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Social inequalities in mental health: results from the EU contribution to the World Mental Health Surveys Initiative

Social Psychiatry and Psychiatric Epidemiology volume 48, pages 173–181 (2013)Cite this article

Abstract

Purpose

The objective of the present study was to provide updated data from nine European countries about the impact of social inequalities in the prevalence of common mental disorders.

Methods

Cross-sectional household survey of a representative sample of the adult general population of Belgium, Bulgaria, Germany, Italy, The Netherlands, Northern Ireland, Portugal, Romania and Spain. In total, 34,395 individuals were included. Social inequalities in 12-month mood, anxiety and alcohol-related disorders were evaluated.

Results

In Europe, income seems not to be related to the prevalence of mental disorders. Unemployment and disablement are associated with mental disorders. Lower educational level augments the risk for mood disorders. Living in small (rural) areas decreases the risk for mood disorders and living in urban settings increases it. Northern Ireland, Portugal and Belgium are the countries with the highest risks for mental disorders.

Conclusions

Despite some contradictions with previous literature, in Europe there are social inequalities in the prevalence of mental disorders. However, income showed not to be associated with inequalities in mental health. Being younger, unemployed or disabled, with no education or incomplete primary studies, living in urban settings, and in Northern Ireland, Portugal or Belgium were associated to an augmented prevalence of mental disorders. Policy makers could focus on mental health promotion and mental disorders prevention programmes for risk groups such as unemployed/disabled individuals. Support to vulnerable groups (unemployed or those with less education) and mental health literacy can improve European citizens’ mental health.

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References

  1. Bradley RH, Corwyn RF (2002) Socioeconomic status and child development. Annu Rev Psychol 53:371–399

    PubMed  Article  Google Scholar 

  2. Muntaner C, Eaton WW, Diala CC (2000) Social inequalities in mental health: a review of concepts and underlying assumptions. Health 4:89–113

    Google Scholar 

  3. Power C, Stansfeld SA, Matthews S, Manor O, Hope S (2005) Childhood and adulthood risk factors for socio-economic differentials in psychological distress: evidence from the 1958 British birth cohort. Soc Sci Med 55:1989–2004

    Article  Google Scholar 

  4. Henderson C, Thornicraft G, Glover G (1998) Inequalities in mental health. Br J Psychiatr 173:105–109

    Article  CAS  Google Scholar 

  5. Lewis G, Bebbington P, Brugha T, Farrell M, Gill B, Jenkins R, Meltzer H (1998) Socioeconomic status, standard of living, and neurotic disorder. Lancet 352:605–609

    PubMed  Article  CAS  Google Scholar 

  6. Lewis G, Bebbington P, Brugha T, Farrell M, Gill B, Jenkins R, Meltzer H (2003) Socio-economic status, standard of living, and neurotic disorder. Int Rev Psychiatry 15:91–96

    PubMed  Article  CAS  Google Scholar 

  7. Jenkins R, Lewis G, Bebbington P, Brugha T, Farrell M, Gill B, Meltzer H (2003) The National Psychiatric Morbidity Surveys of Great Britain—initial findings from the household survey. Int Rev Psychiatry 15:29–42

    PubMed  Article  CAS  Google Scholar 

  8. Muntaner C, Eaton W, Diala C, Kessler R, Sorlie P (1998) Social class, assets, organizational control and the prevalence of common groups of psychiatric disorders. Soc Sci Med 47:2043–2053

    PubMed  Article  CAS  Google Scholar 

  9. Pulkki-Råback L, Ahola K, Elovainio M, Kivimäki M, Hintsanen M, Isometsä E, Lönnqvist J, Virtanen M (2011) Socioeconomic position and mental disorders in a working-age population: the health 2000 study. Eur J Public Health. doi:10.1093/eurpub/ckr127

  10. Meadows G, Burgess P, Bobevski I (2002) Distributing mental health care resources: strategic implications from the National Survey of Mental Health and Wellbeing. Aust N Z J Psychiatry 36:217–223

    PubMed  Article  Google Scholar 

  11. Kivimaki M, Gunnell D, Lawlor D, Davey S, Pentti J, Virtanen M, Elovainio M, Klaukka T, Vahtera J (2007) Social inequalities in antidepressant treatment and mortality: a longitudinal register study. Psychol Med 37:373–382

    PubMed  Article  Google Scholar 

  12. Ortiz-Hernandez L, Lopez-Moreno S, Borges G (2007) Socioeconomic inequality and mental health: a Latin American literature review. Cad Saude Publica 23:1255–1272

    PubMed  Article  Google Scholar 

  13. Marin-Leon L, Oliveira H, Barros M, Dalgalarrondo P, Botega N (2007) Social inequality and common mental disorders. Rev Bras Psiquiatr 29:250–253

    PubMed  Article  Google Scholar 

  14. Melzer D, Fryers T, Jenkins R, Brugha T, McWilliams B (2003) Social position and the common mental disorders with disability: estimates from the National Psychiatric Survey of Great Britain. Soc Psychiatry Psychiatr Epidemiol 38:238–243

    PubMed  Article  Google Scholar 

  15. Lewis G, Bebbington P, Brugha T, Farrell M, Gill B, Jenkins R, Meltzer H (2003) Socio-economic status, standard of living, and neurotic disorder. Int Rev Psychiatry 15:91–96

    PubMed  Article  CAS  Google Scholar 

  16. Perala J, Saarni S, Ostamo A, Pirkola S, Haukka J, Harkanen T, Koskinen S, Lonnqvist J, Suvisaari J (2008) Geographic variation and sociodemographic characteristics of psychotic disorders in Finland. Schizophr Res 106:337–347

    PubMed  Article  Google Scholar 

  17. Almeida-Filho N, Lessa I, Magalhaes L, Araujo M, Aquino E, James S, Kawachi I (2004) Social inequality and depressive disorders in Bahia, Brazil: interactions of gender, ethnicity, and social class. Soc Sci Med 59:1339–1353

    PubMed  Article  Google Scholar 

  18. Vorcaro C, Rocha F, Uchoa E, Lima-Costa M (2004) The burden of social phobia in a Brazilian community and its relationship with socioeconomic circumstances, health status and use of health services: the Bambui study. Int J Soc Psychiatry 50:216–226

    PubMed  Article  CAS  Google Scholar 

  19. Gilman S, Breslau J, Conron K, Koenen K, Subramanian V, Zaslavsky A (2008) Education and race-ethnicity differences in the lifetime risk of alcohol dependence. J Epidemiol Community Health 62:224–230

    PubMed  Article  CAS  Google Scholar 

  20. Bloomfield K, Grittner U, Kramer S, Gmel G (2006) Social inequalities in alcohol consumption and alcohol-related problems in the study countries of the EU concerted action “Gender, culture and alcohol, problems: a multinational study”. Alcohol Alcohol Suppl 41:i26–i36

    PubMed  Google Scholar 

  21. ESEMeD/MHEDEA 2000 Investigators (2004) Sampling and methods of the European Study of Mental Disorders (ESEMeD) project. Acta Psychiatr Scand Suppl 109:8–20

    Article  Google Scholar 

  22. Kessler R, Ustun T (2004) The World Mental Health (WMH) Survey Initiative version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI). Int J Methods Psychiatr Res 13:93–121

    PubMed  Article  Google Scholar 

  23. American Psychiatric Association (1994) Diagnostic and statistical manual of mental disorders, 4th edn. American Psychiatric Association, Washington DC

    Google Scholar 

  24. Rencher AC (2000) Linear Models in Statistiscs. Wiley, New York

    Google Scholar 

  25. SAS Institute Inc. SAS Software® Version 9.1

  26. Mangalore R, Knapp M, Jenkins R (2007) Income-related inequality in mental health in Britain: the concentration index approach. Psychol Med 37:1037–1045

    PubMed  Article  Google Scholar 

  27. Henderson C, Liu X, Diez Roux AV, Link BG, Hasin D (2004) The effects of US state income inequality and alcohol policies on symptoms of depression and alcohol dependence. Soc Sci Med 58:565–575

    PubMed  Article  Google Scholar 

  28. Zimmerman FJ, Bell JF (2006) Income inequality and physical and mental health: testing associations consistent with proposed causal pathways. J Epidemiol Community Health 60:513–521

    PubMed  Article  Google Scholar 

  29. Cohidon C, Imbernon E, Gorldberg M (2009) Prevalence of common mental disorders and their work consequences in France, according to occupational category. Am J Ind Med 52:141–152

    PubMed  Article  Google Scholar 

  30. Comino EJ, Harris E, Chey T, Manicavasagar V, Penrose WJ, Powell DG, Harris MF (2003) Relationship between mental health disorders and unemployment status in Australian adults. Aust N Z J Psychiatry 37:230–235

    PubMed  Article  Google Scholar 

  31. O’Campo P, Eaton WW, Muntaner C (2004) Labor market experience, work organization, gender inequalities and health status: results from a prospective analysis of US employed women. Soc Sci Med 58:585–594

    PubMed  Article  Google Scholar 

  32. Virtanen P, Liukkonen V, Vahtera J, Kivimaki M, Koskenvuo M (2003) Health inequalities in the workforce: the labour market core-periphery structure. Int J Epidemiol 32:1015–1021

    PubMed  Article  CAS  Google Scholar 

  33. Talala K, Huurre T, Aro H, Martelin T, Prättälä R (2009) Trends in socio-economic differences in self-reported depression during the years 1979–2002 in Finland. Soc Psychiatry Psychiatr Epidemiol 44:871–879

    PubMed  Article  Google Scholar 

  34. Vorcaro CM, Rocha FL, Uchoa E, Lima-Costa MF (2004) The burden of social phobia in a Brazilian community and its relationship with socioeconomic circumstances, health status and use of health services: the Bambui study. Int J Soc Psychiatry 50:216–226

    PubMed  Article  CAS  Google Scholar 

  35. Rifel J, Svab I, Ster MP, Pavlic DR, King M, Nazareth I (2008) Impact of demographic factors on recognition of persons with depression and anxiety in primary care in Slovenia. BMC Psychiatry 8:96

    PubMed  Article  Google Scholar 

  36. European Commission (2005) Green Paper Improving the Mental Health of the Population: Towards a strategy on mental health for the European Union. Brussels. http://ec.europa.eu/health/ph_determinants/life_style/mental/green_paper/mental_gp_en.pdf. Accessed 21 May 2012

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Acknowledgments

The World Health Organisation World Mental Health (WMH) Survey Initiative is supported by the National Institute of Mental Health (NIMH; R01 MH070884), the John D. and Catherine T MacArthur Foundation, the Pfizer Foundation, the US Public Health Service (R13-MH066849, R01-MH069864, and R01 DA016558), the Fogarty International Centre (FIRCA R03-TW006481), the Pan American Health Organisation, Eli Lilly and Company, Ortho-McNeil Pharmaceutical, Inc., GlaxoSmithKline, and Bristol-Myers Squibb. The ESEMeD project was funded by the European Commission (Contracts QLG5-1999-01042, SANCO 2004123 and EAHC 20081308), the Piedmont Region (Italy), Fondo de Investigación Sanitaria, Instituto de Salud Carlos III, Spain (FIS 00/0028), Ministerio de Ciencia y Tecnología, Spain (SAF 2000-158-CE), Departament de Salut, Generalitat de Catalunya, Spain, Instituto de Salud Carlos III (CIBER CB06/02/0046, RETICSRD06/0011 REM-TAP). The analysis for this paper was carried out in conjunction with the World Health Organization WMH Survey Initiative. We thank the WMH staff for assistance with instrumentation, fieldwork and data analysis. This project was co-funded by the Executive Agency for Health and Consumers and the European Commission (2008/1308 EU WMH). Information about the funding of WMH can be found here: http://www.hcp.med.harvard.edu/wmh/.

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Parc Sanitari Sant Joan de Déu, C/Dr. Antoni Pujadas, 42, Sant Boi de Llobregat, 08830, Barcelona, Spain

    Alejandra Pinto-Meza, Maria Victoria Moneta & Josep Maria Haro

  2. Health Services Research Unit, IMIM - Hospital del Mar Medical Research Institute, C/Dr. Aiguader, 88, PRBB Building, 08003, Barcelona, Spain

    Jordi Alonso

  3. Center for Public Mental Health, Untere Zeile 13, 3482, Gösing am Wagram, Austria

    Matthias C. Angermeyer

  4. Universitair Psychiatrisch Centrum, Katholieke Universiteit Leuven (UPC-KUL), Herestraat 49, 3000, Leuven, Belgium

    Ronny Bruffaerts

  5. Faculty of Medical Sciences, NOVA University of Lisbon, Campo Mártires da Pátria, 130, 1169-056, Lisbon, Portugal

    José Miguel Caldas de Almeida

  6. IRCCS Fatebenefratelli, Via Pilastroni 4, 25125, Brescia, Italy

    Giovanni de Girolamo

  7. Netherlands Institute of Mental Health and Addiction, Da Costakade 45, 3521 VS, Utrecht, The Netherlands

    Ron de Graaf

  8. National School of Public Health, Management and Professional Development, 31 Vaselor street, Bucharest, Romania

    Silvia Florescu

  9. EHESP Ecole des hautes études en santé publique, Hotel Dieu 1 place du paris de notre dame, 75181, Paris Cedex 04, France

    Viviane Kovess Masfety

  10. Psychology Research Institute, University of Ulster, Northland Road, Londonderry, BT487JL, UK

    Siobhan O’Neill

  11. New Bulgarian University, Bulgaria Sofia 1504 “Chataldja” 17-19 St. “Analytica”, Sofia, Bulgaria

    Svetlozar Vassilev

  12. CIBER de Salud Mental (CIBERSAM), Barcelona, Spain

    Josep Maria Haro

  13. Program of Epidemiology, CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain

    Jordi Alonso

  14. Program of Public Health, Pompeu Fabra University (UPF), Barcelona, Spain

    Jordi Alonso

Authors
  1. Alejandra Pinto-Meza
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  2. Maria Victoria Moneta
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  3. Jordi Alonso
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  4. Matthias C. Angermeyer
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  5. Ronny Bruffaerts
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  6. José Miguel Caldas de Almeida
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  7. Giovanni de Girolamo
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  8. Ron de Graaf
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  9. Silvia Florescu
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  10. Viviane Kovess Masfety
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  11. Siobhan O’Neill
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  12. Svetlozar Vassilev
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  13. Josep Maria Haro
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Corresponding author

Correspondence to Alejandra Pinto-Meza.

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Pinto-Meza, A., Moneta, M.V., Alonso, J. et al. Social inequalities in mental health: results from the EU contribution to the World Mental Health Surveys Initiative. Soc Psychiatry Psychiatr Epidemiol 48, 173–181 (2013). https://doi.org/10.1007/s00127-012-0536-3

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  • DOI: https://doi.org/10.1007/s00127-012-0536-3

Keywords

  • Social inequalities
  • Mental health
  • Europe
  • Risk factors
  • General population