title: Welfare state retrenchment and increasing mental health inequality by educational credentials in Finland: a multicohort study.
abstract: OBJECTIVE
  Epidemiological studies have shown an association between educational credentials and mental disorders, but have not offered any explanation for the varying strength of this association in different historical contexts. In this study, we investigate the education-specific trends in hospitalisation due to psychiatric disorders in Finnish working-age men and women between 1976 and 2010, and offer a welfare state explanation for the secular trends found.
  
  
  METHODS
  Population-based setting with a 25% random sample of the population aged 30-65 years in 7 independent consecutive cohorts (1976-1980, 1981-1985, 1986-1990, 1991-1995, 1996-2000, 2001-2005, 2006-2010).
  
  
  METHODS
  Participants were randomly selected from the Statistics Finland population database (n=2,865,746). These data were linked to diagnosis-specific records on hospitalisations, drawn from the National Hospital Discharge Registry using personal identification numbers. Employment rates by educational credentials were drawn from the Statistics Finland employment database.
  
  
  METHODS
  Hospitalisation and employment.
  
  
  RESULTS
  We found an increasing trend in psychiatric hospitalisation rates among the population with only an elementary school education, and a decreasing trend in those with higher educational credentials. The employment rate of the population with only an elementary school education decreased more than that of those with higher educational credentials.
  
  
  CONCLUSIONS
  We propose that restricted employment opportunities are the main mechanism behind the increased educational inequality in hospitalisation for psychiatric disorders, while several secondary mechanisms (lack of outpatient healthcare services, welfare cuts, decreased alcohol duty) further accelerated the diverging long-term trends. All of these inequality-increasing mechanisms were activated by welfare state retrenchment, which included the liberalisation of financial markets and labour markets, severe austerity measures and narrowing down of public sector employment commitment.
authors.affiliation: Centre of Expertise for the Development of Work and Organizations, Finnish Institute of Occupational Health, Tampere and Helsinki, Finland.
authors.forename: Lauri
authors.initials: L
authors.lastname: Kokkinen
authors.affiliation: Bloomberg Faculty of Nursing, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
authors.forename: Carles
authors.initials: C
authors.lastname: Muntaner
authors.affiliation: Department of Social Research, University of Helsinki, Helsinki, Finland UKCRC Centre of Excellence for Public Health, Queen's University Belfast, Belfast, UK Faculty in Wroclaw, University of Social Sciences and Humanities, Poland.
authors.forename: Anne
authors.initials: A
authors.lastname: Kouvonen
authors.affiliation: Centre of Expertise for the Development of Work and Organizations, Finnish Institute of Occupational Health, Tampere and Helsinki, Finland.
authors.forename: Aki
authors.initials: A
authors.lastname: Koskinen
authors.affiliation: Centre of Expertise for the Development of Work and Organizations, Finnish Institute of Occupational Health, Tampere and Helsinki, Finland.
authors.forename: Pekka
authors.initials: P
authors.lastname: Varje
authors.affiliation: Centre of Expertise for the Development of Work and Organizations, Finnish Institute of Occupational Health, Tampere and Helsinki, Finland.
authors.forename: Ari
authors.initials: A
authors.lastname: Väänänen
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D004522:Educational Status; D005260:Female; D005387:Finland / Q000453:epidemiology; D054624:Health Status Disparities; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology*; D008875:Middle Aged; D012946:Social Welfare / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors