Welfare systems and mental health in OECD and EEA countries: a scoping review

The link between socioeconomic position and mental health is well established. On the macro level, one important determinant of this relationship is the welfare state. As such, welfare systems play an important role in mitigating the adverse effects of poor socioeconomic conditions and improving the mental health of the population. Despite their significance, welfare systems and their impact on mental health have rarely been examined. In this scoping review, we set out to synthesise the available evidence on this subject and offer preliminary evidence on how different welfare systems shape the mental health of societies. Eight databases were searched for articles published between January 2000 and March 2022 that focused on mental health and welfare regimes or welfare expenditure and compared OECD and EEA countries. The final review included 30 studies. Findings were summarised using narrative synthesis. Welfare systems were shown to have a significant relationship with the mental health of the population, with Social Democratic regimes and countries with more generous social expenditures demonstrating superior outcomes on most measures. It is suggested that a key factor behind these positive outcomes is the way in which these countries deal with social inequality. However, the overall composition of the included articles was highly heterogeneous and scattered across several domains. Moreover, important confounding factors such as differences in GPD across countries were often not taken into account. Therefore, the quality of the current evidence is considered weak. Further, questions are raised regarding the specific mental health benefits and drawbacks of welfare generosity for different populations and the specific pathways through which these systems may improve mental health in society. The review highlights the need for a more robust evidence base in this area and emphasises the importance of addressing the macro-level determinants of mental health.