How economic crises affect alcohol consumption and alcohol-related health problems: A realist systematic review

Abstract

Economic crises are complex events that affect behavioral patterns (including alcohol consumption) via opposing mechanisms. With this realist systematic review, we aimed to investigate evidence from studies of previous or ongoing crises on which mechanisms (How?) play a role among which individuals (Whom?). Such evidence would help understand and predict the potential impact of economic crises on alcohol consumption. Medical, psychological, social, and economic databases were used to search for peer-reviewed qualitative or quantitative empirical evidence (published January 1, 1990-May 1, 2014) linking economic crises or stressors with alcohol consumption and alcohol-related health problems. We included 35 papers, based on defined selection criteria. From these papers, we extracted evidence on mechanism(s), determinant, outcome, country-level context, and individual context. We found 16 studies that reported evidence completely covering two behavioral mechanisms by which economic crises can influence alcohol consumption and alcohol-related health problems. The first mechanism suggests that psychological distress triggered by unemployment and income reductions can increase drinking problems. The second mechanism suggests that due to tighter budget constraints, less money is spent on alcoholic beverages. Across many countries, the psychological distress mechanism was observed mainly in men. The tighter budget constraints mechanism seems to play a role in all population subgroups across all countries. For the other three mechanisms (i.e., deterioration in the social situation, fear of losing one's job, and increased non-working time), empirical evidence was scarce or absent, or had small to moderate coverage. This was also the case for important influential contextual factors described in our initial theoretical framework. This realist systematic review suggests that among men (but not among women), the net impact of economic crises will be an increase in harmful drinking. Such a different net impact between men and women could potentially contribute to growing gender-related health inequalities during a crisis.

Changes in directly alcohol-attributable mortality during the great recession by employment status in Spain: a population cohort of 22 million people

“…The unfavourable changes during the crisis in DAA mortality among non-employees (ie, slowing the decrease) could be explained by particularly unfavourable changes in distribution of alcohol consumption among drinkers or drinking patterns (ie, heavy drinking prevalence) in this subgroup, which would match well with the hypothesis of excessive drinking as a coping mechanism to relieve the psychological distress caused by unemployment 5 14. However, the predominance of flows between employment categories towards non-employment during the crisis may also have contributed to the unfavourable change.…”

“…As the upward trend slowed down, it can be hypothesised that in this subgroup, favourable changes in DAA mortality were mainly due to a predominance of the effect of decreasing alcohol affordability and other factors like preventive interventions. Decreased affordability has also been invoked elsewhere to explain favourable changes in alcohol consumption (ie, drinking prevalence or frequency or per capita alcohol consumption) during recessions 5 10 14 23…”

“…The post-2008 economic crisis has aroused intense concern about its potential adverse impact on alcohol-related problems 1–3. Alcohol consumption can be affected by economic cycles through various mechanisms, such as changes in alcohol affordability (due to changes in income, taxes or fees), leisure time availability or psychological distress (due to changes in ability to cope with working conditions, expenses or debts) 4 5. Moreover, alcohol-related mortality can be influenced by economic cycles through changes in social welfare and healthcare, whose accessibility may be limited during crises, shifting the financial burden to households 6…”

Consumo de tabaco y alcohol en una muestra en proceso de desahucio

“…El segundo mecanismo propone que, debido a las limitaciones del presupuesto más estrictas, se gasta menos dinero en bebidas alcohólicas. La evidencia muestra principalmente una reducción en el volumen del consumo de alcohol y el número de bebidas en lugar de una reducción en consumo excesivo y problemático (De Goeij et al, 2015).…”

A procura pelos cuidados de urgência de saúde mental em Portugal em tempos de crise

“…Evidência da elasticidade específica da procura por serviços de saúde mental -a medida em que a procura pelos serviços de mental diminui mais ou menos do que a procura por outros cuidados de saúde -não é definitiva (Frank and McGuire, 1986, Lu et al, 2008, Keeler Emmett B. et al, 1986 (de Goeij et al, 2015).…”