City University London, Northampton Square, EC1V 0HB, London, UK.
Hull York Medical School, University of York, Heslington, York, YO10 5DD, England.
BMC Public Health. 2021 Nov 18;21(1):2118. doi: 10.1186/s12889-021-12145-1.
Social circumstances in which people live and work impact the population's mental health. We aimed to synthesise evidence identifying effective interventions and policies that influence the social determinants of mental health at national or scaled population level. We searched five databases (Cochrane Library, Global Health, MEDLINE, EMBASE and PsycINFO) between Jan 1st 2000 and July 23rd 2019 to identify systematic reviews of population-level interventions or policies addressing a recognised social determinant of mental health and collected mental health outcomes. There were no restrictions on country, sub-population or age. A narrative overview of results is provided. Quality assessment was conducted using Assessment of Multiple Systematic Reviews (AMSTAR 2). This study was registered on PROSPERO (CRD42019140198).
We identified 20 reviews for inclusion. Most reviews were of low or critically low quality. Primary studies were mostly observational and from higher income settings. Higher quality evidence indicates more generous welfare benefits may reduce socioeconomic inequalities in mental health outcomes. Lower quality evidence suggests unemployment insurance, warm housing interventions, neighbourhood renewal, paid parental leave, gender equality policies, community-based parenting programmes, and less restrictive migration policies are associated with improved mental health outcomes. Low quality evidence suggests restriction of access to lethal means and multi-component suicide prevention programmes are associated with reduced suicide risk.
This umbrella review has identified a small and overall low-quality evidence base for population level interventions addressing the social determinants of mental health. There are significant gaps in the evidence base for key policy areas, which limit ability of national policymakers to understand how to effectively improve population mental health.
人们生活和工作的社会环境会影响到人群的心理健康。我们旨在综合现有的证据，确定有效的干预措施和政策，这些措施和政策会影响到国家或规模化人群层面的心理健康的社会决定因素。我们于 2000 年 1 月 1 日至 2019 年 7 月 23 日在五个数据库（Cochrane Library、全球卫生、MEDLINE、EMBASE 和 PsycINFO）中进行了检索，以确定针对公认的心理健康社会决定因素的人群层面的干预措施或政策的系统评价，并收集了心理健康结果。对国家、亚人群或年龄没有限制。结果以叙述性综述的形式呈现。使用评估多项系统评价（AMSTAR 2）对质量进行评估。本研究已在 PROSPERO（CRD42019140198）上注册。
我们确定了 20 项纳入的综述。大多数综述的质量较低或批判性地较低。主要研究大多是观察性研究，来自高收入国家。更高质量的证据表明，更慷慨的福利可能会减少心理健康结果的社会经济不平等。低质量的证据表明，失业保险、温暖住房干预、社区更新、带薪育儿假、性别平等政策、基于社区的育儿计划以及更宽松的移民政策与改善心理健康结果相关。低质量的证据表明，限制获得致命手段和多组分自杀预防计划与降低自杀风险有关。
本 umbrella 综述确定了针对影响心理健康的社会决定因素的人群层面干预措施的小型且总体质量较低的证据基础。在关键政策领域的证据基础存在重大差距，这限制了国家政策制定者了解如何有效改善人口心理健康的能力。
