Veerle Buffel

Employment status and mental health care use in times of economic contraction: a repeated cross-sectional study in Europe, using a three-level model

IntroductionFramed within the recent economic crisis, in this study we investigate the medical mental health care use of the unemployed compared with that of the employed in Europe, and whether the relationship between employment status and mental health care use varies across macro-economic conditions. We examine whether the macro-economic context and changes therein are related to mental health care use, via their impact on mental health, or more directly, irrespective of mental health.MethodsWe use data from three waves of the Eurobarometer (2002, 2005/2006, and 2010), which has a repeated cross-sectional and cross-national design. Linear and logistic multilevel regression analyses are performed with mental health, contacting a general practitioner, and contacting a psychiatrist for mental health problems as dependent variables. The multilevel design has three levels (the individual, the period-country, and the country), which allows us to estimate both longitudinal and cross-sectional macro-effects. The macro-economic context and changes therein are assessed using national unemployment rates and growth rates in Gross Domestic Product (GDP).ResultsThe mean unemployment rate is negatively related to mental health, although for women, this effect only applies to the employed. Among women, no relationship is found between changes in the macro-economic context and mental health. The unemployment rate, and changes in both the unemployment rate and the real GDP growth rate, are associated with men’s care use, regardless of their mental health, whereas this does not hold for women. In countries with an increase in the unemployment rate, both unemployed and employed men tend to medicalize their problems more by contacting a general practitioner, irrespective of their mental health, while the likelihood of contacting a psychiatrist is lower among employed men.ConclusionsOur findings stress the importance of taking the macro-economic context and changes therein into account when studying the mental health care use of unemployed people compared with the employed, in particular among men. Moreover, it is important to make the distinction between primary and specialized medical care use, as the impact of macro-economic conditions is dependent on the type of care, which also applies when controlling for mental health.

The social norm of unemployment in relation to mental health and medical care use: the role of regional unemployment levels and of displaced workers

The relationships between unemployment, mental health (care) and medication use among 50–65 year-old men (N = 11,789) and women (N = 15,118) are studied in Europe. Inspired by the social norm theory of unemployment, the relevance of regional unemployment levels and workplace closure are explored, using multilevel analyses of data from the Survey of Health, Ageing and Retirement. In line with the social norm theory, the results show that – only for men – displaced workers are less depressed and use less medication than the non-displaced unemployed. However, they report more depressive symptoms than the employed, which supports the causal effect of unemployment on mental health. Non-displaced unemployed men are also more likely to consume medication than the displaced unemployed. In addition, using regional unemployment as a proxy for the social norm of unemployment can be questioned when studying mental health effects, as it seems to be a stronger measurement of labour market conditions than of the social norm of unemployment, especially during a recession.

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.

PurposeThis 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.MethodsData from the Eurobarometer 248 (2005–2006) for 29 European countries is used and country-specific logistic regression analyses are performed.ResultsGender 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.ConclusionsOur 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 specific effects of financial and housework contributions on depression: A multi-actor study among three household types in Belgium

Abstract Studies that focus on the effects of both the division of household chores and of financial contributions on the mental health of couples are scarce. This paper expands on previous research by paying attention to the variation of this relationship among three types of households: Male breadwinner, one-and-a-half-earner and dual-earner. Using paired data from the 10th wave of the Panel Study of Belgian Households, collected in 2001, we perform separate linear regressions for men (N = 1054) and women (N = 1054). The results suggest that in one-and-a-half-earner households, women’s employment has a negative effect on their partner’s depression level and that in dual-earner households, the effect of women’s employment is only negative if men are not the major breadwinner. Crossover effects of depression between partners seem to mediate part of the aforementioned associations.

The institutional foundations of medicalization : a Cross-national analysis of mental health and unemployment

In this study, we question (1) whether the relationship between unemployment and mental healthcare use, controlling for mental health status, varies across European countries and (2) whether these differences are patterned by a combination of unemployment and healthcare generosity. We hypothesize that medicalization of unemployment is stronger in countries where a low level of unemployment generosity is combined with a high level of healthcare generosity. A subsample of 36,306 working-age respondents from rounds 64.4 (2005–2006) and 73.2 (2010) of the cross-national survey Eurobarometer was used. Country-specific logistic regression and multilevel analyses, controlling for public disability spending, changes in government spending, economic capacity, and unemployment rate, were performed. We find that unemployment is medicalized, at least to some degree, in the majority of the 24 nations surveyed. Moreover, the medicalization of unemployment varies substantially across countries, corresponding to the combination of the level of unemployment and of healthcare generosity.

The use of mental health care, psychotropic drugs and social services by divorced people: does informal support matter?

This study compares the mental health care, psychotropic drugs and social service use of divorced people (re-partnered or single) with that of married people. This paper questions whether the availability of informal support facilitates or substitutes for formal care seeking. Data from the Divorce in Flanders survey of 2009–2010 are used. Logistic regression analyses are performed separately for women (N = 3450) and men (N = 3020). Greater use of mental health care, psychotropic drugs and social services by single divorced men is explained by their higher need for care, while divorced women (especially single divorced) more frequently contact a general practitioner (GP), a psychiatrist, or a psychologist, regardless of their mental health, socio-economic background and informal support. Women who have support from non-family members are more inclined to use social services and to contact a GP, while support from family members is only positively related to GP consultations. With regard to men, informal support from non-family members positively influences each type of formal care seeking. Our results suggest that non-family members (and only among women, family members as well) can provide help and advice about seeking professional mental health care and social services, but they do not have an influence on psychotropic drug use.

Medicalization of sleep problems in an aging population : a longitudinal cross-national study of medication use for sleep problems in older European adults

Objective: The association between age and sleep problems is considered to be positive, and medication use is a common health care intervention among older individuals. Because daytime consequences are often stated as a reason to seek care, we study to what extent the medicalization of sleep problems is found in an aging European population, with a focus on daily activities. Method: Data from the Survey of Health Ageing and Retirement in Europe are used in three-level, generalized linear mixed models. Medicalization is operationalized as the use of medication for sleep problems at least once per week. Results: Men are more likely than women to use medication for sleep problems, and the process of aging is associated with a decrease in medicalization. Discussion: Sleep problems seem to be medicalized particularly when they prevent aging individuals from engaging in work-related responsibilities, as medication is especially used by employed individuals with sleep problems.

The relation between religion and depression in Europe: The moderating role of the religious context

Previous research has found that religiosity is positively related to mental well-being. This study assesses whether the religious context moderates the relationship between individual levels of religiosity and depression in the religiously diverse European context. We apply multilevel models, examining 68,874 individuals in 29 European countries subdivided into 277 regions from the sixth (2012) and seventh (2014) wave of the European Social Survey. First, we found that religious service attendance is associated with fewer depressive feelings, but the opposite is true for frequency of prayer. Second, the results indicate that the association between religiosity and depression is moderated by the religious context. In less religious regions, depressive symptoms relate less to service attendance than in highly religious regions, while frequency of praying relates to more depressive symptoms in regions with lower levels of religiosity.

Mental Well-Being and the Eco-State: A Classification of Regions and Countries of the European Union

This chapter reports exploratory research work on the link between mental well-being and the ‘eco-state’ within the context of countries and regions of the European Union (EU). For the purpose of this chapter, the ‘eco-state’ is defined—paraphrasing Meadowcroft (2005: 3)—as “a state that places [climate change] considerations at the core of its activities”. It is hypothesized that regions with higher levels of mental well-being are located in eco-states with a good ecological performance. For the purpose of this work, ecological performance in the area of climate change is measured using the Climate Change Performance Index 2013, while mental well-being using the WHO-5 scale derived from the third wave of the cross-sectional European Quality of Life Survey for the year 2011. Using exploratory spatial data analysis (ESDA) and regression analysis, regional clusters of mental well-being are identified and classified according to eco-state typologies of EU countries. While it emerges that the better a country performs in ecological terms, the better the levels of regional mental well-being are, the mechanisms of this association remain to be determined. The chapter concludes by suggesting future directions for research on mental well-being and the eco-state.