Katia Levecque

Gender differences in depression in 23 European countries. Cross-national variation in the gender gap in depression

One of the most consistent findings in the social epidemiology of mental health is the gender gap in depression. Depression is approximately twice as prevalent among women as it is among men. However, the absence of comparable data hampers cross-national comparisons of the prevalence of depression in general populations. Using information about the frequency and severity of depressive symptoms from the third wave of the European Social Survey (ESS-3), we are able to fill the gap the absence of comparable data leaves. In the ESS-3, depression is measured with an eight-item version of the Center for Epidemiological Studies-Depression Scale. In the current study, we examine depression among men and women aged 18-75 in 23 European countries. Our results indicate that women report higher levels of depression than men do in all countries, but there is significant cross-national variation in this gender gap. Gender differences in depression are largest in some of the Eastern and Southern European countries and smallest in Ireland, Slovakia and some Nordic countries. Hierarchical linear models show that socioeconomic as well as family-related factors moderate the relationship between gender and depression. Lower risk of depression is associated in both genders with marriage and cohabiting with a partner as well as with having a generally good socioeconomic position. In a majority of countries, socioeconomic factors have the strongest association with depression in both men and women. This research contributes new findings, expanding the small existing body of literature that presents highly comparable data on the prevalence of depression in women and men in Europe.

Economic hardship and depression across the life course: the impact of welfare state regimes.

Previous research in the United States suggests that depression related to economic hardship decreases with age. We test whether this pattern can be generalized to other developed nations. Based on data from 23 countries in the European Social Survey (2006–2007), multilevel analyses show that the moderating role of age depends on the socio-political context. While the hardship–depression link is not significantly different across the life course in Nordic and Bismarckian regimes, the hardship–depression link increases with age in Southern and Eastern European countries and decreases with age in strength in Anglo-Saxon welfare states. Our findings suggest that welfare state regimes play a significant role in attenuating, boosting, or even reversing the health effects of social experiences such as economic hardship on aging. Health knowledge gained through research that ignores the socio-political context may be limited in terms of generalization.

Psychosocial working conditions and self-reported health in a representative sample of wage-earners: A test of the different hypotheses of the Demand-Control-Support model

PurposeThis paper presents an in-depth examination of the demand–control–support–model (DCS-model). Each hypothesis of the DCS-model is tested: the main effects of job demands, job autonomy, task variation and social support; the additive effects of job strain, active learning and iso-strain; and the interactive buffer-effects of job autonomy, task variation and support on job demands.MethodsData from a representative cross-sectional sample of 11,099 male and female wage-earners are investigated using log linear methods. The outcome measures are self-reported persistent fatigue, musculoskeletal complaints and emotional well-being.ResultsThere is some support for each of the hypotheses. Quantitative job demands and superior support have the strongest effects. The job autonomy and buffer hypotheses are only partially supported.ConclusionsThe strong effects of job demands, support, job strain and active learning are suggesting that a policy aimed at improving psychosocial working conditions should focus on a bearable level of job demands and the quality of social relationships at work.

Measuring employment precariousness in the European Working Conditions Survey: The social distribution in Europe

BACKGROUND Precarious employment is becoming an increasingly important social determinant of health inequalities among workers. The way in which contemporary employment arrangements and their health consequences are addressed in empirical research is mostly based on the contract-related or employment instability dimension. A broader conceptual approach including various important characteristics of the degrading of employment conditions and relations is needed. OBJECTIVE The general objective of this paper is to empirically test a new multidimensional construct for measuring precarious employment in an existing database. Special focus is on the social distribution of precarious employment. METHODS A subsample of 21,415 participants in the EU-27 from the Fourth European Working Conditions Survey-2005 was analysed. A cross-sectional study of the social distribution of precarious employment was conducted through the analysis of proportional differences according to gender, social class and credentials for the European Union as a whole and within each country. The 8 dimensions of the employment precariousness construct were represented by 11 indicators. RESULTS In general, women, workers without supervisory authority, those with fewer credentials, and those living in Eastern and Southern European countries suffer the highest levels of precarious employment. Exceptionally, men, workers with supervisory authority and those with the highest credentials suffer the highest levels of long working hours, schedule unpredictability and uncompensated flexible working times. CONCLUSIONS This article offers the first validation for an innovative multidimensional conceptualisation of employment precariousness applied to the analysis of existing survey data, showing the unequal distribution of precarious employment across the European labour force. This set of indicators can be useful for monitoring precarious employment.

Depression in Europe: does migrant integration have mental health payoffs? A cross-national comparison of 20 European countries

Objectives. Depression is a leading cause of ill health and disability. As migrants form an increasing group in Europe, already making up about 8.7% of the population in 2010, knowledge on migrant-related inequalities in depression is of main public health interest. In this study, we first assess whether migrants in Europe are at higher risk for depression compared to the native population. Second, we assess whether the association between migration and depression is dependent on different forms of migrant integration. Migrant integration is looked at both from the individual and from the national level. Design. Hierarchical linear regression analyses based on data for 20 countries in the European Social Survey 2006/2007 (N = 37,076 individuals aged 15 or more). Depression is measured using the center for Epidemiologic Depression Scale. We consider migrant integration over time (first- and second-generation migrants, differentiated according to European Union (EU) or non-EU origin), barriers to integration (low educational level, financial difficulties, being out of the labor market, ethnic minority status, discrimination), and the host country environment (national migrant integration policy). Controls are gender, age, partner relationship, social support, and welfare state regime. Results. Natives and second-generation migrants do not differ significantly in their risk profile for depression. First-generation migrants show higher levels of depression, with those born outside of Europe to be the worst off. This higher risk for depression is not attributable to ethnic minority status but is mainly due to experienced barriers to socioeconomic integration and processes of discrimination. A countrys national policy on migrant integration shows not to soften the depressing effect of being a first-generation migrant nor does it have indirect beneficial health effects by reducing barriers to integration. Conclusion. In Europe, first-generation EU and non-EU migrants experience higher levels of depression. Second-generation migrants and natives show similar risk profiles.

The structuring of occupational stressors in a Post-Fordist work environment. Moving beyond traditional accounts of demand, control and support

In this study, the traditional components of the Demand-Control-Support-Model are extended with a broad number of occupational stressors, while investigating associations with persistent fatigue, musculoskeletal complaints and emotional well-being. Furthermore, it is assessed how these stressors are structured into distinct dimensions within a population of wage-earners. In a representative cross-sectional sample of 11,099 Flemish (Belgian) employees a range of loglinear techniques is used: logit modelling, latent class analysis and Modified LISREL-modelling. Quantitative, emotional and physical demands, repetitive movements, types of work schedules, problematic autonomy, task variation, social relationships with superiors, job insecurity and bullying behaviour are associated with at least one of the health outcomes, while sudden schedule changes are not. These occupational stressors constitute five dimensions: immaterial demands, physical demands, control over the work environment, social relationships at work and employment uncertainty. These latent dimensions are all significantly related with at least one of the health outcomes - with immaterial demands having the strongest effects. Contemporary work is characterised by a complex combination of stressors, structured within the population into a number of dimensions. More research on the interrelatedness of occupational stressors is needed.

Differential exposure and differential vulnerability as counteracting forces linking the psychosocial work environment to socioeconomic health differences

Background In this article, the link between (1) psychosocial working conditions (job demands, job autonomy, task variation, social support), (2) self-reported health (persistent fatigue, musculoskeletal complaints, emotional well-being) and (3) socioeconomic position (skill levels, occupational status) is explored. The two theoretical pathways linking the psychosocial work environment to socioeconomic differences in health are explored: differential exposure and differential vulnerability. Previously, the focus has often been on social inequalities in exposure to the stressors. The pathway of differential vulnerability in different socioeconomic positions is often neglected. Methods In a representative cross-sectional sample of 11 099 Flemish (Belgian) wage earners, 16–65 years of age (47.5% women), logit modelling is applied. Results Higher exposure to psychosocial occupational stressors is associated with a higher prevalence of adverse health outcomes. Lower skill levels and subordinate occupational positions show a higher prevalence of musculoskeletal complaints, but not of persistent fatigue or emotional well-being. High demands, job strain and iso-strain are more common in higher-skilled, supervisory and managerial positions, but have the strongest health-damaging effects in lower socioeconomic positions. Low control is more prevalent in lower-skilled and subordinate positions, while having stronger adverse health effects in higher socioeconomic positions—the same holds for social support, although it has no clear socioeconomic distribution. Conclusion Differential exposure and differential vulnerability constitute two counteracting forces in constituting the association between the psychosocial work environment and socioeconomic differences in self-reported health complaints among wage earners.

Mental health in a gendered context: Gendered community effect on depression and problem drinking

Socio-economic features of a community influence peoples health. However, not all inhabitants are affected similarly. The present study explores gendered contextual effects on problem drinking and depression with the differential exposure, vulnerability and expression hypotheses of the social stress model in mind. Analyses are based on the pooled data of the Belgian Health Interview Survey 2001 and 2004 (N=21.367 respondents, N=589 municipalities). Results reveal that living in an area with high unemployment is more detrimental for women in terms of depression, but has the same impact on men and women when problem drinking is the outcome.

Linking credentialed skills, social class, working conditions and self-reported health: a focus on health inequality-generating mechanisms.

In this study, focus is on the mechanisms linking credentialed skills and social class relations to five dimensions of occupational stressors and three self-reported health outcomes: persistent fatigue, musculoskeletal complaints and emotional wellbeing. We test for direct health associations of skills/class. Moreover, indirect health associations of skills/class, through differential exposure to occupational stressors and effect modifications of the occupational stressors, are tested. A modified LISREL analysis is applied to a representative cross-sectional sample of 11,099 Flemish wage-earners. The direct health effects of credentialed skills/class are limited, but they are clearly indirectly related to the self-reported health outcomes through differential exposure to occupational stressors. The indirect mechanisms point to both reinforcing and moderating effects on socio-economic health inequalities. Two cases of effect modification are also observed: social class modifying the association between control and persistent fatigue; and skills affecting the association between the quality of social relations and emotional wellbeing. Differential exposure to occupational stressors is a crucial mechanism linking skills/class to socio-economic health inequalities. Direct effects and effect modification of class/skills are relevant, but of limited importance. One of the effect modifications found suggests that a specific focus on contradictory class positions might be warranted in future research.

The association between residential area characteristics and mental health outcomes among men and women in Belgium

AimRecently, interest has grown in the association between contextual factors and health outcomes. This study questions whether mental health complaints vary according to the socio-economic characteristics of the residential area where people live. The gender-specific patterns are studied.MethodsComplaints of depression and generalized anxiety were measured by means of the relevant subscales of the Symptoms Checklist 90-Revised. Multilevel models were estimated with PASW statistics 18, based on a unique dataset, constructed by merging data from the Belgian Health Interview Surveys from 2001 and 2004 with data from 264 municipalities derived from Statistics Belgium and the General Socio-Economic Survey.Main findingsThe results of this exploratory study indicate that the local unemployment rate is associated with complaints of depression among women.ConclusionThis study suggests that policy should approach the male and female population differently when implementing mental health prevention campaigns.