Social Psychiatry and Psychiatric Epidemiology

, Volume 49, Issue 10, pp 1641–1653 | Cite as

Professional care seeking for mental health problems among women and men in Europe: the role of socioeconomic, family-related and mental health status factors in explaining gender differences

  • V. BuffelEmail author
  • S. Van de Velde
  • P. Bracke
Original Paper



This comparative study examines cross-national variation in gender differences in primary and specialized mental health care use in Europe. We investigate to what extent socioeconomic, family-related, and mental health factors explain the gender difference, and how the impact of these groups of determinants on gender differences in mental health care use varies between countries.


Data from the Eurobarometer 248 (2005–2006) for 29 European countries is used and country-specific logistic regression analyses are performed.


Gender differences in professional care seeking are largely need based. In almost one-third of the countries examined, the gender difference is mainly attributable to women’s poorer mental health status. However, in some countries, family and socioeconomic characteristics also have an independent contribution to the gender difference in mental health care use. Women’s higher likelihood of a lower socioeconomic position, might partly explain their higher primary care use, while in some countries, it restricts their specialized care use. In addition, some social conditions, as having children and being widowed, seem to function in a few countries as suppressors of women’s care use.


Our study has shown that the gender difference in mental health care use, with women having a higher care use, is not a consistent European phenomenon and is dependent on the type of care provider, with greater gender inequity in the use of primary health care. The social roles adopted by men and women have in some countries on top of the mental health status a relevant influence on the greater tendency among women to contact a care provider. How the socioeconomic and family characteristics moderate the relation between gender and mental health care use is not straightforward and country dependent.


Gender differences Primary and specialized mental health care use Cross-national variation Family characteristics Socioeconomic characteristics 


  1. 1.
    Alonso J, Angermeyer MC, Bernert S, Bruffaerts R, Brugha IS, Bryson H et al (2004) Use of mental health services in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project. Acta Psychiatr Scand 109:47–54CrossRefGoogle Scholar
  2. 2.
    Koopmans GT, Lamers LM (2007) Gender and health care utilization: the role of mental distress and help-seeking propensity. Soc Sci Med 64(6):1216–1230PubMedCrossRefGoogle Scholar
  3. 3.
    Fleury MJ, Grenier G, Bamvita JM, Perreault M, Caron J (2012) Determinants Associated with the Utilization of Primary and Specialized Mental Health Services. Psychiatr Q 83(1):41–51PubMedCrossRefGoogle Scholar
  4. 4.
    Rhodes AE, Goering PN, To T, Williams JI (2002) Gender and outpatient mental health service use. Soc Sci Med 54(1):1–10PubMedCrossRefGoogle Scholar
  5. 5.
    Gabilondo A, Rojas-Farreras S, Rodriguez A, Fernandez A, Pinto-Meza A, Vilagut G et al (2011) Use of primary and specialized mental health care for a major depressive episode in Spain by ESEMeD respondents. Psychiatr Serv 62(2):152–161PubMedCrossRefGoogle Scholar
  6. 6.
    Kovess-Masfety V, Alonso J, Brugha TS, Angermeyer MC, Haro JM, Sevilla-Dedieu C (2007) Differences in lifetime use of services for mental health problems in six European countries. Psychiatr Serv 58(2):213–220PubMedCrossRefGoogle Scholar
  7. 7.
    Tomov TV, Keukens R, Puras D (2007) Mental health policy in former eastern bloc countries. In: Knapp D, Mossialos E, Thornicroft G (eds) Mental health policy and practice across Europe. The McGraw-Hill companies, New York, p 397425Google Scholar
  8. 8.
    Wang PS, Aguilar-Gaxiola S, Alonso J, Angermeyer MC, Borges G, Bromet EJ et al (2007) Use of mental health services for anxiety, mood, and substance disorders in 17 countries in the WHO world mental health surveys. Lancet 370(9590):841–850PubMedPubMedCentralCrossRefGoogle Scholar
  9. 9.
    Alonso J, Codony M, Kovess V, Angermeyer MC, Katz SJ, Haro JM et al (2007) Population level of unmet need for mental healthcare in Europe. Br J Psychiatry 190:299–306PubMedCrossRefGoogle Scholar
  10. 10.
    Dezetter A, Briffault X, Alonso J, Angermeyer MC, Bruffaerts R, de Girolamo G et al (2011) Factors associated with use of psychiatrists and nonpsychiatrist providers by ESEMeD respondents in six European countries. Psychiatr Serv 62(2):143–151PubMedCrossRefGoogle Scholar
  11. 11.
    Bertakis KD, Azari R, Helms LJ, Callahan EJ, Robbins JA (2000) Gender differences in the utilization of health care services. J Fam Pract 49(2):147–152PubMedGoogle Scholar
  12. 12.
    Redondo-Sendino A, Guallar-Castillon P, Banegas JR, Rodriguez-Artalejo F (2006) Gender differences in the utilization of health-care services among the older adult population of Spain. BMC Public Health 6:155Google Scholar
  13. 13.
    Van de Velde S, Huijts T, Bracke P, Bambra C (2013) Macro-level gender equality and depression in men and women in Europe. Sociol Health Illn 35(5):682–698Google Scholar
  14. 14.
    Vesga-Lopez O, Schneier FR, Wang S, Heimberg RG, Liu SM, Hasin DS, Blanco C (2008) Gender differences in generalized anxiety disorder: results from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). J Clin Psychiatry 69(10):1606–1616PubMedCrossRefGoogle Scholar
  15. 15.
    Bijl RV, Ravelli A (2000) Psychiatric morbidity, service use, and need for care in the general population: results of The Netherlands Mental Health Survey and Incidence Study. Am J Public Health 90(4):602–607PubMedPubMedCentralCrossRefGoogle Scholar
  16. 16.
    Gouwy A, Christiaens W, Bracke P (2008) Mental health service use in the general Belgian population: estimating the impact of mental health and social determinants. Arch Public Health 66:50–68Google Scholar
  17. 17.
    Alegria M, Bijl RV, Lin E, Walters EE, Kessler RC (2000) Income differences in persons seeking outpatient treatment for mental disorders—a comparison of the United States with Ontario and The Netherlands. Arch Gen Psychiatry 57(4):383–391PubMedCrossRefGoogle Scholar
  18. 18.
    Vasiliadis HM, Tempier R, Lesage A, Kates N (2009) General practice and mental health care: determinants of outpatient service use. Can J Psychiatry-Rev Can de Psychiatr 54(7):468–475Google Scholar
  19. 19.
    Bracke P, Christiaens W, Wauterickx N (2008) The pivotal role of women in informal care. J Fam Issues 29(10):1348–1378CrossRefGoogle Scholar
  20. 20.
    Bracke P, Colman E, Symoens S, Van Praag L (2010) Divorce, divorce rates, and professional care seeking for mental health problems in Europe: a cross-sectional population-based study. BMC Public Health 10:224Google Scholar
  21. 21.
    Umberson D (1987) Family status and health behaviors—social-control as a dimension of social integration. J Health Soc Behav 28(3):306–319PubMedCrossRefGoogle Scholar
  22. 22.
    Joung IMA, Vandermeer JBW, Mackenbach JP (1995) Marital-status and health-care utilization. Int J Epidemiol 24(3):569–575PubMedCrossRefGoogle Scholar
  23. 23.
    Prigerson HG, Maciejewski PK, Rosenheck RA (1999) The effects of marital dissolution and marital quality on health and health service use among women. Med Care 37(9):858–873PubMedCrossRefGoogle Scholar
  24. 24.
    Lewis J, Campbell M, Huerta C (2008) Patterns of paid and unpaid work in Western Europe: gender, commodification, preferences and the implications for policy. J Eur Soc Policy 18(1):21–37CrossRefGoogle Scholar
  25. 25.
    Aneshensel CS, Frerichs RR, Clark VA (1981) Family roles and sex-differences in depression. J Health Soc Behav 22(4):379–393PubMedCrossRefGoogle Scholar
  26. 26.
    Simon RW (2002) Revisiting the relationships among gender, marital status, and mental health. Am J Sociol 107(4):1065–1096PubMedCrossRefGoogle Scholar
  27. 27.
    Colman E, Sara S, Bracke P (2012) Professional health care use and subjective unmet need for social or emotional problems: a cross-sectional survey of the married and divorced population of Flanders. Health Serv Res 12(420):25Google Scholar
  28. 28.
    Cairney J, Boyle MH, Offord DR, Racine Y (2003) Stress, social support and depression in single and married mothers. Soc Psychiatry Psychiatr Epidemiol 38(8):442–449PubMedCrossRefGoogle Scholar
  29. 29.
    Cairney J, Boyle MH, Lipman EL, Racine Y (2004) Single mothers and the use of professionals for mental health care reasons. Soc Sci Med 59(12):2535–2546PubMedCrossRefGoogle Scholar
  30. 30.
    Bambra C (2007) Defamilisation and welfare state regimes: a cluster analysis. Int J Soc Welf 16(4):326–338CrossRefGoogle Scholar
  31. 31.
    Hopcroft RL, Bradley DB (2007) The sex difference in depression across 29 countries. Soc Forces 85(4):1483–1507CrossRefGoogle Scholar
  32. 32.
    Levecque K, Van Rossem R, De Boyser K, Van de Velde S, Bracke P (2011) Economic hardship and depression across the life course: the impact of welfare state regimes. J Health Soc Behav 52(2):262–276PubMedCrossRefGoogle Scholar
  33. 33.
    Van de Velde S, Bracke P, Levecque K (2010) Gender differences in depression in 23 European countries. Cross-national variation in the gender gap in depression. Soc Sci Med 71(2):305–313PubMedCrossRefGoogle Scholar
  34. 34.
    Mojtabai R (2010) Mental illness stigma and willingness to seek mental health care in the European Union. Soc Psychiatry Psychiatr Epidemiol 45(7):705–712PubMedCrossRefGoogle Scholar
  35. 35.
    WHO (2011) Mental health atlass 2011. World Health Organisation (WHO), GenevaGoogle Scholar
  36. 36.
    Grosse Frie K, Eikemo TA, von dem Knesebeck O (2010) Education and self-reported health care seeking behaviour in European welfare regimes: results from the European Social Survey. Int J Public Health 55(3):217–220CrossRefGoogle Scholar
  37. 37.
    van Doorslaer E, Jones AM (2004) Income-related inequality in health and health care in the European Union. Health Econ 13(7):605–608PubMedCrossRefGoogle Scholar
  38. 38.
    van Doorslaer E, Koolman X, Jones AM (2004) Explaining income-related inequalities in doctor utilisation in Europe. Health Econ 13(7):629–647PubMedCrossRefGoogle Scholar
  39. 39.
    Forhlich N, Carriere K, Potvin L, Black C (2001) Assessing socioeconomic effects on different sized populations: to weight or not to weight? J Epidemiol Community Health 55:913–920CrossRefGoogle Scholar
  40. 40.
    Ware JE, Sherbourne CD (1992) The MOS 36-item Short-Form Health Survey (Sf-36).1. Conceptual-framework and item selection. Med Care 30(6):473–483PubMedCrossRefGoogle Scholar
  41. 41.
    Mchorney CA, Ware JE, Raczek AE (1993) The MOS 36-item Short-Form Health Survey (Sf-36).2. Psychometric and clinical-tests of validity in measuring physical and mental-health constructs. Med Care 31(3):247–263PubMedCrossRefGoogle Scholar
  42. 42.
    Lehto-Järnstedt U, Aromaa A (2003) Mental health measurement in comprehensive national health surveys. National Public Health Institute, KTL, HelsinkiGoogle Scholar
  43. 43.
    Wagner AK, Gandek B, Aaronson NK, Acquadro C, Alonso J, Apolone G, Ware JE (1998) Cross-cultural comparisons of the content of SF-36 translations across 10 countries: results from the IQOLA project. J Clin Epidemiol 51(11):925–932PubMedCrossRefGoogle Scholar
  44. 44.
    Strand BH, Dalgard OS, Tambs K, Rognerud M (2003) Measuring the mental health status of the Norwegian population: a comparison of the instruments SCL-25, SCL-10, SCL-5 and MHI-5 (SF-36). Nord J Psychiatry 57(2):113–118PubMedCrossRefGoogle Scholar
  45. 45.
    McCabe CJ, Thomas KJ, Brazier JE, Coleman P (1996) Measuring the mental health status of a population: a comparison of the GHQ-12 and the SF-36 (MHI-5). Br J Psychiatry 169(4):517–521CrossRefGoogle Scholar
  46. 46.
    Rumpf HJ, Meyer C, Hapke U, John U (2001) Screening for mental health: validity of the MHI-5 using DSM-IV Axis I psychiatric disorders as gold standard. Psychiatry Res 105(3):243–253PubMedCrossRefGoogle Scholar
  47. 47.
    Mood C (2010) Logistic regression: why we cannot do what we think we can do, and what we can do about it. Eur Sociol Rev 26(1):67–82CrossRefGoogle Scholar
  48. 48.
    Holmes WC (1998) A short, psychiatric, case-finding measure for HIV seropositive outpatients: performance characteristics of the 5-item mental health subscale of the SF-20 in a male, seropositive sample. Med Care 36(2):237–243PubMedCrossRefGoogle Scholar
  49. 49.
    Ritter PL, Stewart AL, Kaymaz H, Sobel DS, Block DA, Lorig KR (2001) Self-reports of health care utilization compared to provider records. J Clin Epidemiol 54(2):136–141PubMedCrossRefGoogle Scholar
  50. 50.
    Sevilla-Dedieu C, Kovess-Masfety V, Angermeyer M, Bruffaerts R, Fernandez A, De Girolamo G, Investigators EM (2011) Measuring use of services for mental health problems in epidemiological surveys. Int J Methods Psychiatr Res 20(3):182–191PubMedGoogle Scholar
  51. 51.
    Golding JM, Gongla P, Brownell A (1988) Feasibility of validating survey self-reports of mental-health service use. Am J Community Psychol 16(1):39–51PubMedCrossRefGoogle Scholar
  52. 52.
    Williams R (2009) Using heterogeneous choice models to compare logit and probit coefficients across groups. Sociol Methods Res 37(4):531–559CrossRefGoogle Scholar
  53. 53.
    Wooldridge JM (2002) Econometric analysis of cross section and panel data. Mit Press, CombridgeGoogle Scholar
  54. 54.
    WHO (2001) The world health report. Mental health: new understanding, new hope. World Health Organisation (WHO), GenevaGoogle Scholar
  55. 55.
    Leaf PJ, Bruce ML (1987) Gender differences in the use of mental health-related services—a reexamination. J Health Soc Behav 28(2):171–183PubMedCrossRefGoogle Scholar
  56. 56.
    Emese B (2008) Reconciliation of work and private life. a comparative review of thirty European countries. Szociol Szle 1:139–145Google Scholar
  57. 57.
    Lloyd M (2010) Mental health policy and practice across Europe. Crit Public Health 20(2):267–269CrossRefGoogle Scholar
  58. 58.
    Schomerus G, Holzinger A, Matschinger H, Lucht M, Angermeyer MC (2010) Public attitudes towards alcohol dependence an overview. Psychiatr Prax 37(3):111–118PubMedCrossRefGoogle Scholar
  59. 59.
    Green CA, Pope CR (1999) Gender, psychosocial factors and the use of medical services: a longitudinal analysis. Soc Sci Med 48(10):1363–1372PubMedCrossRefGoogle Scholar
  60. 60.
    Kovess-Masfety V, Boyd A, Van de Velde S, de Graaf R et al (in press) Are there gender differences in services use for mental disorders across EU countries? Results from the WMH Europe survey. JECHGoogle Scholar
  61. 61.
    Ozmen E, Ogel K, Aker T, Sagduyu A, Tamar D, Boratav C (2004) Public attitudes to depression in urban Turkey—the influence of perceptions and causal attributions on social distance towards individuals suffering from depression. Soc Psychiatry Psychiatr Epidemiol 39(12):1010–1016PubMedCrossRefGoogle Scholar
  62. 62.
    Riska E, Ettorre E (1999) Mental distress—gender aspects of symptoms and coping. Acta Oncol 38(6):757–761PubMedCrossRefGoogle Scholar

Copyright information

© European Union 2014

Authors and Affiliations

  1. 1.Research Group HeDeRA, Department of SociologyGhent UniversityGhentBelgium

Personalised recommendations