; Samineh Sanatkar; Douglas Williams; Daniel Collins; Marnie Harris; Samuel B Harvey; Mark Deady

doi:10.1016/j.jad.2023.05.027

Mental health and unemployment: A systematic review and meta-analysis of interventions to improve depression and anxiety outcomes

J Affect Disord. 2023 Aug 15:335:450-472. doi: 10.1016/j.jad.2023.05.027. Epub 2023 May 17.

Authors

Andrew F Arena¹, Sophia Mobbs², Samineh Sanatkar², Douglas Williams², Daniel Collins², Marnie Harris², Samuel B Harvey², Mark Deady²

Affiliations

¹ Black Dog Institute, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia. Electronic address: a.arena@blackdog.org.au.
² Black Dog Institute, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.

PMID: 37201898
DOI: 10.1016/j.jad.2023.05.027

Abstract

Background: Unemployment is associated with substantially greater depression and anxiety, constituting a considerable public health concern. The current review provides the most comprehensive synthesis to date, and first meta-analysis, of controlled intervention trials aimed at improving depression and anxiety outcomes during unemployment.

Methods: Searches were conducted within PsycInfo, Cochrane Central, PubMed and Embase from their inception to September 2022. Included studies conducted controlled trials of interventions focused on improving mental health within unemployed samples, and reported on validated measures of depression, anxiety, or distress (mixed depression and anxiety). Narrative syntheses and random effects meta-analyses were conducted among prevention- and treatment-level interventions for each outcome.

Results: A total of 39 articles reporting on 33 studies were included for review (sample sizes ranging from 21 to 1801). Both prevention and treatment interventions tended to be effective overall, with treatment interventions producing larger effect sizes than prevention interventions. The clearest evidence for particular intervention approaches emerged for prevention-level Cognitive Therapy/CBT, followed by prevention-level work-related interventions, although neither produced entirely consistent effects.

Limitations: Risk of bias was generally high across studies. Low numbers of studies within subgroups precluded any comparisons between long-term and short-term unemployment, limited comparisons among treatment studies, and reduced the power of meta-analyses.

Conclusions: Both prevention- and treatment-level mental health-focused interventions have merit for reducing symptoms of anxiety and depression among those experiencing unemployment. Cognitive Therapy/CBT and work-related interventions hold the most robust evidence base, which can inform both prevention and treatment strategies implemented by clinicians, employment services providers, and governments.

Keywords: Anxiety; Depression; Intervention; Meta-analysis; Systematic review; Unemployment.

Publication types

Meta-Analysis
Systematic Review
Review
Research Support, Non-U.S. Gov't

MeSH terms

Anxiety / prevention & control
Anxiety Disorders / therapy
Depression* / diagnosis
Depression* / prevention & control
Humans
Mental Health*
Unemployment