Piet Bracke

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.

Assessment of social psychological determinants of satisfaction with childbirth in a cross-national perspective.

BackgroundThe fulfilment of expectations, labour pain, personal control and self-efficacy determine the postpartum evaluation of birth. However, researchers have seldom considered the multiple determinants in one analysis. To explore to what extent the results can be generalised between countries, we analyse data of Belgian and Dutch women. Although Belgium and the Netherlands share the same language, geography and political system and have a common history, their health care systems diverge. The Belgian maternity care system corresponds to the ideal type of the medical model, whereas the Dutch system approaches the midwifery model. In this paper we examine multiple determinants, the fulfilment of expectations, labour pain, personal control and self-efficacy, for their association with satisfaction with childbirth in a cross-national perspective.MethodsTwo questionnaires were filled out by 605 women, one at 30 weeks of pregnancy and one within the first 2 weeks after childbirth either at home or in a hospital. Of these, 560 questionnaires were usable for analysis. Women were invited to participate in the study by independent midwives and obstetricians during antenatal visits in 2004–2005. Satisfaction with childbirth was measured by the Mackey Satisfaction with Childbirth Rating Scale, which takes into account the multidimensional nature of the concept. Labour pain was rated retrospectively using Visual Analogue Scales. Personal control was assessed with the Wijma Delivery Expectancy/Experience Questionnaire and Pearlin and Schoolers mastery scale. A hierarchical linear analysis was performed.ResultsSatisfaction with childbirth benefited most consistently from the fulfilment of expectations. In addition, the experience of personal control buffered the lowering impact of labour pain. Women with high self-efficacy showed more satisfaction with self-, midwife- and physician-related aspects of the birth experience.ConclusionOur findings focus the attention toward personal control, self-efficacy and expectations about childbirth. This study confirms the multidimensionality of childbirth satisfaction and demonstrates that different factors predict the various dimensions of satisfaction. The model applies to both Belgian and Dutch women. Cross-national comparative research should further assess the dependence of the determinants of childbirth satisfaction on the organisation of maternity care.

Stigmatization and Self-Esteem of Persons in Recovery From Mental Illness: the Role of Peer Support

Background: Persons with mental health problems often experience stigmatization, which can have detrimental consequences for their objective and subjective quality of life. Previous research seeking for elements buffering this negative association focused on coping strategies and revealed that none of the most often used strategies is successful. Aims: This article studies whether peer support among clients can moderate this negative link, and to what extent. Following the buffering hypothesis on stress and social support, it was expected that the association between stigmatization and self-esteem would be less among persons experiencing greater peer support. Methods: This research problem was studied by means of ordinary least squares regression analysis using quantitative data from structured questionnaires completed by 595 clients of rehabilitation centres. Results and Conclusions: The results confirm that stigmatization is negatively related to self-esteem, while peer support is positively linked with it. Furthermore, they show that peer support moderates the negative association between stigmatization and self-esteem, but not in the expected way. These findings suggest that peer support can only have positive outcomes among clients with few stigma experiences, and that stigmatization itself could impede the formation and beneficial consequences of constructive peer relationships among persons receiving professional mental healthcare.

The three-year persistence of depressive symptoms in men and women.

Little is known about sex differences in the course of depression. The results of the few surveys of the general population are inconsistent. Furthermore, the generalizability of most of these findings is limited. First, only a handful of studies of the general population use a prospective design to estimate the persistence of depression in women and men. Second, in some studies only particular subgroups of the general population are sampled, and finally, depression persistence is often measured using unconventional short time-intervals. Using data from five waves of the Flemish subsample of the Panel Study of Belgian Households (PSBH)--a probability sample of 1168 (52.5%) women and 1055 (47.5%) men--we tried to go beyond these shortcomings. Depression persistence is estimated using a self-report inventory on four occasions separated by intervals of one year (1993, 1994, 1995, 1996). Results show a significant influence of sex, other sociodemographic characteristics, and depression severity at baseline on three-year depression persistence. Women experience more chronicity, a difference that can be partially ascribed to sex differences in employment status, education and marital status. Persistence in linked to marital status in women. In men persistence is associated with level of education and with employment status. Depression severity at baseline, however, largely explains the influence of these social conditions on depression persistence.

Gender and age inequalities in regular sports participation: A cross-national study of 25 European countries

Abstract This article provides a unique opportunity to compare gender inequalities in sports participation across Europe, and the extent to which this varies by age using large, cross-sections of the population. The Eurobarometer Survey 62.0 (carried out in 2004 at the request of the European Commission and covering the adult population of 25 European member states, N = 23,909) was used to analyse differences in regular sports participation by gender and by age in the different countries. For the majority of countries, the occurrence of regular sporting activity was less than 40%. Additionally, binary logistic regression analyses identified significant gender differences in sports participation in 12 countries. In Belgium, France, Greece, Latvia, Lithuania, Slovakia, Spain, and the UK, men were more likely to report being regularly active in sports than women, whereas in Denmark, Finland, Sweden, and the Netherlands the opposite was true. Moreover, the extent to which these gender inequalities differ by age varies considerably across countries. The results imply that: (i) in some European countries more efforts must be undertaken to promote the original goals of the Sport for All Charter, and (ii) to achieve more female participation in sports will require different policy responses in the diverse European member states.

Sex differences in the course of depression: evidence from a longitudinal study of a representative sample of the Belgian population.

Abstract Outcome studies of major depression indicate high rates of relapse and chronicity, and social role theories imply that chronicity should be greater for women, together suggesting that the well-known sex difference in depression is, at least partially, the result of differences in chronicity. Due to a lack of prospective, longitudinal research, answers to this empirical question are missing. Furthermore, the results of the few available surveys of the general population are inconsistent, showing either higher chronicity for older women or a lack of sex differences in the overall course of depression. Using data from three waves of the Panel Study of Belgian Households (complete data for 3204 women and 2907 men, aged 16 years and older) sex differences in the persistence of depressive behavior are estimated. Depression is measured using a self-report inventory on three occasions separated by intervals of 1 year (1992, 1993, 1994). Results show a significant influence of sex, other sociodemographic characteristics, and depression severity at baseline on depression persistence. Women experience more symptoms for a longer period of time, a difference that can be partially ascribed to sex differences in employment status, education, and marital status. The findings are discussed.

The Pivotal Role of Women in Informal Care

Supporting and caring for each other are crucial parts of the social tissue that binds people together. In these networks, men and women hold different positions: Women more often care more for others, listen more to the problems of others, and, as kin keepers, hold families together. Is this true for all life stages? And are social conditions, among other things bound to the organization of work and family, an essential explanation of these differences? Data from the sixth wave (1997) of the Panel Study of Belgian Households allow us to answer these questions. The results show that women are the glue holding social relations together. They play a central role as friends, daughters, sisters, mothers, and grandmothers throughout all stages of the life course. Similar life commitments do not reduce these gender differences but instead emphasize them even further.

The association between network social capital and self-rated health: pouring old wine in new bottles?

This study examines whether there is an association between network social capital and self-rated health after controlling for social support. Moreover, we distinguish between network social capital that emerges from strong ties and weak ties. We used a cross-sectional representative sample of 815 adults from the Belgian population. Social capital is measured with the position generator and perceived social support with the MOS Social Support-scale. Results suggest that network social capital is associated with self-rated health after adjustment for social support. Because different social classes have access to different sets of resources, resources of friends and family from the intermediate and higher service classes are beneficial for self-rated health, whereas resources of friends and family from the working class appear to be rather detrimental for self-rated health. From a health-promoting perspective, these findings indicate that policy makers should deal with the root causes of socioeconomic disadvantages in society.

Does a referral from home to hospital affect satisfaction with childbirth? A cross-national comparison

BackgroundThe Belgian and Dutch societies present many similarities but differ with regard to the organisation of maternity care. The Dutch way of giving birth is well known for its high percentage of home births and its low medical intervention rate. In contrast, home births in Belgium are uncommon and the medical model is taken for granted. Dutch and Belgian maternity care systems are compared with regard to the influence of being referred to specialist care during pregnancy or intrapartum while planning for a home birth. We expect that a referral will result in lower satisfaction with childbirth, especially in Belgium.MethodsTwo questionnaires were filled out by 605 women, one at 30 weeks of pregnancy and one within the first two weeks after childbirth, either at home or in a hospital. Of these, 563 questionnaires were usable for analysis. Women were invited to participate in the study by independent midwives and obstetricians during antenatal visits in 2004–2005. Satisfaction with childbirth was measured by the Mackey Satisfaction with Childbirth Rating Scale, which takes into account the multidimensional nature of the concept.ResultsBelgian women are more satisfied than Dutch women and home births are more satisfying than hospital births. Women who are referred to the hospital while planning for a home birth are less satisfied than women who planned to give birth in hospital and did. A referral has a greater negative impact on satisfaction for Dutch women.ConclusionThere is no reason to believe Dutch women receive hospital care of lesser quality than Belgian women in case of a referral. Belgian and Dutch attach different meaning to being referred, resulting in a different evaluation of childbirth. In the Dutch maternity care system home births lead to higher satisfaction, but once a referral to the hospital is necessary satisfaction drops and ends up lower than satisfaction with hospital births that were planned in advance. We need to understand more about referral processes and how women experience them.

Macro-level gender equality and depression in men and women in Europe.

A recurrent finding in international literature is a greater prevalence of depression in women than in men. While explanations for this gender gap have been studied extensively at the individual level, few researchers have studied macro-level determinants of depression in men and women. In the current study we aim to examine the micro-macro linkage of the relationship between gender equality and depression by gender in Europe, using data from the European Social Survey, 2006-2007 (N=39,891). Using a multilevel framework we find that a high degree of macro-level gender equality is related to lower levels of depression in both women and men. It is also related to a smaller gender difference in depression, but only for certain social subgroups and only for specific dimensions of gender equality.