TY - JOUR
T1 - Gender gap in health service utilisation and outcomes of depression
T2 - a cross-country longitudinal analysis of European middle-aged and older adults
AU - Roxo, Luis
AU - Silva, Manuela
AU - Perelman, Julian
N1 - Funding Information:
This paper uses data from SHARE Waves 4 (DOI: https://doi.org/10.6103/SHARE.w4.710 ), 5 (DOI: https://doi.org/10.6103/SHARE.w5.710 ) and 6 (DOI: https://doi.org/10.6103/SHARE.w6.710 ). The SHARE data collection has been funded by the European Commission through FP5 ( QLK6-CT-2001-00360 ), FP6 (SHARE-I3: RII-CT-2006-062193 , COMPARE: CIT5-CT-2005-028857 , SHARELIFE: CIT4-CT-2006-028812 ), FP7 (SHARE-PREP: GA N° 211909 , SHARE-LEAP: GA N° 227822 , SHARE M4: GA N° 261982 , DASISH: GA N° 283646 ) and Horizon 2020 (SHARE-DEV3: GA N° 676536 , SHARE-COHESION: GA N° 870628 , SERISS: GA N° 654221 , SSHOC: GA N° 823782 ) and by DG Employment, Social Affairs & Inclusion. Additional funding from the German Ministry of Education and Research, the Max Planck Society for the Advancement of Science, the U.S. National Institute on Aging ( U01_AG09740-13S2 , P01_AG005842 , P01_AG08291 , P30_AG12815 , R21_AG025169 , Y1-AG-4553-01 , IAG_BSR06-11 , OGHA_04-064 , HHSN271201300071C ) and from various national funding sources is gratefully acknowledged (see www.share-project.org ).
Funding Information:
LR is a PhD candidate funded by the Portuguese Foundation for Science and Technology – FCT [PD/BD/135591/2018]. This institution had no role in the study design; collection, analysis and interpretation of data; the writing of the manuscript; or the decision to submit the manuscript for publication.
Publisher Copyright:
© 2021
PY - 2021/12
Y1 - 2021/12
N2 - Research has shown that health service utilisation for depression (HSUD) is less common among men than women. However, most evidence is cross-sectional, and there is limited information about gendered outcomes of depression. This cross-country study assesses gender differences in HSUD and in the persistence of depression by using cross-sectional and longitudinal data. We used data from the Survey of Health, Ageing and Retirement in Europe (SHARE), from 5428 participants between 50 and 80 from nine European countries, fulfilling criteria for depression in Wave 5 (assessed by the EURO-D depression scale). We modelled non-HSUD among all those depressed in Wave 5 (“cross-sectional data”) and those not depressed in Wave 4 (“longitudinal data”), and the persistence of depression in Wave 6, as a function of gender. We used logistic regressions adjusted for age, marital status, country, education, financial strain, and severity of depression. Non-HSUD was more likely among depressed men than women in both cross-sectional (82.4% vs 73.2%, OR = 1.54, 99%CI = 1.54–1.55) and longitudinal analyses (94.4% vs 88.3%, OR = 2.27, 99%CI = 2.25–2.29). Gender differences were greater among low-educated participants and those with less pronounced financial strain. Among those with HSUD, men were more likely to remain depressed (62.3%, OR = 2.26, 99%CI = 2.22–2.30). Among those without HSUD, depression was more likely to persist among women (45.4%, OR = 0.79, 99%CI = 0.78–0.79). Results suggest that cross-sectional analyses underestimate men's disadvantage in HSUD. Interventions are needed to improve the demand for care and treatment adequacy among men, increasing their perception of need and their mental health literacy.
AB - Research has shown that health service utilisation for depression (HSUD) is less common among men than women. However, most evidence is cross-sectional, and there is limited information about gendered outcomes of depression. This cross-country study assesses gender differences in HSUD and in the persistence of depression by using cross-sectional and longitudinal data. We used data from the Survey of Health, Ageing and Retirement in Europe (SHARE), from 5428 participants between 50 and 80 from nine European countries, fulfilling criteria for depression in Wave 5 (assessed by the EURO-D depression scale). We modelled non-HSUD among all those depressed in Wave 5 (“cross-sectional data”) and those not depressed in Wave 4 (“longitudinal data”), and the persistence of depression in Wave 6, as a function of gender. We used logistic regressions adjusted for age, marital status, country, education, financial strain, and severity of depression. Non-HSUD was more likely among depressed men than women in both cross-sectional (82.4% vs 73.2%, OR = 1.54, 99%CI = 1.54–1.55) and longitudinal analyses (94.4% vs 88.3%, OR = 2.27, 99%CI = 2.25–2.29). Gender differences were greater among low-educated participants and those with less pronounced financial strain. Among those with HSUD, men were more likely to remain depressed (62.3%, OR = 2.26, 99%CI = 2.22–2.30). Among those without HSUD, depression was more likely to persist among women (45.4%, OR = 0.79, 99%CI = 0.78–0.79). Results suggest that cross-sectional analyses underestimate men's disadvantage in HSUD. Interventions are needed to improve the demand for care and treatment adequacy among men, increasing their perception of need and their mental health literacy.
KW - Depression
KW - Europe
KW - Gender differences
KW - Longitudinal analysis
KW - SHARE
KW - Socioeconomic status
UR - http://www.scopus.com/inward/record.url?scp=85117720763&partnerID=8YFLogxK
U2 - 10.1016/j.ypmed.2021.106847
DO - 10.1016/j.ypmed.2021.106847
M3 - Article
C2 - 34662596
AN - SCOPUS:85117720763
SN - 0091-7435
VL - 153
JO - Preventive Medicine
JF - Preventive Medicine
M1 - 106847
ER -