Children mental health after the 2008 global economic crisis: Assessing the impact of austerity in Portugal

Background: The austerity measures implemented in Europe after the 2008 global economic crisis, had a negative impact on the population health. The mental health of adults from southern Europe was particularly affected during this period, however, much less is known about the impact of austerity on the mental health of children. This study measured the impact on Portuguese children's mental health of specific changes in family life during the 2008 economic crisis. Methods: In this study, a cross-sectional analysis of school-aged children (aged 7.5-11 years old, n = 1157) was conducted in 118 public and private schools of three Portuguese districts during 2016/2017. Parent reports of child's psychosocial functioning (Strengths and Difficulties Questionnaire - SDQ) and children self-reports of depression, anxiety and stress symptoms (Depression, Anxiety and Stress Scales, Children version - DASS-C) and health-related quality of life (HRQoL - KIDSCREEN-27), were compared according to eight yes/no questions specifically developed about changes to normal life during the economic crisis (e.g. During the economic crisis did you: "Started buying cheaper food?" "Had to change to more economic housing?"). General linear regression models were fitted to estimate mean scores of the selected mental health outcomes according to the positive or negative answers to each question about the changes to life during the economic crisis. The models were adjusted for age, sex, socioeconomic status and district of residence. Results: Following the crisis 48.6% of the parents reported that they had to use their savings, and 6.8% reported that they had to change to a more economic housing. The questions about the changes to life that occurred during the crisis were associated with more frequent psychosocial problems, depression, anxiety and stress symptoms and with poorer HRQoL among children, after adjustment for potential confounders in the regression models. The effect sizes in mean differences for all mental health outcomes assessed according to the changes were small to moderate (Cohen's d from 0.01 to 0.68). Conclusion: Specific changes to normal life attributed to the economic crisis seem to have an independent negative impact on the mental health outcomes of primary school-aged children. These results highlight the need to tackle early-life determinants of inequalities in children mental health, particularly among those that were exposed to the economic crisis.