Background

Lower incomes are associated with poorer mental health and wellbeing, but the extent to which income has a causal effect is debated. We aimed to synthesise evidence from studies measuring the impact of changes in individual and household income on mental health and wellbeing outcomes in working-age adults (aged 16–64 years).

Methods

For this systematic review and meta-analysis, we searched MEDLINE, Embase, Web of Science, PsycINFO, ASSIA, EconLit, and RePEc on Feb 5, 2020, for randomised controlled trials (RCTs) and quantitative non-randomised studies. We had no date limits for our search. We included English-language studies measuring effects of individual or household income change on any mental health or wellbeing outcome. We used Cochrane risk of bias (RoB) tools. We conducted three-level random-effects meta-analyses, and explored heterogeneity using meta-regression and stratified analyses. Synthesis without meta-analysis was based on effect direction. Critical RoB studies were excluded from primary analyses. Certainty of evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE). This study is registered with PROSPERO, CRD42020168379.

Findings

Of 16 521 citations screened, 136 were narratively synthesised (12·5% RCTs) and 86 meta-analysed. RoB was high: 30·1% were rated critical and 47·1% serious or high. A binary income increase lifting individuals out of poverty was associated with 0·13 SD improvement in mental health measures (95% CI 0·07 to 0·20; n=42 128; 18 studies), considerably larger than other income increases (0·01 SD improvement, 0·002 to 0·019; n=216 509, 14 studies). For wellbeing, increases out of poverty were associated with 0·38 SD improvement (0·09 to 0·66; n=101 350, 8 studies) versus 0·16 for other income increases (0·07 to 0·25; n=62 619, 11 studies). Income decreases from any source were associated with 0·21 SD worsening of mental health measures (–0·30 to –0·13; n=227 804, 11 studies). Effect sizes were larger in low-income and middle-income settings and in higher RoB studies. Heterogeneity was high (I²=79–87%). GRADE certainty was low or very low.

Interpretation

Income changes probably impact mental health, particularly where they move individuals out of poverty, although effect sizes are modest and certainty low. Effects are larger for wellbeing outcomes, and potentially for income losses. To best support population mental health, welfare policies need to reach the most socioeconomically disadvantaged.

Funding

Wellcome Trust, Medical Research Council, Chief Scientist Office, and European Research Council.

中文翻译：

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收入变化如何影响工作年龄成年人的心理健康和福祉？系统回顾和荟萃分析

背景

较低的收入与较差的心理健康和福祉相关，但收入的因果影响程度存在争议。我们旨在综合衡量个人和家庭收入变化对工作年龄成年人（16-64 岁）心理健康和福祉结果影响的研究证据。

方法

为了进行这项系统评价和荟萃分析，我们于 2020 年 2 月 5 日检索了 MEDLINE、Embase、Web of Science、PsycINFO、ASSIA、EconLit 和 RePEc，以查找随机对照试验 (RCT) 和定量非随机研究。我们的搜索没有日期限制。我们纳入了英语研究，衡量个人或家庭收入变化对心理健康或福祉结果的影响。我们使用 Cochrane 偏倚风险 (RoB) 工具。我们进行了三水平随机效应荟萃分析，并使用荟萃回归和分层分析探索异质性。没有荟萃分析的合成是基于效果方向的。关键 RoB 研究被排除在主要分析之外。使用建议评估、制定和评价分级 (GRADE) 来评估证据的确定性。本研究已在 PROSPERO 注册，CRD42020168379。

发现

在筛选的 16 521 条引用中，136 条进行了叙述性综合（12·5% RCT），86 条进行了荟萃分析。RoB 较高：30·1% 被评为严重，47·1% 被评为严重或高。使个人摆脱贫困的二元收入增加与心理健康指标的 0·13 SD 改善相关（95% CI 0·07 至 0·20；n=42 128；18 项研究），远大于其他收入增加（0 ·01 SD 改善，0·002 至 0·019；n=216 509，14 项研究）。就福祉而言，摆脱贫困的增加与 0·38 标准差改善相关（0·09 至 0·66；n=101 350，8 项研究），而其他收入增加则与 0·16 标准差改善相关（0·07 至 0·25；n=101 350；n =62 619，11 项研究）。任何来源的收入减少都与心理健康指标的 0·21 SD 恶化相关（–0·30 至 –0·13；n=227 804，11 项研究）。在低收入和中等收入环境以及较高 RoB 研究中，效应大小更大。异质性较高（I ² =79–87%）。成绩确定性低或非常低。

解释

收入变化可能会影响心理健康，特别是在使个人摆脱贫困的情况下，尽管影响程度不大且确定性较低。对福祉结果和潜在收入损失的影响更大。为了最好地支持人口心理健康，福利政策需要惠及社会经济地位最弱势的群体。

资金

威康信托基金会、医学研究委员会、首席科学家办公室和欧洲研究委员会。