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Effects of social security policy reforms on mental health and inequalities: A systematic review of observational studies in high-income countries

Lookup NU author(s): Julija Simpson, Dr Viviana AlbaniORCiD, Zoe Bell, Professor Clare BambraORCiD, Dr Heather BrownORCiD



This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).


Evidence increasingly shows that changes to social security policies can affect population mental health. Thus, in the context of rising burden of mental illness, it is of major importance to better understand how expansions and contractions to the social security system may impact on mental health of both adults and children. The aim of this systematic review is to provide a synthesis of observational literature on the effects on mental health and inequalities in mental health of social security reforms. We conducted a systematic review of quantitative observational studies of specific national and regional social security policy changes in high-income countries and summarised the mental health effects of these policies. We searched seven electronic databases, including Medline, PsychInfo, Embase, CINAHL, ASSIA (Proquest), Scopus and Research Papers in Economics from January 1979 to June 2020. We included both objective and subjective mental health and wellbeing measures. The study quality was assessed using the Validity Assessment tool for econometric studies. We identified 13,403 original records, thirty-eight of which were included in the final review. Twenty-one studies evaluated expansionary social security policies and seventeen studies evaluated contractionary policies. Overall, we found that policies that improve social security benefit eligibility/generosity are associated with improvements in mental health, as reported by fourteen of the included studies. Social security policies that reduce eligibility/generosity were related to worse mental health, as reported by eleven studies. Ten studies found no effect for either policies contracting or expanding welfare support. Fourteen studies also evaluated the impact on mental health inequalities and found that contractionary policies tend to increase inequalities whereas expansionary policies have the opposite effect. Changes in social security policies can have significant effects on mental health and health inequalities across different recipient groups. Such health effects should be taken into account when designing future social policy reforms.

Publication metadata

Author(s): Simpson J, Albani V, Bell Z, Bambra C, Brown H

Publication type: Article

Publication status: Published

Journal: Social Science & Medicine

Year: 2021

Volume: 272

Print publication date: 01/03/2021

Online publication date: 26/01/2021

Acceptance date: 22/01/2021

Date deposited: 22/01/2021

ISSN (print): 0277-9536

ISSN (electronic): 1873-5347

Publisher: Elsevier Ltd


DOI: 10.1016/j.socscimed.2021.113717


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