Are there gender differences in service use for mental disorders across countries in the European Union? Results from the EU-World Mental Health survey

Kovess-Masfety, Vivane; Boyd, Anders; Van de Velde, Sarah; de Graaf, Ron; Vilagut, Gemma; Maria Haro, Josep; Florescu, Silvia; O'Neill, Siobhan; Weinberg, Lauren; Alonso, Jordi

doi:10.1136/JECH-2013-202962

Title

Are there gender differences in service use for mental disorders across countries in the European Union? Results from the EU-World Mental Health survey

Author

Kovess-Masfety, Vivane

Boyd, Anders

Van de Velde, Sarah

de Graaf, Ron

Vilagut, Gemma

Maria Haro, Josep

Florescu, Silvia

O'Neill, Siobhan

Weinberg, Lauren

Alonso, Jordi

Institution/Organisation

EU-WMH Investigators

Abstract

Background Women are more likely than men to use mental healthcare (MHC) due to differences in the types of problems and help-seeking behaviours. The consistency of this relationship across European countries, whose MHC organisation differs substantially, is unknown. Methods Lifetime MHC-use and the type of MHC provider were assessed in 37 289 participants from the EU-World Mental Health (EU-WMH) survey, including 10 European countries (Northern Ireland, The Netherlands, Belgium, Germany, France, Spain, Italy, Portugal, Bulgaria and Romania). Lifetime mood/anxiety disorders (DSM-IV) and severity were evaluated using the CIDI V. 3.0. Results MHC use was significantly higher for women than men in every country except for Romania (overall OR=1.80, 95% CI1.64 to 1.98), while remaining so after adjusting for socioeconomic characteristics (age, income level, employment status, education, marital status; adjusted OR=1.87, 95% CI 1.69 to 2.06) and country-level indicators (MHC provision, private household out-of-pocket expenditure, and Gender Gap Index; adjusted OR=1.89, 95% CI 1.71 to 2.08). Compared with men, women were also more likely to consult general practitioners (GP) versus specialised MHC (OR=1.32, 95% CI 1.12 to 1.56) with high between-country variability. In participants with mood disorder, the gender relationship in MHC use and type of MHC did not change. Conversely, in participants with anxiety disorder, no significant gender relationship in MHC use was observed (adjusted OR=1.21, 95% CI 0.99 to 1.47). Finally, men with severe mental health problems had a significantly higher odds of MHC use (OR=14.70) when compared with women with similar levels (OR=8.95, p for interaction=0.03) after adjusting for socioeconomic characteristics and country-level indicators. Conclusions Women use MHC and GPs more frequently than men, yet this depends on the type and severity of mental health problems.

Language

English

Source (journal)

Journal of epidemiology and community health / British Medical Association. - London

Publication

London : 2014

ISSN

0143-005X

DOI

10.1136/JECH-2013-202962

Volume/pages

68 :7 (2014) , p. 649-656