Effectiveness of community interventions for protecting and promoting the mental health of working-age adults experiencing financial uncertainty: a systematic review.

BACKGROUND: The COVID-19 pandemic has created a period of global economic uncertainty. Financial strain, personal debt, recent job loss and housing insecurity are important risk factors for the mental health of working-age adults. Community interventions have the potential to attenuate the mental health impact of these stressors. We examined the effectiveness of community interventions for protecting and promoting the mental health of working-age adults in high-income countries during periods of financial insecurity. METHODS: Eight electronic databases were systematically screened for experimental and observational studies published since 2000 measuring the effectiveness of community interventions on mental health outcomes. We included any non-clinical intervention that aimed to address the financial, employment, food or housing insecurity of participants. A review protocol was registered on the PROSPERO database (CRD42019156364) and results are reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RESULTS: From 2326 studies screened, 15 met our inclusion criteria. Five categories of community intervention were identified: advice services colocated in healthcare settings; link worker social prescribing; telephone debt advice; food insecurity interventions; and active labour market programmes. In general, the evidence for effective and cost-effective community interventions delivered to individuals experiencing financial insecurity was lacking. From the small number of studies without a high risk of bias, there was some evidence that financial insecurity and associated mental health problems were amenable to change and differences by subpopulations were observed. CONCLUSION: There is a need for well-controlled studies and trials to better understand effective ingredients and to identify those interventions warranting wider implementation.

Review of the 6th symposium for the search for the causes of schizophrenia, Sao Paulo, Brazil, 3-6 February 2009.

In this review, we present the main findings of the 6th Symposium for the Search for the Causes of Schizophrenia, which took place between 3 and 6 February 2009, in Sao Paulo, Brazil. In a few short years, the landscape of the causes of schizophrenia has changed dramatically. The flat and featureless epidemiological horizon has developed undulating contours, which promise new avenues for research, particularly if we are able to integrate such findings with tantalising new findings from genetics as novel methods for identifying genuine sites of genetic risk emerge. The Search highlighted and fostered the emerging acknowledgement that we will need to integrate knowledge across traditionally disparate disciplines in psychiatry in order to develop complex, testable hypotheses in the search for the causes of schizophrenia. Such challenges are beginning to be addressed. From epidemiology, gene-environment studies are becoming more sophisticated, while neuroscience is increasingly concerned about social organisation and how social factors impinge upon biological pathways to potentially lead to psychosis. Tantalising new insights from genome-wide association studies offer new clues about rare genetic mutations, which have large effect sizes for schizophrenia, including copy number variants and de novo mutations. It is only through forums such as the 6th Symposium for the Search for the Causes of Schizophrenia that the seeds of integrated collaborations across disciplines can be sown to address the complex polyfactorial basis of schizophrenia.