Sarah Van de Velde

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.

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.

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.

Gender differences in mental disorders and suicidality in Europe: Results from a large cross-sectional population-based study

INTRODUCTION When evaluating gender differences in mental disorders and suicidality, specifically between European countries, studies are sparse and frequently hindered by methodological issues, such as the limited items evaluated and inconsistent sampling designs. METHODS In ten European countries participating in the World Mental Health Survey Initiative, lifetime internalizing and externalizing disorders and suicidality were assessed among 37,289 respondents. Disorders were classified using DMS-IV criteria. Odds ratios (OR) for gender differences were calculated using logistic regression, while trends across age-groups were tested via gender × age interaction. RESULTS Within countries, prevalence of any lifetime internalizing disorder ranged from 10.8% to 44.5% among women and 5.9% to 26.5% among men, with women having consistently higher odds than men (OR range: 1.52-2.73). Prevalence of any lifetime externalizing disorders ranged from 0.2% to 6.6% among women and 2.2% to 22.4% among men, with women having consistently lower odds than men (OR range: 0.05-0.35). Any lifetime suicide attempt was found in 0.8-5.4% of women and 0.3-2.4% of men, showing inconsistent relative gender-differences across countries (OR range: 0.77-4.72). Significant effects in gender OR across age-groups were not observed for any internalizing disorder or suicide attempt, yet were present for any externalizing disorder in France (p = 0.01), the Netherlands (p = 0.05), and Spain (p = 0.02). LIMITATIONS Mental disorders were assessed with the CIDI 3.0 and not psychiatric evaluations. Suicidality does not fully represent more important clinical events, such as suicide mortality. CONCLUSIONS Consistent across European countries, internalizing disorders are more common among women and externalizing disorders among men, whereas gender differences in suicidality varied.

Does country-context matter? A cross-national analysis of gender and leisure time physical inactivity in Europe

BACKGROUND It is well known that European women are less physically active in their leisure time than European men. Attempts to explain this gender difference often do not succeed in raising the problem above the individual level. However, the size of the disadvantage for women varies considerably across countries, proving that leisure time physical (in)activity takes place in a broader societal context and must also be approached as such. In this sense, some authors have explained womens lack of leisure time physical activity in terms of gendered power relations in society. Therefore, the present article postulates that over and above the individual effect of gender, there is an additional impact of a societys gender-based (in)equality distribution. METHODS By means of the 2005 Eurobarometer survey (comprising 25,745 adults from 27 European countries), gender differences in leisure time physical inactivity (LTPI) were analysed by means of multilevel logistic regression analysis. National gender-based (in)equality was measured by the Gender Empowerment Measure and the Gender Gap Index. RESULTS Controlled for compositional effects, gender differences in LTPI varied as a function of gender-related characteristics at the macro-level. In particular, in countries characterized by high levels of gender-based equality, LTPI differences between men and women even disappeared. CONCLUSION The findings underscore the need to adopt a society-level approach and to incorporate socio-contextual factors in the study of gender disparities in LTPI.

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

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.

Measurement equivalence of the CES-D 8 depression-scale among the ageing population in eleven European countries

Depression is one of the most prevalent mental disorders in later life. However, despite considerable research attention, great confusion remains regarding the association between ageing and depression. There is doubt as to whether a depression scale performs identically for different age groups and countries. Although measurement equivalence is a crucial prerequisite for valid comparisons across age groups and countries, it has not been established for the eight-item version of the Centre for Epidemiological Studies Depression Scale (CES-D8). Using multi-group confirmatory factor analysis, we assess configural, metric, and scalar measurement equivalence across two age groups (50-64 years of age and 65 or older) in eleven European countries, employing data from the Survey of Health, Ageing, and Retirement (SHARE). Results indicate that the construct of depression is comparable across age and country groups, allowing the substantive interpretation of correlates and mean levels of depressive symptoms.

Pregnant women's fear of childbirth in midwife- and obstetrician-led care in Belgium and the Netherlands: test of the medicalization hypothesis

Fear of childbirth has gained importance in the context of increasing medicalization of childbirth. Belgian and Dutch societies are very similar but differ with regard to the organization of maternity care. The Dutch have a high percentage of home births and low medical intervention rates. In contrast, home births in Belgium are rarer, and the medical model is more widely used. By comparing the Belgian and Dutch maternity care models, the association between fear of childbirth and medicalization can be explored. For this study an antenatal questionnaire was completed by 833 women at 30 weeks of pregnancy. Fear of childbirth was measured by a shortened Dutch version of the Childbirth Attitudes Questionnaire. A four-dimensional model with baby-related, pain and injuries-related, general and personal control-related, and medical interventions and hospital care-related fear, fitted well in both countries. Multiple regression analysis showed no country differences, except that Belgian women in midwife-led care were more fearful of medical interventions and hospital care than the Dutch. For the other dimensions, both Belgian and Dutch women receiving midwifery care reported less fear compared to those in obstetric antenatal care. Hence, irrespective of the maternity care model, antenatal care providers are crucial in preventing fear of childbirth.

Keeping it in the family : the self-rated health of lone mothers in different European welfare regimes.

This study examines whether health inequalities exist between lone and cohabiting mothers across Europe, and how these may differ by welfare regime. Data from the European Social Survey were used to compare self-rated general health, limiting long-standing illness and depressive feelings by means of a multi-level logistic regression. The 27 countries included in the analyses are classified into six welfare regimes (Anglo-Saxon, Bismarckian, Southern, Nordic, Central East Europe (CEE) (new EU) and CEE (non-EU). Lone motherhood is defined as mothers not cohabiting with a partner, regardless of their legal marital status. The results indicate that lone mothers are more at risk of poor health than cohabiting mothers. This is most pronounced in the Anglo-Saxon regime for self-rated general health and limiting long-standing illness, while for depressive feelings it is most pronounced in the Bismarckian welfare regime. While the risk difference is smallest in the CEE regimes, both lone and cohabiting mothers also reported the highest levels of poor health compared with the other regimes. The results also show that a vulnerable socioeconomic position is associated with ill-health in lone mothers and that welfare regimes differ in the degree to which they moderate this association.

The worst of both worlds? Origin and destination effects on migrant religiosity

AbstractInsecurity theory states that religiosity is predominantly affected by insecurities experienced during childhood, instead of present insecurities. The empirical research of these aspects, however, has been hampered by the difficulty to disentangle past and present contextual effects. In this respect, first-generation migrants offer an interesting case study that allows us to discern: (1) contextual effects experienced during childhood (i.e. associated with the origin country); (2) contextual effects experienced during later life (i.e. associated with the destination country); and (3) individual effects experienced during later life in the destination country. We test hypotheses using the European Social Survey (ESS) in cross-classified multi-level analyses on 5,900 individuals within on the one hand twenty-five destination countries and on the other 146 origin countries. While insecurity theory offers interesting prospects of explaining origin country variance, the applicability of insecurity theo...Abstract Insecurity theory states that religiosity is predominantly affected by insecurities experienced during childhood, instead of present insecurities. The empirical research of these aspects, however, has been hampered by the difficulty to disentangle past and present contextual effects. In this respect, first-generation migrants offer an interesting case study that allows us to discern: (1) contextual effects experienced during childhood (i.e. associated with the origin country); (2) contextual effects experienced during later life (i.e. associated with the destination country); and (3) individual effects experienced during later life in the destination country. We test hypotheses using the European Social Survey (ESS) in cross-classified multi-level analyses on 5,900 individuals within on the one hand twenty-five destination countries and on the other 146 origin countries. While insecurity theory offers interesting prospects of explaining origin country variance, the applicability of insecurity theory to migrants at the individual and destination level is questioned by the results.