title: Gender differences in mental disorders and suicidality in Europe: results from a large cross-sectional population-based study.
abstract: BACKGROUND
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Ecole des Hautes Etudes en Santé Publique (EHESP) and EA4057 Paris Descartes University, Paris, France; INSERM UMR_S1136, Institut Pierre-Louis d'Epidémiologie 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) and EA4057 Paris Descartes University, Paris, France; Ghent University, Ghent, and Research Foundation-Flanders, Brussels, Belgium.
authors.forename: Sarah
authors.initials: S
authors.lastname: Van de Velde
authors.affiliation: Health Services Research Unit IMIM-Hospital del Mar Medical Research Institute, Barcelona, and CIBER de Epidemiología y Salud Pública (CIBERESP), Spain.
authors.forename: Gemma
authors.initials: G
authors.lastname: Vilagut
authors.affiliation: Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands.
authors.forename: Ron
authors.initials: R
authors.lastname: de Graaf
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: National School of Public Health, Management and Professional Development, Bucharest, Romania.
authors.forename: Silvia
authors.initials: S
authors.lastname: Florescu
authors.affiliation: Health Services Research Unit IMIM-Hospital del Mar Medical Research Institute, Barcelona, and CIBER de Epidemiología y Salud Pública (CIBERESP), Spain; Department of Experimental and Health Sciences, Pompeu Fabra University (UPF), Barcelona, Spain.
authors.forename: Jordi
authors.initials: J
authors.lastname: Alonso
authors.affiliation: Ecole des Hautes Etudes en Santé Publique (EHESP) and EA4057 Paris Descartes University, Paris, France. Electronic address: viviane.kovess@ehesp.fr.
authors.forename: Vivane
authors.initials: V
authors.lastname: Kovess-Masfety
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D005060:Europe / Q000453:epidemiology; D005260:Female; D006262:Health; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology* / Q000523:psychology; D008875:Middle Aged; D015995:Prevalence; D012727:Sex Characteristics; D013405:Suicide / Q000523:psychology / Q000706:statistics & numerical data*; D013406:Suicide, Attempted / Q000523:psychology / Q000706:statistics & numerical data*
keywords: Europe; Externalizing disorders; Gender differences; Internalizing disorders; Prevalence; Suicidality