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Are there gender differences in service use for mental disorders across countries in the European Union? Results from the EU-World Mental Health survey
  1. Vivane Kovess-Masfety1,
  2. Anders Boyd1,2,
  3. Sarah van de Velde1,3,
  4. Ron de Graaf4,
  5. Gemma Vilagut5,
  6. Josep Maria Haro6,
  7. Silvia Florescu7,
  8. Siobhan O'Neill8,
  9. Lauren Weinberg1,
  10. Jordi Alonso5,
  11. the EU-WMH investigators
  1. 1Ecole des Hautes Etudes en Santé Publique (EHESP), EA 4057 Paris Descartes University, Paris, France
  2. 2Inserm UMR_S1136, Institut Pierre-Louis d'Epidemiologie et de Santé Publique, Paris, France
  3. 3Ghent University, Ghent, Belgium
  4. 4Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
  5. 5Institute of Municipal d'Investigacio Medica (IMIM), Barcelona, Spain
  6. 6Parc Sanitari Sant Joan de Déu, CIBERSAM, Universitat de Barcelona, Barcelona, Spain
  7. 7National School of Public Health, Management and Professional Development, Bucharest, Romania
  8. 8Bamford Centre for Mental Health and Well-Being, University of Ulster, Londonderry, Northern Ireland
  1. Correspondence to Professor Viviane Kovess-Masfety, E.H.E.S.P. Rue du Pr Léon Bernard, Rennes 35043, France; viviane.kovess{at}


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.

  • Gender
  • Health Behaviour
  • Health Services
  • Mental Health

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