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Evaluation of the Biases in the Studies that Assess the Effects of the Great Recession on Health. A Systematic Review

Research Group on Statistics, Econometrics and Health (GRECS), University of Girona, 17003 Girona, Spain
Network Biomedical Research Center of Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
Andalusian School of Public Health, 18080 Granada, Spain
Instituto de Investigación Biosanitaria (IBS), Hospital Universitario de Granada, Universidad de Granada, 18014 Granada, Spain
Observatorio de Salud y Medio Ambiente de Andalucía (OSMAN), 18080 Granada, Spain
Author to whom correspondence should be addressed.
Int. J. Environ. Res. Public Health 2019, 16(14), 2479;
Received: 13 June 2019 / Revised: 6 July 2019 / Accepted: 8 July 2019 / Published: 11 July 2019
PDF [528 KB, uploaded 11 July 2019]


Background: Our main objective was to evaluate the fundamental biases detected in studies assessing the effects the Great Recession had on health for the case of Spain. As secondary objectives we presented methods to control these biases and to discuss the results of the studies in question if they had controlled for them. Methods: We carried out a systematic review of the literature published up to June 2018. We evaluated the biases that could have happened in all the eligible studies. Results: From the review, we finally selected 53 studies. Of the studies we reviewed, 60.38% or 32 out of 53, were evaluated as having a high risk of bias. The main biases our review revealed were problems with evaluation, time bias, lack of control of unobserved confounding, and non-exogeneity when defining the onset of the Great Recession. Conclusions: The results from the studies that controlled the biases were quite consistent. Summing up, the studies reviewed found that the Great Recession increased the risk of declaring poor self-rated health and the deterioration of mental health. Both the mortality rate and the suicide rate may well have increased after the Great Recession, probably after a three- to four-year delay. View Full-Text
Keywords: health; great recession; bias; evaluation problem; time bias health; great recession; bias; evaluation problem; time bias

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Saez, M.; Barceló, M.A.; Saurina, C.; Cabrera, A.; Daponte, A. Evaluation of the Biases in the Studies that Assess the Effects of the Great Recession on Health. A Systematic Review. Int. J. Environ. Res. Public Health 2019, 16, 2479.

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Int. J. Environ. Res. Public Health EISSN 1660-4601 Published by MDPI AG, Basel, Switzerland RSS E-Mail Table of Contents Alert
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