The Great Recession may have made our wallets lighter and our hearts heavier, suggests a new study published in The BMJ Tuesday.

Researchers reviewed 41 earlier studies looking at the connection between the worldwide economic turmoil that first began around 2007 and health outcomes in various countries belonging to the European Union. While many of the studies were biased or sometimes contradictory, they nevertheless found a consistent decline in mental health and increased suicides following the recession, the latter especially prevalent among working-age men. Countries hit hardest by the downturn, such as Greece and Spain, were more likely to report a stronger association.

“The cautious conclusions that we can draw from the studies we analysed, is that the effect of the crisis was different across and within countries,” wrote the authors. “Most studies on suicides showed an increase in suicides during the financial crisis, in particular among men. Studies looking at mental health found similar increases, but these results were more mixed.”

Though the evidence for the recession’s influence on physical health was similarly mixed, the researchers did find some evidence that immigrants, especially those illegal, may have suffered the worst health-related declines. It may have also exacerbated health inequalities between the well-off and poor, possibly because many governments were forced to cut down on public health care spending. Overall, however, the recession didn’t appear to have any effect on mortality rates, with people either dying at the same pace as before or even living longer. While financial and unemployment woes can increase suicide risk, it can ironically also force people to adopt healthier lifestyles, the authors noted.

Other research has found that the recession may have contributed to 10,000 more suicides in North America and Europe combined during its harshest years. Because of the reviewed studies' flaws, however, the researchers believe there’s more much quality evidence needed on the subject. Out of the 41 studies they looked at, only 2 were found to have little bias.

“We need more empirical studies that explore the impact of the crisis on health and, more importantly, investigate the mechanisms that affect health outcomes,” they wrote.

In particular, they hope that future studies can study longer lengths of time before and after the recession to account for any potential lag effects on health.

Source: Parmar D, Stavropoulou C, Ioannidis J. Health outcomes during the 2008 financial crisis in Europe: systematic literature review. The BMJ . 2016.