A review of studies investigating the 2008 recession in Europe show it was associated with adverse health outcomes, particularly for suicides and mental health problems, finds a study in The BMJ today.

However, the authors warn that most published studies on this topic had a substantial risk of bias and therefore results need to be cautiously interpreted.

In 2008, Europe entered a period of unprecedented financial crisis following a global economic downturn. Yet despite growing interest in the impact of the crisis on the health of populations, the evidence so far has been fragmented.

So a team of researchers based at City University in London and Stanford University in California analysed studies reporting on the impact of the European financial crisis on health outcomes, published from January 2008 to December 2015.

A total of 41 studies met the inclusion criteria and were analysed, the vast majority focused on two countries - Spain and Greece. The main health outcomes that these studies explored were suicides and mental health.

All studies were assessed for risk of bias. Of these, 29 (73%) were deemed to be at high risk of bias, nine (23%) at moderate risk of bias, and only two at low risk of bias, limiting the conclusions that could be drawn.

Although there were differences across countries and groups, there was some indication that suicides increased during the financial crisis, particularly among men.

Studies looking at mental health found similar increases, but these results were more mixed. Women seemed to be more affected by mental health problems than men.

Studies focusing on mortality seemed to show a different picture, with overall mortality not being affected or even declining during the crisis years. It has been argued in previously published studies that, among other reasons, this is probably due to healthier lifestyles during years of economic difficulties.

There was also some evidence that the health of immigrants, especially those who had illegal status and lacked social security, deteriorated much more during the crisis than that of natives.

Evidence on self-rated health and other indicators was mixed.

These results need to be interpreted with caution, say the authors, but overall, the financial crisis in Europe seems to have had mixed effects on health outcomes, with the evidence being most consistent for suicides and mental health.

"There is a need for better empirical studies, especially those focused on identifying mechanisms that can mitigate the adverse effects of the crisis," they conclude.

In a linked editorial, researchers at the University of Liverpool, agree that recessions can harm health, but argue that a government's response can exacerbate the damage. "It is therefore critical to distinguish between the health effects of recessions and the effect of different policy responses to recession," they write.

And they call on doctors "to advocate for social and welfare policies that are informed by the evidence available and evaluated for their health effects, so that they protect people during crisis rather than creating further health problems."