The impact of national and international financial crises on mental health and well-being: a systematic review

Figures & data

Figure 1. PRISMA flowchart of study selection.

Table 1. Characteristics of the included studies.

Study information			Participant characteristics				Study characteristics		Results
Author(s) (Year)	Country	Financial crisis (Data collection period)	N (%Female)	Age in years M (SD)	Race and ethnicity	Socioeconomic status	Study Design	Mental health outcomes
Alvarez-Galvez et al. (2017)	Spain	Global Financial Crisis (1995–2006, 2007–2011, 2011–2014)	Nation-wide dataset	–	–	–	Repeated cross-sectional	Suicide rates	Suicide rates increased during the second period of economic recession (2011–2014), but not during the first period (2007–2011); unemployment and per capita GDP positively associated with suicide rates
Alvarez-Galvez et al. (2021)	Spain	Multiple periods of economic recession & austerity (1980–1991, 1992–2007, 2008–2010, 2011–2017)	Nation-wide dataset	–	–	–	Repeated cross-sectional	Suicide rates	Suicide rates did not change after the 2008 recession, but increased after the 2011 recession; unemployment positively associated with suicide rates; mixed effect of age on suicide rates
Antonakakis & Collins (2014)	Greece	Global Financial Crisis (1968–2011)	–	–	–	–	Repeated cross-sectional	Suicide rates	Suicide rates increased from 2009 to 2011; male sex, unemployment (men > women), higher age, and reductions in government expenditure (men only) positively associated with suicide rates; increased fertility rates negatively associated with suicide rates; alcohol consumption and divorce rates not associated with suicide rates
Ásgeirsdóttir et al. (2020)	Iceland	Global Financial Crisis (2002–2008, 2008–2014)	Nation-wide dataset	–	–	–	Repeated cross-sectional	Suicide rates	No significant change in suicide rates from pre- to post-crisis; among men only, higher age and being unmarried predicted higher suicide rates; sex, unemployment, GDP, and balance of trade did not predict suicide rates
Astell-Burt & Feng (2013)	United Kingdom	Global Financial Crisis (2006–2010)	1,361,216 (50%)	18.8% 16–15 yrs, 19.9% 26–35 yrs, 25.1% 36–45 yrs, 22.5% 46–55 yrs, 13.8% 56–64 yrs	90.2% White, 2.1% Indian, 1.6% other ethnic group, 1.5% Pakistani, 1.2% Black African, 0.9% Black Caribbean, 0.8% other Asian, 0.5% Bangladeshi, 0.5% Chinese, 0.8% mixed ethnicity	Education: 12.4% none, 22.9% GCSE, 23.0% A-Level, 28.8% higher education, degree, or equivalent, 12.1% other qualifications; economic status: 73.8% employed, 4.9% unemployed, 21.3% economically inactive; occupation: 33.9% managerial and professional, 17.4% intermediate, 30.2% routine and manual, 18.5% never worked and long-term unemployed	Repeated cross-sectional	Health status (depression, mental illness)	Rise in unemployment following financial crisis predicted prevalence of depression and mental illness
Avčin et al. (2011)	Slovenia	Global Financial Crisis (2009)	1592 (72%)	39.2 (9.3)	–	Education: 0.6% primary school, 6.5% vocational school, 23.4% high school, 14.3% some college, 42.8% university, 8.2% masters, 3.7% doctorate; employment: 54.4% private sector, 28.0% public sector, 88.6% permanent job position, 11.4% temporary job position; occupation: >70% employed as ‘white collar workers’	Cross-sectional	Depression, anxiety	Employees affected by the crisis reported higher levels of depression and anxiety; perceived impact of economic crisis associated with working in the private sector, lower income, having a bank loan, stock market losses, company profit reductions, increased workload, mobbing at work, and older age
Bacigalupe et al. (2016)	Spain	Global Financial Crisis (1997, 2002, 2007, 2013)	20,231 (53%)	16–64 yrs	–	Employment: men: 65.7–76.9% employed, 4.2–16.7% unemployed, 9.4–14.5% student, 7.5–10.2% retired and others; women: 34.5–57.2% employed, 5.2–13.0% unemployed, 17.4–38.7% homemaker, 9.6–13.6% student, 1.7–4.9% retired and others	Repeated cross-sectional	Mental health (depression, anxiety)	Depression and anxiety increased from 2007 to 2023; mental health worsened more among individuals aged 35–44yrs, employed men, students and unemployed individuals, manual workers, and individuals from lower classes
Barr et al. (2012)	United Kingdom	Global Financial Crisis (2000–2008)	Nation-wide dataset	–	–	–	Repeated cross-sectional	Suicide rates	Suicide rates increased above the expected trend between 2008 and 2010; unemployment associated with suicide rates among men only
Barr et al. (2015)	United Kingdom	Global Financial Crisis, consequent austerity and welfare reform (2004–2013)	2,171,741 (-)	–	–	–	Repeated cross-sectional	Mental health (depression, bad nerves, anxiety, mental illness, phobias, panics, other nervous disorders)	Prevalence of people reporting mental health problems significantly increased between 2009 and 2013, compared to previous trends; prevalence associated with lower education, unemployment, and decrease in income
Bartoll et al. (2014)	Spain	Global Financial Crisis (2006–2007, 2011–2012)	2006–2007: 12,019 (-); 2011–2012: 8355 (-)	–	–	Employment: men: 74.8% and 61.2% employed in 2006–2007 and 2011–2012, respectively; women: 52.3% and 51.1% employed in 2006–2007 and 2011–2012, respectively	Repeated cross-sectional	Mental health (depression, anxiety)	Depression and anxiety increased from pre- to post-crisis among men and decreased among women; increase in depression and anxiety higher among men aged 35–44 and 45–54yrs, lower social class, lower education, foreigners, and breadwinners
Baumbach & Gulis (2014)	Europe (Bulgaria, Czech Republic, Finland, Germany, Poland, Portugal, Slovakia, Slovenia)	Global Financial Crisis (2000–2010)	Nation-wide datasets	–	–	–	Repeated cross-sectional	Suicide rates	Suicide mortality increased in Germany (+5.3%), Portugal (+5.2%), Czech Republic (+7.6%), Slovakia (+22.7%), and Poland (+19.3%); effect of unemployment on suicide higher in countries with lower social spending
Bayliss et al. (2017)	United Kingdom	Global Financial Crisis (2004–2010)	10,260 (51%)	Pre-recession: 8% 16–24 yrs, 19% 25–34 yrs, 40% 35–49 yrs, 33% 50–59/64 yrs; post-recession: 9% 16–24 yrs, 20% 25–34 yrs, 43% 35–49 yrs, 28% 50–59/64 yrs	–	Employment: pre-recession: 66% employed; post-recession: 65% employed; education: pre-recession: 20% high, 69% intermediate, 11% none; post-recession: 21% high, 69% intermediate, 10% none; income: pre-recession: £3,605/month; post-recession: £3696/month	Repeated cross-sectional	Life satisfaction, positive psychological health	Life satisfaction remained stable from pre- to post-recession; positive psychological health declined from pre- to post-recession; positive psychological health lower in women, people in older age bands (35–49 and 50 + yrs), those that considered themselves disabled, people with lower average household income, and people who are unemployed or in unstable employment
Boyce et al. (2018)	United Kingdom	Global Financial Crisis (2006– 2007, 2009–2010)	8661 (56%)	46.4 (17.3)	–	Education: 25% none; 16% degree; 7% other higher degree; 19% A-levels; 26% O-levels; 5% other; 2% missing data; employment: 51% employed; 7% self-employed; 3% unemployed; 20% retired; 1% on maternity leave; 7% looking after family; 4% full-time student; 4% long-term sick/disabled; 1% other; 2% missing data; income: £2822 (1896)	Longitudinal	Life satisfaction	Life satisfaction decreased from pre- to post-recession; lower or middle age, unemployment, loss of income, and pre-existing sickness or disability associated with decreased life satisfaction; higher education, employment, and higher income associated with increased life satisfaction
Branas et al. (2015)	Greece	Multiple periods of austerity and prosperity (1983–2012)	Nation-wide dataset	–	–	–	Repeated cross-sectional	Suicide rates	Austerity events associated with increased suicide rates among men and women; prosperity events associated with decreased suicide rates among men only
Buffel et al. (2015)	20 countries across Europe	Global Financial Crisis (2006, 2012)	51,679 (53%)	–	–	–	Repeated cross-sectional	Depression	Overall depression decreased from 2006 to 2012; country-specific depression increased from 2006 to 2012, particularly in countries most strongly affected by the crisis (Spain, Cyprus); rate of unemployment positively associated with depression, particularly among men and middle-aged individuals (35–49yrs)
Chan et al. (2014)	South Korea	Global Financial Crisis (2003–2011)	Nation-wide dataset	–	–	–	Repeated cross-sectional	Suicide rates	Suicide rates increased from pre- to post-crisis; unemployment and working in a managerial role positively associated with suicide rates
Chang et al. (2009)	Hong Kong, Japan, Singapore, South Korea, Taiwan, Thailand	Asian Economic Crisis (1985–2006)	Nation-wide dataset	–	–	–	Repeated cross-sectional	Suicide rates	Among men/women, suicide rates rose from 1997 to 1998 by 39/23% in Japan, 44/14% in Hong Kong, 45/25% in Korea, and in Thailand (incomplete data), but not in Taiwan or Singapore; increases in unemployment partially predicted male suicide rates; middle-aged men (35–64yrs; Japan) and older adults (65 + yrs) had highest suicide rates
Chang et al. (2013)	54 countries (27 European countries, 18 American countries, 8 Asian countries, 1 African country)	Global Financial Crisis (2000–2007, 2009)	Nation-wide datasets	–	–	–	Repeated cross-sectional	Suicide rates	Suicide rates mainly increased among men in European (15–24yrs) and American (45–64yrs) countries; increase in unemployment positively associated with suicide rates, particularly in countries with low levels of unemployment before the crisis
Coope et al. (2014)	United Kingdom (England & Wales)	Global Financial Crisis (2001–2011)	Nation-wide datasets	–	–	–	Repeated cross-sectional	Suicide rates	No change in female suicide rates from pre- to post-crisis; male suicide rates increased from pre- to post-crisis; increase in unemployment rates, personal debt, house repossessions in younger men, and job loss and long-term unemployment in men aged 35–44yrs associated with increased suicide rates
Corcoran et al. (2015)	Ireland	Global Financial Crisis (2008–2012)	Nation-wide dataset	–	–	–	Repeated cross-sectional	Suicide rates, self-harm presentations	No change in female suicide rates from pre- to post-crisis; male suicide rates increased by 57% from pre- to post-crisis; male and female self-harm presentations increased by 31% and 22%, respectively; men aged 25–44yrs at highest risk for increased suicide and self-harm
Córdoba-Doña et al. (2014)	Spain	Global Financial Crisis (2003–2007, 2008–2012)	24,380 (53%)	–	–	–	Repeated cross-sectional	Suicide attempts	Suicide attempts increased from pre-to post-crisis, particularly among individuals aged 35–54yrs; unemployment rates positively associated with suicide attempts in men only
De Vogli et al. (2013)	Italy	Global Financial Crisis (2000–2010)	Nation-wide dataset	–	–	–	Repeated cross-sectional	Suicide rates and suicide attempts	Rise in suicides rates and suicide attempts increased from pre- to post-crisis
Deaton (2012)	United States of America	Global Financial Crisis (2008–2010)	Nation-wide dataset	–	–	–	Longitudinal	Self-reported well-being	Life evaluation and positive affect decreased and worry and stress increased from 2008 to 2009; measures had largely recovered by 2010
Drydakis (2015)	Greece	Global Financial Crisis (2008–2009, 2010–2013)	21,609 (52%)	39.4 (8.8)	–	Employment: 62.2% employed; education: 25.4% higher education; income: €884.83 (89.37)	Repeated cross-sectional	Depression	Mental health decreased from pre- to post-crisis; unemployment negatively associated with mental health, particularly in women
Economou et al. (2011)	Greece	Global Financial Crisis (2009, 2011)	2256 (-)	–	–	–	Repeated cross-sectional	Suicide attempts	Suicide attempts increased by 36% from 2009 to 2011; economic distress positively associated with suicide attempts
Economou et al. (2013)	Greece	Global Financial Crisis (2008, 2011)	2008: 2197 (50.9%); 2011: 2256 (51.7%)	–	–	Employment: 2008: 91.0% employed; 2011: 85.5% employed; education: 2008: 54.4% <11 yrs, 36.1% 12 yrs, 13.5% >13 yrs; 2011: 59.9% <11 yrs, 29.0% 12 yrs, 11.1% >13 yrs	Repeated cross-sectional	Major depression	Prevalence in major depression increased from 2008 to 2011; economic hardship positively associated with depression prevalence; young people, married persons, individuals with financial distress, and people who used medication were more likely to have major depression in 2011
Economou et al. (2013)	Greece	Global Financial Crisis (2009, 2011)	2009: 2192 (51%); 2011: 2256 (52%)	2009: 9.6% <24 yrs, 18.7% 25–34 yrs, 14.8% 35–44 yrs, 20.6% 45–54 yrs, 17.5% 55–64 yrs, 18.6% >65 yrs; 2011: 9.9% < 24 yrs, 18.9% 25–34 yrs, 16.3% 35–44 yrs, 18.8% 45–54 yrs, 16.3% 55–64 yrs, 19.8% >65 yrs	–	Employment: 2009: 84.4% employed; 2011: 85.5% employed; education: 2009: 49.1% <11 yrs, 37.1% 12 yrs, 13.8% >13 yrs; 2011: 59.9% <11 yrs, 29.0% 12 yrs, 11.1% >13 yrs	Repeated cross-sectional	Suicidal ideation, suicide attempts	Suicidal ideation and suicide attempts increased from 2009 to 2011, particularly among men, older people, married individuals, individuals with higher education, individuals who used psychotropic medications, individuals who had sought help from a mental health professional, individuals with major depression, and individuals with a history of suicide attempts
Economou et al. (2016a)	Greece	Global Financial Crisis (2008, 2009, 2011, 2013)	2188 (-)	–	–	–	Repeated cross-sectional	Suicidal ideation, suicide attempts	Suicidal ideation and suicidal attempts declined from 2011 to 2013; presence of major depression, previous suicide attempt, unemployment, and economic hardship increased odds of suicidal ideation; presence of major depression, previous suicide attempt, and low levels of interpersonal trust increased odds of suicide attempts
Economou et al. (2016b)	Greece	Global Financial Crisis (2008, 2009, 2011, 2013)	∼ 2100/survey (-)	–	–	–	Repeated cross-sectional	Major depression	Prevalence in major depression increased between 2008 and 2013; in 2008, 2009, and 2011, women manifested higher rates of major depression than men; in 2013, men aged 35–44yrs had higher prevalence of depression
Friedman & Thomas (2009)	Indonesia	Asian Economic Crisis (1993, 1998, 2000)	1993: 12,521 (55%); 1998: 6150 (52%); 2000: 21,399 (53%)	–	–	–	Longitudinal	Psychological distress (sadness, anxiety, sleeping difficulties, poor general health)	Psychological distress increased from pre- to post-crisis; older age, female sex, and lower education associated with higher levels of anxiety, sadness, sleeping difficulties, and poor general health; lower education associated with higher levels of sadness, sleeping difficulties, and poor general health, but higher education associated with higher levels of anxiety
Garcy and Vågerö (2012)	Sweden	Swedish Economic Recession (1997–2002)	3,392,169 (-)	–	–	–	Repeated cross-sectional	Suicide rates	Unemployment due to the crisis associated with increased suicide rates among men
Garcy and Vagerö (2013)	Sweden	Swedish Economic Recession (1993–1996, 1997–2002)	3,424,550 (48%)	–	–	Education: 30.7% of men and 37.8% of women ≤2yrs secondary upper school	Repeated cross-sectional	Suicide rates	Suicide rates increased from pre- to post-recession (but not during) in unemployed men
Gili et al. (2013)	Spain	Global Financial Crisis (2006–2007, 2010–2011)	13,816 (61.3%)	48.4 (15.1)	–	–	Repeated cross-sectional	Mental disorders (mood, anxiety, somatoform symptoms, alcohol-related disorders, eating disorders)	Prevalence in all mental disorders, apart from eating disorders, increased from pre- to post-crisis; unemployment, mortgage repayment difficulties, and evictions predicted risk of mental disorders
Hagquist (1998)	Sweden	Swedish Economic Recession (1980–1996)	1,166,164 (49%)	–	–	–	Repeated cross-sectional	Suicide rates	Suicide rate decreased between 1980 and 1996, as well as during and following the recession; suicide risk higher among those who had ever received social allowance
Halvorsen (2016)	Greece, Portugal, Ireland, Spain	Global Financial Crisis (2002–2014)	Nation-wide datasets	–	–	–	Repeated cross-sectional	Life satisfaction	Life satisfaction decreased in all countries, apart from Portugal, from pre- to post-crisis; Ireland had strongest decline in life satisfaction; lack of political trust (Greece), poor health (Ireland), and unemployment (Portugal, Spain) associated with lower life satisfaction
Harper & Bruckner (2017)	United States of America	Global Financial Crisis (1999–2013)	Nation-wide dataset	–	–	–	Repeated cross-sectional	Suicide rates	The crisis did not have an added impact on suicide rates
Hauksdóttir et al. (2013)	Iceland	Global Financial Crisis (2007, 2009)	3755 (53%)	52.3 (16.0)	–	Education: 47.1% basic, 27.1% middle, 25.9% University degree; employment: 75.6% employed, 4.0% unemployed, 14.1% student, 18.2% homemaker/on parental leave, 8.1% disabled, 21.5% retired; occupation: 22.9% executive, 39.1% skilled, 20.3% nonskilled, 17.7% not engaged in paid work; income: 20.6% low (≤3.4 million IKr), 61.4% middle (3.5–9.4 million IKr), 18.0% high (≥9.5 million IKr)	Longitudinal	Perceived stress	Stress increased from pre-to post-crisis among women only, particularly among unemployed women, students, women with middle level education, and women in the middle-income bracket
Hintikka et al. (1999)	Finland	Finnish Economic Recession (1985–1995)	Nation-wide dataset	–	–	–	Repeated cross-sectional	Suicide rates	Male and female suicide rates decreased from pre- to post-recession; mean alcohol consumption (men) and GDP (men and women) positively associated with suicide rates; no effect of unemployment or divorce rate on suicide rates
Iglesias García et al. (2014)	Spain	Global Financial Crisis (2000–2010)	1,078,406 (52%)	–	–	–	Repeated cross-sectional	Mental health services demand	Demand for mental health services decreased from 2000 to 2010; unemployment rate negatively associated with demand; CPI and GDP not associated with demand
Iglesias-García et al. (2017)	Spain	Global Financial Crisis (1999–2013)	Nation-wide dataset	–	–	–	Repeated cross-sectional	Suicide rates	Suicide rates did not increase from pre- to post-crisis; unemployment was not associated with suicide rates during or post-crisis
Jenkins et al. (2023)	United States of America	Global Financial Crisis (2004–2011)	Pre-recession cohort: 587 (53%); post-recession cohort: 351 (52%)	Pre-recession cohort: 52.6 (10.0); post-recession cohort: 51.8 (10.3)	91% White, 4% Hispanic, 3% Black, 1% Native American or Alaska Native Aleutian Islander/Eskimo, <1% Asian, 3% other or unspecified	Education: pre-recession cohort: 7.84yrs (2.26), post-recession cohort: 8.18yrs (2.30); employment: pre-recession cohort: 57.17% employed, post-recession cohort: 59.53% employed; income: pre-recession cohort: $91,614.01 (63,255.98), post-recession cohort: $105,981.59 (65,068.43)	Repeated cross-sectional	Positive and negative affect	Post-recession cohort reported higher negative affect and lower positive affect relative to the pre-recession cohort; lower financial well-being associated with greater negative affect among pre-recession cohort only
Katikireddi et al (2012)	United Kingdom (England)	Global Financial Crisis (1991–2010)	106,985 (>50%)	25–64 yrs	–	–	Repeated cross-sectional	Mental health (anxiety, depression)	Mental health decreased from pre- to post-crisis among men only; employment status not associated with changes in mental health
Khang et al. (2005)	South Korea	South Korean Financial Crisis (1990–2002)	Nation-wide dataset	–	–	–	Repeated cross-sectional	Suicide rates	Suicide rates increased from pre- to post-crisis, particularly among men
Kim (2021)	South Korea	Periods of economic recession (1993–2017)	Nation-wide dataset	–	–	–	Repeated cross-sectional	Suicide rates	Suicide rates increased during the 1997 and 2008 financial crises, particularly among those in managerial positions
Kim et al. (2004)	South Korea	South Korean Financial Crisis (1995–1999)	Nation-wide dataset	–	–	–	Repeated cross-sectional	Suicide rates	Suicide rates increased from pre- to during the crisis and then decreased post-crisis to pre-crisis levels
Konieczna et al. (2022)	Denmark	Global Financial Crisis (2001–2008; 2009–2016)	Nation-wide dataset	–	–	–	Repeated cross-sectional	Suicide rates	Suicide rates increased among men but decreased among women from pre- to post-crisis; unemployment rates positively associated with suicide rates
Konstantakopoulos et al. (2019)	Greece	Global Financial Crisis (2008–2013)	1,865 (66–72%)	43.9–46.4 (-)	–	Education: 10.9–11.4yrs	Repeated cross-sectional	Suicide attempts, mental disorders	Mental disorders increased from pre-to post-crisis; changes in rates of suicide attempts were not statistically significant
Kronenberg & Boehnke (2019)	United Kingdom (England, Wales, Scotland)	Global Financial Crisis (2011–2012)	21,981 (54%)	–	93% White	–	Repeated cross-sectional	Work-related common mental distress	Increased workload and changes in nonfinancial benefits of work due to the financial crisis positively associated with mental distress
Kubrin et al. (2022)	Greece	Greek Debt Crisis (1995–2015)	–	–	–	–	Repeated cross-sectional	Suicide rates	Austerity policies associated with increased suicide rates, particularly among men
Laliotis et al. (2016)	Greece	Global Financial Crisis (2001–2008, 2008–2013)	Nation-wide dataset	–	–	–	Repeated cross-sectional	Suicide rates, mental health	Suicide rates and mental health problems increased from pre- to post-crisis
Lee et al. (2010)	Hong Kong	Global Financial Crisis (2007, 2009)	2007: 3016 (53%); 2009: 2011 (53%)	–	–	Income: 2007: 47.9% $10,000–$29,999 per month; 2009: 46.6% $10,000–$29,999 per month	Repeated cross-sectional	Major Depressive Episodes (MDEs)	MDE prevalence increased from pre- to post-crisis among men and women, individuals aged 55–65yrs, those with only a secondary education level, married/cohabiting individuals, divorced/widowed individuals, employed, homemaking, individuals in the lowest and high-middle income groups, and those who experienced large investment loss
Bonnie Lee et al. (2017)	Taiwan	Global Financial Crisis (2007–2012)	11.6 million (47%)	24–59yrs	–	–	Longitudinal	Hospitalisation due to depressive illnesses	Hospitalisations increased from pre- to post-crisis, particularly among women and individuals on a low income
Lindström and Giordano (2016)	United Kingdom	Global Financial Crisis (2007–2009)	11,743 (55%)	29.1% 16–34 yrs, 19.7% 35–44 yrs, 16.9% 45–54 yrs, 15.2% 55–64 yrs, 19.1% ≥65 yrs	–	Education: 22.4% undergraduate or higher, 20.5% year 13, 31.2% year 11, 25.9% none; employment: 58.7% employed, 5.9% full-time student, 21.4% retired, 14.0% unemployed	Longitudinal	Psychological well-being	Psychological well-being decreased from pre- to post-crisis, particularly among women, unmarried individuals, individuals with poor self-reported health, unemployed, and those whose financial situation worsened due to the crisis; being better off financially, lower level of education, and older age protected against worse psychological well-being
Lopez Bernal et al. (2013)	Spain	Global Financial Crisis (2005–2008, 2008–2010)	45.7 million (51%)	–	–	–	Repeated cross-sectional	Suicide rates	Suicide rates increased from pre- to post-crisis, particularly among men, individuals living in the Mediterranean and Northern areas, and those of working age
López-Contreras et al. (2019)	Spain	Global Financial Crisis (2006–2008, 2009–2012, 2013–2016)	1,178 (31%)	≥25 yrs	–	–	Repeated cross-sectional	Suicide rates	Suicide rates decreased from pre- to post-crisis
Madianos et al. (2011)	Greece	Global Financial Crisis (2008, 2009)	2008: 2,197 (51%); 2009: 2192 (51%)	2008: men: 38.9 (1.5), women: 37.4 (1.7); 2009: men: 37.8 (1.6), women: 37.0 (1.5)	–	Education: 2008: 13.5% > 13 yrs; 2009: 13.8% > 13 yrs	Repeated cross-sectional	Major Depressive Episodes (MDEs)	MDE prevalence increased from pre- to post-crisis; individuals experiencing economic hardship most at risk for MDEs
Mattei et al. (2014)	Italy	Global Financial Crisis (2000–2010)	–	–	–	–	Ecological	Suicide rates	Suicide rate did not change from pre- to mid-crisis; male completed and attempted suicides significantly associated with unemployment rate and GDP
McInerney et al. (2013)	United States of America	Global Financial Crisis (2006, 2008)	10,020 (57%)	>50 yrs	16% Black, 10% Hispanic, 4% other	–	Longitudinal	Mental health status and behaviours	Depression and use of antidepressants increased from pre- to post-crisis, particularly among respondents with prior high levels of stock holdings
McLaughlin et al. (2012)	United States of America	Global Financial Crisis (2008, 2010)	1,547 (53%)	65% <52 yrs; 35% ≥52 yrs	8% White, 87.6% Black	Education: 15.3% <12 yrs, 42.9% high school diploma, 41.8% college; income: 55.3% <US$35000/yr, 44.7% ≥US$35000/yr; employment: 25.9% unemployed and seeking for employment	Longitudinal	Depression, anxiety, post-traumatic stress	Exposure to foreclosure during wave 1 of the crisis (2008) associated with an increased rate of symptoms of depression and anxiety at wave 2 (2010)
Mertens & Beblo (2016)	United Kingdom, Germany	Global Financial Crisis (1996–2010)	Nation-wide datasets	–	–	–	Longitudinal	Life satisfaction	Life satisfaction decreased from pre- to post-crisis
Merzagora et al. (2016)	Italy	Global Financial Crisis (2002–2007, 2008–2013)	–	–	–	–	Repeated cross-sectional	Suicide rates	Suicide rates did not change from pre- to post-crisis; physical or psychological disease increased suicide risk; lower age and married status decreased suicide risk; sex, urban context, and employment status not associated with suicide risk
Milner et al. (2014)	Australia	Global Financial Crisis (2001–2010)	Nation-wide dataset	–	–	–	Repeated cross-sectional	Suicide rates	Suicide rates increased from pre- to post-crisis, particularly among employed men and economically inactive/unemployed men and women
Milner et al. (2015)	Australia	Global Financial Crisis (2001–2006, 2007, 2008, 2009)	20.1 million (63%)	–	–	–	Repeated cross-sectional	Suicide rates	Suicide rates increased from pre- to post-crisis, particularly among unskilled, technical, and trade workers
Mohseni-Cheraghlou (2016)	Multi-country	Various financial/banking crises (1981–2007)	Nation-wide datasets	–	–	–	Repeated cross-sectional	Suicide rates	Suicide rates increased in time of financial crises; women, individuals in middle-income countries, and East-Asian economies were more susceptible to increased suicide rates; higher rates of recession associated with worse suicide rates
Mylona et al. (2014)	Greece	Global Financial Crisis (2006, 2011)	6136 (56%)	59.1% >45 yrs	–	–	Repeated cross-sectional	Depressive symptoms	Depressive symptoms increased from pre- to post-crisis, particularly among those on lower income, those with lower education, those with chronic disease, unemployed individuals, women, and those who were widowed/divorced
Neocleous & Apostolou (2021)	Cyprus	Global Financial Crisis (-)	205 (64%)	Women: 34.2 (7.9); men: 37.4 (9.3)	–	Profession: 41.9 % social workers, 17.6% psychologists, 8.3% sociologists, 32.2% other profession; education: 54.0% university degree, 32.6% post-graduate degree, 13.4% high school diploma	Mixed method	Concerns related to, and psychological impact of, financial crisis	Social service professionals reported concerns related to the crisis and impact of the crisis on their psychological health; those with higher education reported less impact of the crisis
Neumayer (2004)	Germany	Various recession periods (1980–2000)	Nation-wide dataset	–	–	–	Repeated cross-sectional	Suicide rates	Suicide rates decreased during periods of recession
Norström and Grönqvist (2015)	Multi-country	Global Financial Crisis (1960–2012)	Nation-wide datasets	20–64 yrs	–	–	Repeated cross-sectional	Suicide rates	Suicide rates increased from pre- to post-crisis; unemployment associated with male suicides, particularly in welfare state regimes with least generous unemployment protection; male suicides consistent across all welfare regimes, expect for Scandinavia; unemployment associated with female suicides in East European countries only
Ostamo & Lönnqvist (2001)	Finland	Finnish Economic Recession (1989–1997)	Nation-wide dataset	–	–	–	Repeated cross-sectional	Suicide attempts	Overall suicide attempts did not change from pre- to post-crisis and decreased among men, particularly those aged 15–34 yrs
Paleologou et al. (2018)	Greece	Greek Debt Crisis (2013–2014)	2150 (-)	Adolescents	–	–	Cross-sectional	Mental health problems	One in ten adolescents scored above the cut-off point for mental health concerns, particularly those that reported not having enough food in their house in the previous month due to the crisis
Parker et al. (2016)	Australia	Global Financial Crisis (-)	38,017 (-)	–	–	–	Cohort	Subjective well-being	The crisis had a negative effect on well-being
Pfoertner et al. (2014)	Multi-country	Global Financial Crisis (2005–2006, 2009–2010)	2005–2006: 164,623 (-); 2009–2010: 168,284 (-)	–	–	–	Repeated cross-sectional	Psychological health complaints	Risks of psychological health complaints were higher in older, medium- and low-affluent, and female students and in countries with higher absolute youth unemployment rates; change rate in youth unemployment not related to psychological health complaints (apart from in Ireland and Portugal)
Pompili et al. (2014)	Italy	Global Financial Crisis (1980–2010)	Nation-wide dataset	–	–	–	Repeated cross-sectional	Suicide rates	Suicide rates increased from pre- to post-crisis, particularly among men aged 25–64 yrs; female suicide rates decreased from pre- to post-crisis
Rachiotis et al. (2015)	Greece	Global Financial Crisis (2003–2010, 2011–2012)	Nation-wide dataset	–	–	–	Repeated cross-sectional	Suicide rates	Suicide rates increased after the introduction of austerity measures in 2010, particularly among men aged 20–59 yrs; unemployment positively associated with suicide rates
Rahmqvist & Carstensen (1998)	Sweden	Swedish Economic Recession (1989–1995)	6562 (52%)	20–39 yrs	–	Employment status: women 20-29yrs: 1989: 74.0%, 1991: 65.5%, 1993: 56.0%, 1995: 56.8%; women 30-39yrs: 1989: 85.8%, 1991: 80.6%, 1993: 75.3%, 1995: 76.7%; men 20-29yrs: 1989: 84.8%, 1991: 77.6%, 1993: 58.0%, 1995: 70.0%; men 30-39yrs: 1989: 95.5%, 1991: 93.3%, 1993: 84.7%, 1995: 85.6%	Repeated cross-sectional	Psychological distress (anxiety, anguish, depression, sleeplessness)	Psychological distress increased from pre- to post-recession across all genders and age groups (highest in older men); increase in psychological distress remained significant after controlling for unemployment (except for among women aged 30–39yrs); unemployed group reported higher psychological distress over the study period than employed group
Reeves et al. (2012)	United States of America	Global Financial Crisis (1999–2010)	308,745,538 (-)	–	–	–	Repeated cross-sectional	Suicide rates	Suicide rates increased from pre- to post-crisis; unemployment positively associated with suicide rates
Reeves et al. (2015)	Europe	Global Financial Crisis (1981–2011)	Nation-wide datasets	–	–	–	Repeated cross-sectional	Suicide rates	Suicide rates increased from pre- to post-crisis; unemployment and indebtedness positively associated with male suicide rates
Reeves et al. (2014)	Europe, Canada	Global Financial Crisis (2007, 2008–2010 [Europe]/2008–2009 [Canada])	Nation-wide datasets	–	–	–	Repeated cross-sectional	Suicide rates	Suicide rates increased from pre- to post-crisis, particularly among men (accelerating rate of previous increase in suicides: USA and Poland; increase from stable trends: Canada; reversal of downward suicide trends: Bulgaria, Czech Republic, Estonia, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Latvia, Lithuania, The Netherlands, Portugal, Poland, Romania, Slovenia, Spain, and United Kingdom; no significant change: Austria and Sweden)
Reibling et al. (2017)	Europe	Global Financial Crisis (2006–2014)	Nation-wide datasets	–	–	–	Repeated cross-sectional	Depressive symptoms	Depressive symptoms decreased from pre- to post-crisis, except for in Cyprus and Spain
Rihmer et al. (2013)	Hungary	Periods of economic recession & austerity (1929–2011)	Nation-wide dataset	–	–	–	Repeated cross-sectional	Suicide rates	Suicide rates decreased until 2006 and then remained steady from 2006 to 2011
Riumallo-Herl et al. (2014)	United States of America, Europe	Global Financial Crisis (2004–2010)	15,055 (-)	50–64 yrs	–	–	Longitudinal	Depressive symptoms	Depressive symptoms increased in the US sample from 2004 to 2006 and then decreased, no change in depressive symptoms observed in Europe; job loss positively associated with depressive symptoms; workers who were poorer before the recession experienced larger increase in depressive symptoms in US sample only
Isabel et al. (2017)	Spain	Global Financial Crisis (2002–2012)	Nation-wide dataset	–	–	–	Repeated cross-sectional	Suicide rates	Decrease in overall suicide rate reversed in 2008–2009 and 2012; suicide rates higher in men
Sánchez-Recio et al. (2021)	Spain	Global Financial Crisis (2006–2017)	32,105 (47%)	42.3 (10.7)	–	–	Repeated cross-sectional	Self-rated health, work-related stress, job satisfaction, perceived social support	No change in self-rated health, work-related stress, job satisfaction, or perceived social support from pre- to post-crisis
Sargent-Cox et al. (2011)	Australia	Global Financial Crisis (2005–2006, 2009–2010)	1973 (48%)	66.6 (1.5)	–	Employment: 80.5% retired, 4.3% employed full-time, 12.2% employed part-time, 0.9% unemployed	Longitudinal	Psychological functioning (number of depression and anxiety symptoms)	Psychological functioning decreased from pre- to post-crisis, particularly among individuals who reported an impact as a result of the economic slowdown
Saurina et al. (2015)	Spain	Global Financial Crisis (2000–2011)	Nation-wide dataset	–	–	–	Repeated cross-sectional	Suicide rates	Suicide rates increased from pre- to post-crisis among working-aged women (16–64yrs) living in municipalities with 10,000 or more inhabitants; employment not associated with suicide rates
Saville (2021)	United Kingdom (Wales)	Global Financial Crisis (2004–2006, 2003–2015)	180,462 (-)	–	–	–	Repeated cross-sectional	Depression	Depression rates increased from pre- to post-crisis; trust but not sense of belonging was a protective factor against depression
Shi et al. (2011)	Australia	Global Financial Crisis (2002–2009	38,979 (-)	–	–	–	Repeated cross-sectional	Anxiety, stress, depression, suicidal ideation, psychological distress	Anxiety increased among part-time workers and decreased among full-time workers, stress and psychological distress decreased, and depression and suicidal ideation remained stable from pre- to post-crisis
Snorradóttir et al. (2013)	Iceland	Global Financial Crisis (2009)	1880 (74%)	16.1% 20–29 yrs, 27.1% 30–39 yrs, 26.4% 40–49 yrs, 22.9% 50–59 yrs, 7.2% ≥60 yrs	–	Education: 17.0% primary, 29.8% secondary, 44.4% university degree, 8.4% other; occupation: 11.1% cashiers/clerks, 12.9% office and administrative support, 23.9% customer service representatives, 8.3% computer specialists, 26.1% specialists, 11.6% managers, 4.4% other	Cross-sectional	Psychological distress (depression, anxiety, sleep disturbances, being overly concerned, feeling exhausted)	Downsizing, salary reduction, being transferred to another department, and being assigned new tasks due to financial crisis positively associated with psychological distress; psychological distress higher among households with more children, women, customer service representatives, specialists, and managers; support from friends or family negatively associated with psychological distress; education, age, and marital status not significantly associated with psychological distress
Stuckler et al. (2011)	Europe (Austria, Finland, Greece, Ireland, The Netherlands, United Kingdom, Czech Republic, Hungary, Lithuania, Romania)	Global Financial Crisis (2000–2009)	Nation-wide dataset	–	–	–	Repeated cross-sectional	Suicide rates	Countries most impacted by the crisis (e.g. Greece, Ireland) had greatest rises in suicide rates (17% and 13%, respectively)
Swift et al. (2020)	United States of America	Global Financial Crisis (2005–2010)	5,157 (52%)	45.5 (3.5)	38.9% Black	–	Repeated cross-sectional	Depressive symptoms, alcohol use, drug use	Negative shocks to financial well-being and unemployment associated with greater depressive symptomatology and decreased alcohol consumption
Thomson et al. (2018)	United Kingdom (England)	Global Financial Crisis (1991–2014)	Nation-wide dataset	–	–	–	Repeated cross-sectional	Anxiety, depression	Anxiety and depression increased from pre- to post-crisis among men, but recovered to pre-crisis levels after 2010; anxiety and depression increased from 2008 to 2012 among women following the onset of austerity
Thomson & Katikireddi (2018)	United Kingdom	Global Financial Crisis (1991–2014)	200,326 (55%)	–	–	–	Repeated cross-sectional	Anxiety, depression	Anxiety and depression increased from pre- to post-recession in men of younger and older working age before returning to baseline during austerity
Toffolutti & Suhrcke (2014)	23 countries across the European Union	Global Financial Crisis (2000–2010)	–	–	–	–	Repeated cross-sectional	Suicide rates	An increase in the standardised unemployment rate was associated with an increase in suicide rate, particularly in countries with low social protection
Urbanos-Garrido and Lopez-Valcarcel (2015)	Spain	Global Financial Crisis (2006, 2011–2012)	2006: 15,324 (52%); 2011–2012: 10,855 (46%)	2006: 40.5 (10.9); 2011–2012: 42.0 (10.8)	–	–	Repeated cross-sectional	Mental health problems	Prevalence of mental health concerns decreased from pre- to post-crisis; long-term unemployment increased the probability of showing mental health risk by 10.4% before the crisis, compared to 16.0% during 2011–2012
Viinamäki et al. (2000)	Finland	Finnish Economic Recession (1993, 1994, 1995)	Approximately 1800 participants each year	Men: 43.3–43.9 (14.9–14.6); women: 44.0–44.9 (15.4–14.8)	–	–	Repeated cross-sectional	Mental disorders	Among men, mental disorders increased from 1993 to 1994, and decreased in 1995; among women, mental disorders increased from 1993 to 1995; problems with partner, uncertain future orientation, poor physical health, and use of psychoactive drugs (men only) associated with mental disorders marital status, age, and education not associated with mental disorders
Wang et al. (2010)	Canada	Global Financial Crisis (2008–2009)	3,579 (46%)	25-34; 35-44; 45-54; 55-65yrs	–	Education: 35.6% university, 59.4% college/high school, 5.0% <high school; income: 10.4% <$30,000, 34.1% $30-59,999, 21.7% $60-70,999, 33.8% >$80,000; employment: 83.4% full-time, 12.3% part-time, 4.3% other	Longitudinal	Mental disorders	Prevalence of major depressive disorder increased from pre- to post-crisis; no change in social phobia, panic disorder, or generalized anxiety disorder from pre- to post-crisis
Wilkinson (2016)	United States of America	Global Financial Crisis (2006, 2010)	5,366 (-)		–	2006: 39.0% employed, 1.1% unemployed, 60.0% retired; 2010: 26.6% employed, 1.8% unemployed, 66.6% retired	Repeated cross-sectional	Anxiety, depression	No change in anxiety and depression from pre- to post-crisis; greater financial strain, being unmarried, and greater negative social support predicted levels of anxiety; greater financial strain, being unmarried, lower positive social support, and greater negative social support predicted levels of depression; no effect of age on mental health
Yilmazer et al. (2015)	United States of America	Global Financial Crisis (2007, 2009, 2011)	4007 (22%)	53.5 (-)	0.09% African American, 0.08% Hispanic	–	Longitudinal	Psychological distress, rates of clinical depression	Psychological distress increased from pre- to post-crisis, but levelled off in 2011; decline in housing wealth associated with an increase in psychological distress; homeowners who had difficulties with mortgage payments reported 20% increases in psychological distress and had 3.86% higher rates of depression

CPI: consumer price index; GDP: gross domestic product. Countries: Australia (n = 5), Canada (n = 1), Cyprus (n = 1), Denmark (n = 1), Finland (n = 3), Germany (n = 1), Greece (n = 15), Hong Kong (n = 1), Hungary (n = 1), Iceland (n = 3), Indonesia (n = 1), Ireland (n = 1), Italy (n = 4), Slovenia (n = 1), South Korea (n = 4), Spain (n = 14), Sweden (n = 4), Taiwan (n = 1), the United Kingdom (n = 12), the United States (n = 9), multiple countries (n = 15).

Table 2. Quality assessment of quantitative non-randomised studies using the mixed Methods Appraisal Tool (MMAT).

Author(s) (Year)	Screening Questions		Domains					Total Score	Overall Quality Appraisal
	Clear Research Objectives	Data Addressing Research Objectives	Participants	Measurements	Outcome Data	Confounders	Exposure
Alvarez-Galvez et al. (2017)	+	+	+	+	+	+	+	7	High
Alvarez-Galvez et al. (2021)	+	+	+	+	+	+	+	7	High
Antonakakis & Collins (2014)	+	+	+	+	+	+	+	7	High
Ásgeirsdóttir et al. (2020)	+	+	+	+	+	+	+	7	High
Astell-Burt & Feng (2013)	+	+	+	+	+	+	+	7	High
Avčin et al. (2011)	+	+	–	–	+	+	+	5	Medium
Bacigalupe et al. (2016)	+	+	+	–	+	+	+	6	High
Barr et al. (2012)	+	+	+	–	+	+	+	6	High
Barr et al. (2015)	+	+	+	–	+	+	+	6	High
Bartoll et al. (2014)	+	+	+	+	+	+	+	7	High
Baumbach & Gulis (2014)	+	+	+	+	+	–	+	6	High
Bayliss et al. (2017)	+	+	+	+	+	+	+	7	High
Boyce et al. (2018)	+	+	+	+	+	+	+	7	High
Branas et al. (2015)	+	+	+	+	+	–	+	6	High
Buffel et al. (2015)	+	+	+	+	+	+	+	7	High
Chan et al. (2014)	+	+	+	+	+	+	+	7	High
Chang et al. (2009)	+	+	?	+	+	+	+	6	High
Chang et al. (2013)	+	+	+	+	+	+	+	7	High
Coope et al. (2014)	+	+	?	+	+	+	+	6	High
Corcoran et al. (2015)	+	+	?	+	+	+	+	6	High
Córdoba-Doña et al. (2014)	+	+	+	+	+	+	+	7	High
De Vogli et al. (2013)	+	+	?	+	+	–	+	5	Medium
Economou et al. (2013)	+	+	+	+	+	+	+	7	High
Economou et al. (2013)	+	+	+	+	+	+	+	7	High
Economou et al. (2016a)	+	+	–	+	?	–	+	4	Medium
Economou et al. (2016b)	+	+	?	+	?	+	+	5	Medium
Friedman & Thomas (2009)	+	+	+	+	–	+	+	6	High
Garcy & Vågerö (2012)	+	+	+	+	–	+	+	6	High
Garcy and Vagerö (2013)	+	+	+	+	+	+	+	7	High
Gili et al. (2013)	+	+	+	+	+	+	+	7	High
Hagquist (1998)	+	+	+	+	–	+	+	6	High
Halvorsen (2016)	+	+	+	–	+	+	+	6	High
Harper & Bruckner (2017)	+	+	+	+	+	+	+	7	High
Hintikka et al. (1999)	+	+	+	+	+	+	+	7	High
Iglesias García et al. (2014)	+	+	+	+	?	–	+	5	Medium
Iglesias-García et al. (2017)	+	+	+	+	+	+	+	7	High
Jenkins et al. (2023)	+	+	+	+	+	+	+	7	High
Katikireddi et al. (2012)	+	+	+	+	–	+	+	6	High
Khang et al. (2005)	+	+	+	+	+	–	+	6	High
Kim (2021)	+	+	+	+	+	–	+	6	High
Kim et al. (2004)	+	+	+	+	+	–	+	6	High
Konieczna et al. (2022)	+	+	+	+	+	+	+	7	High
Konstantakopoulos et al. (2019)	+	+	+	+	+	–	+	6	High
Kronenberg & Boehnke (2019)	+	+	+	+	–	+	+	6	High
Kubrin et al. (2022)	+	+	+	+	–	+	+	6	High
Laliotis et al. (2016)	+	+	+	+	+	+	+	7	High
Bonnie Lee et al. (2017)	+	+	+	+	+	+	+	7	High
Lindström & Giordano (2016)	+	+	+	+	+	+	+	7	High
Lopez Bernal et al. (2013)	+	+	+	+	–	+	+	6	High
López-Contreras et al. (2019)	+	+	+	+	–	+	+	6	High
Mattei et al. (2014)	+	+	+	+	+	–	+	6	High
McInerney et al. (2013)	+	+	+	+	+	+	+	7	High
Mertens & Beblo (2016)	+	+	+	–	–	+	+	5	Medium
Merzagora et al. (2016)	+	+	–	+	+	+	+	6	High
Milner et al. (2014)	+	+	+	+	+	+	+	7	High
Milner et al. (2015)	+	+	+	+	+	+	+	7	High
Mohseni-Cheraghlou (2016)	+	+	+	+	?	+	+	6	High
Mylona et al. (2014)	+	+	+	–	+	+	+	6	High
Neocleous & Apostolou (2021)	+	+	?	–	+	+	+	5	Medium
Neumayer (2004)	+	+	–	+	+	+	+	6	High
Norström and Grönqvist (2015)	+	+	+	+	+	+	+	7	High
Paleologou et al. (2018)	+	+	?	+	+	+	?	5	Medium
Parker et al. (2016)	+	+	+	+	+	+	+	7	High
Pfoertner et al. (2014)	+	+	+	+	+	–	+	6	High
Pompili et al. (2014)	+	+	+	+	+	+	+	7	High
Rachiotis et al. (2015)	+	+	+	+	+	+	+	7	High
Rahmqvist & Carstensen (1998)	+	+	–	–	+	+	+	5	Medium
Reeves et al. (2012)	+	+	+	+	+	?	+	6	High
Reeves et al. (2015)	+	+	?	+	+	+	+	6	High
Reeves et al. (2014)	+	+	+	+	+	?	+	6	High
Rihmer et al. (2013)	+	+	+	+	+	?	+	6	High
Reibling et al. (2017)	+	+	+	+	+	+	+	7	High
Riumallo-Herl et al. (2014)	+	+	+	+	+	+	+	7	High
Isabel et al. (2017)	+	+	+	+	+	+	+	7	High
Sánchez-Recio et al. (2021)	+	+	+	+	+	+	+	7	High
Sargent-Cox et al. (2011)	+	+	+	+	+	+	+	7	High
Saurina et al. (2015)	+	+	+	+	+	+	+	7	High
Saville (2021)	+	+	+	+	+	+	+	7	High
Snorradóttir et al. (2013)	+	+	+	–	+	+	+	6	High
Swift et al. (2020)	+	+	–	+	+	+	+	6	High
Thomson et al. (2018)	+	+	+	+	+	+	+	7	High
Toffolutti & Suhrcke (2014)	+	+	+	+	+	+	+	7	High
Urbanos-Garrido and Lopez-Valcarcel (2015)	+	+	+	+	+	+	+	7	High
Viinamäki et al. (2000)	+	+	+	+	+	+	+	7	High
Wilkinson (2016)	+	+	+	+	+	+	+	7	High
Yilmazer et al. (2015)	+	+	+	+	+	+	+	7	High

‘+’ = yes, ‘–’ = no, ‘?’ = cannot tell. An overall quality appraisal score was calculated for the purposes of this review as follows: 6–7+ = high; 3–5+ = medium; < 3+ = low.

Table 3. Quality Assessment of quantitative descriptive studies using the mixed Methods Appraisal Tool (MMAT).

Author(s) (Year)	Screening Questions		Domains					Total Score	Overall Quality Appraisal
	Clear Research Objectives	Data Addressing Research Objectives	Sampling Strategy	Population	Measurements	Non-Response Bias	Statistical Analysis
Deaton (2012)	+	+	?	?	?	?	+	3	Medium
Economou et al. (2011)	+	+	+	?	+	?	–	4	Medium
Hauksdóttir et al. (2013)	+	+	+	+	+	+	+	7	High
Lee et al. (2010)	+	+	+	+	+	?	+	6	High
Madianos et al. (2011)	+	+	+	+	+	+	+	7	High
McLaughlin et al. (2012)	+	+	+	+	+	?	+	6	High
Ostamo & Lönnqvist (2001)	+	+	+	+	+	?	+	6	High
Stuckler et al. (2011)	+	+	+	+	+	+	–	6	High
Thomson & Katikireddi (2018)	+	+	+	+	+	+	+	7	High
Shi et al. (2011)	+	+	+	+	+	+	+	7	High
Wang et al. (2010)	+	+	+	+	+	–	+	6	High

‘+’ = yes, ‘–’ = no, ‘?’ = cannot tell. An overall quality appraisal score was calculated for the purposes of this review as follows: 6–7+ = high; 3–5+ = medium; <3+ = low.

Table 4. Quality assessment of mixed methods studies using the mixed Methods Appraisal Tool (MMAT).

Author(s) (Year)	Screening Questions		Domains					Total Score	Overall Quality Appraisal
	Clear Research Objectives	Data Addressing Research Objectives	Rationale	Integration	Interpretation	Divergences	Quality Criteria
Drydakis (2015)	+	+	+	+	+	+	+	7	High

‘+’ = yes, ‘–’ = no, ‘?’ = cannot tell. An overall quality appraisal score was calculated for the purposes of this review as follows: 6–7+ = high; 3–5+ = medium; <3+ = low.

Figure 2. ASPIRE: Principles and stakeholder actions to prevent adverse consequences of financial crises on mental health and well-being outcomes.

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