title: Are there gender differences in service use for mental disorders across countries in the European Union? Results from the EU-World Mental Health survey.
abstract: 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.
authors.affiliation: Ecole des Hautes Etudes en Santé Publique (EHESP), EA 4057 Paris Descartes University, Paris, France.
authors.forename: Vivane
authors.initials: V
authors.lastname: Kovess-Masfety
authors.affiliation: Ecole des Hautes Etudes en Santé Publique (EHESP), EA 4057 Paris Descartes University, Paris, France Inserm UMR_S1136, Institut Pierre-Louis d'Epidemiologie et de Santé Publique, Paris, France.
authors.forename: Anders
authors.initials: A
authors.lastname: Boyd
authors.affiliation: Ecole des Hautes Etudes en Santé Publique (EHESP), EA 4057 Paris Descartes University, Paris, France Ghent University, Ghent, Belgium.
authors.forename: Sarah
authors.initials: S
authors.lastname: van de Velde
authors.affiliation: Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands.
authors.forename: Ron
authors.initials: R
authors.lastname: de Graaf
authors.affiliation: Institute of Municipal d'Investigacio Medica (IMIM), Barcelona, Spain.
authors.forename: Gemma
authors.initials: G
authors.lastname: Vilagut
authors.affiliation: Parc Sanitari Sant Joan de Déu, CIBERSAM, Universitat de Barcelona, Barcelona, Spain.
authors.forename: Josep Maria
authors.initials: JM
authors.lastname: Haro
authors.affiliation: National School of Public Health, Management and Professional Development, Bucharest, Romania.
authors.forename: Silvia
authors.initials: S
authors.lastname: Florescu
authors.affiliation: Bamford Centre for Mental Health and Well-Being, University of Ulster, Londonderry, Northern Ireland.
authors.forename: Siobhan
authors.initials: S
authors.lastname: O'Neill
authors.affiliation: Ecole des Hautes Etudes en Santé Publique (EHESP), EA 4057 Paris Descartes University, Paris, France.
authors.forename: Lauren
authors.initials: L
authors.lastname: Weinberg
authors.affiliation: Institute of Municipal d'Investigacio Medica (IMIM), Barcelona, Spain.
authors.forename: Jordi
authors.initials: J
authors.lastname: Alonso
mesh_terms: D000328:Adult; D005062:European Union; D005260:Female; D006801:Humans; D008297:Male; D008603:Mental Health; D008605:Mental Health Services / Q000706:statistics & numerical data*; D008875:Middle Aged; D016017:Odds Ratio; D012737:Sex Factors; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Gender; Health Behaviour; Health Services; Mental Health