Top

Social Psychiatry and Psychiatric Epidemiology

Published in:

Open Access 01-07-2016 | Original Paper

Social protection spending and inequalities in depressive symptoms across Europe

Authors: Claire L. Niedzwiedz, Richard J. Mitchell, Niamh K. Shortt, Jamie R. Pearce

Published in: Social Psychiatry and Psychiatric Epidemiology | Issue 7/2016

Abstract

Purpose

Common mental disorders are an increasing global public health concern. The least advantaged in society experience a greater burden of mental illness, but inequalities in mental health vary by social, political, and economic contexts. This study investigates whether spending on different types of social protection alters the extent of social inequality in depressive symptoms.

Methods

Data were obtained from the 2006 and 2012 cross-sectional waves of the European Social Survey, which included 48,397 individuals from 18 European countries. Depressive symptoms were measured using the Centre for Epidemiologic Studies-Depression Scale (CES-D 8). Statistical interactions between country-level social protection spending and individuals’ education level, employment and family status were explored using multilevel regression models.

Results

Higher spending on active labour market programmes was related to narrower inequality in depressive symptoms by education level. Compared to men with high education, the marginal effect of having low education was 1.67 (95 % CI, 1.46–1.87) among men in countries with lower spending and 0.85 (95 % CI, 0.66–1.03) in higher spending countries. Single parents exhibited fewer depressive symptoms, as spending on family policies increased. Little evidence was found for an overall association between spending on unemployment benefits and employment-related inequalities in depressive symptoms, but in 2012, unemployment spending appeared beneficial to mental health among the unemployed.

Conclusions

Greater investment in social protection may act to reduce inequalities in depressive symptoms. Reductions in spending levels or increased conditionality may adversely affect the mental health of disadvantaged social groups.

Available only for authorised users

Economou M, Madianos M, Peppou LE, Patelakis A, Stefanis CN (2013) Major depression in the Era of economic crisis: a replication of a cross-sectional study across Greece. J Affect Disord 145(3):308–314. doi:10.1016/j.jad.2012.08.008 CrossRefPubMed

Katikireddi SV, Niedzwiedz CL, Popham F (2012) Trends in population mental health before and after the 2008 recession: a repeat cross-sectional analysis of the 1991–2010 Health Surveys of England. BMJ Open 2(5):e001790CrossRefPubMedPubMedCentral

Reeves A, McKee M, Gunnell D, Chang S-S, Basu S, Barr B, Stuckler D (2015) Economic shocks, resilience, and male suicides in the Great Recession: cross-national analysis of 20 EU countries. Eur J Public Health 25(3):404–409. doi:10.1093/eurpub/cku168 CrossRefPubMed

Cylus J, Glymour MM, Avendano M (2014) Do generous unemployment benefit programs reduce suicide rates? A state fixed-effect analysis covering 1968–2008. Am J Epidemiol 180(1):45–52. doi:10.1093/aje/kwu106

Reeves A, McKee M, Stuckler D (2014) Economic suicides in the Great Recession in Europe and North America. Br J Psychiatry 205(3):246–247CrossRefPubMed

Allen J, Balfour R, Bell R, Marmot M (2014) Social determinants of mental health. Int Rev Psychiatry 26(4):392–407. doi:10.3109/09540261.2014.928270 CrossRefPubMed

Pinto-Meza A, Moneta M, Alonso J, Angermeyer M, Bruffaerts R, Caldas de Almeida J, de Girolamo G, de Graaf R, Florescu S, Kovess Masfety V, O’Neill S, Vassilev S, Haro J (2013) Social inequalities in mental health: results from the EU contribution to the World Mental Health Surveys Initiative. Soc Psychiatry Psychiatr Epidemiol 48(2):173–181. doi:10.1007/s00127-012-0536-3 CrossRefPubMed

Muntaner C, Eaton WW, Miech R, O’Campo P (2004) Socioeconomic position and major mental disorders. Epidemiol Rev 26(1):53–62. doi:10.1093/epirev/mxh001 CrossRefPubMed

Whitehead M, Pennington A, Orton L, Nayak S, Petticrew M, Sowden A, White M (2016) How could differences in ‘control over destiny’ lead to socio-economic inequalities in health? A synthesis of theories and pathways in the living environment. Health Place 39:51–61. doi:10.1016/j.healthplace.2016.02.002 CrossRefPubMed

10.

Taylor AW, Chittleborough C, Gill TK, Winefield H, Baum F, Hiller JE, Goldney R, Tucker G, Hugo G (2011) Relationship of social factors including trust, control over life decisions, problems with transport and safety, to psychological distress in the community. Soc Psychiatry Psychiatr Epidemiol 47(3):465–473. doi:10.1007/s00127-011-0354-z CrossRefPubMedPubMedCentral

11.

Van de Velde S, Huijts T, Bracke P, Bambra C (2013) Macro-level gender equality and depression in men and women in Europe. Sociol Health Illn 35(5):682–698CrossRefPubMed

12.

Artazcoz L, Benach J, Borrell C, Cortès I (2004) Unemployment and mental health: understanding the interactions among gender, family roles, and social class. Am J Public Health 94(1):82–88. doi:10.2105/AJPH.94.1.82 CrossRefPubMedPubMedCentral

13.

Ensminger ME, Celentano DD (1990) Gender differences in the effect of unemployment on psychological distress. Soc Sci Med 30(4):469–477. doi:10.1016/0277-9536(90)90349-W CrossRefPubMed

14.

Van de Velde S, Bracke P, Levecque K (2010) Gender differences in depression in 23 European countries. Cross-national variation in the gender gap in depression. Soc Sci Med 71(2):305–313CrossRefPubMed

15.

Chung H, Ng E, Ibrahim S, Karlsson B, Benach J, Espelt A, Muntaner C (2013) Welfare state regimes, gender, and depression: a multilevel analysis of middle and high income Countries. Int J Environ Res Public Health 10(4):1324–1341CrossRefPubMedPubMedCentral

16.

Eikemo TA, Huisman M, Bambra C, Kunst AE (2008) Health inequalities according to educational level in different welfare regimes: a comparison of 23 European countries. Sociol Health Illn 30(4):565–582. doi:10.1111/j.1467-9566.2007.01073.x CrossRefPubMed

17.

Levecque K, Van Rossem R, De Boyser K, Van de Velde S, Bracke P (2011) Economic hardship and depression across the life course the impact of welfare state regimes. J Health Soc Behav 52(2):262–276CrossRefPubMed

18.

Niedzwiedz CL, Katikireddi SV, Pell JP, Mitchell R (2014) Socioeconomic inequalities in the quality of life of older Europeans in different welfare regimes. Eur J Public Health 24(3):364–370CrossRefPubMedPubMedCentral

19.

Niedzwiedz CL, Pell JP, Mitchell R (2015) The relationship between financial distress and life-course socioeconomic inequalities in well-being: cross-national analysis of European Welfare States. Am J Public Health 105(10):2090–2098. doi:10.2105/AJPH.2015.302722 CrossRefPubMed

20.

Bergqvist K, Yngwe M, Lundberg O (2013) Understanding the role of welfare state characteristics for health and inequalities—an analytical review. BMC Public Health 13(1):1234CrossRefPubMedPubMedCentral

21.

Bambra C (2007) Going beyond The three worlds of welfare capitalism: regime theory and public health research. J Epidemiol Community Health 61(12):1098–1102CrossRefPubMedPubMedCentral

22.

Niedzwiedz CL, Katikireddi SV, Pell JP, Mitchell R (2014) The association between life course socioeconomic position and life satisfaction in different welfare states: European comparative study of individuals in early old age. Age Ageing 43(3):431–436CrossRefPubMedPubMedCentral

23.

Dahl E, van der Wel KA (2013) Educational inequalities in health in European welfare states: a social expenditure approach. Soc Sci Med 81:60–69. doi:10.1016/j.socscimed.2012.12.010 CrossRefPubMed

24.

Avendano M, Berkman LF, Brugiavini A, Pasini G (2015) The long-run effect of maternity leave benefits on mental health: evidence from European countries. Soc Sci Med 132:45–53. doi:10.1016/j.socscimed.2015.02.037 CrossRefPubMedPubMedCentral

25.

Reeves A, McKee M, Gunnell D, Chang S-S, Basu S, Barr B, Stuckler D (2014) Economic shocks, resilience, and male suicides in the Great Recession: cross-national analysis of 20 EU countries. Eur J Public Health. doi:10.1093/eurpub/cku168 PubMed

26.

O’Campo P, Molnar A, Ng E, Renahy E, Mitchell C, Shankardass K, St. John A, Bambra C, Muntaner C (2015) Social welfare matters: a realist review of when, how, and why unemployment insurance impacts poverty and health. Soc Sci Med 132:88–94. doi:10.1016/j.socscimed.2015.03.025 CrossRefPubMed

27.

Laven Z, Santi F (2012) EU austerity and reform: a country by country table. The European Institute. http://www.europeaninstitute.org/index.php/ei-blog/148-April-2012/1579-eu-austerity-and-reform-a-country-by-country-table-updated-may-3. Accessed 29 Mar 2016

28.

Huijts T, Reeves A, McKee M, Stuckler D (2015) The impacts of job loss and job recovery on self-rated health: testing the mediating role of financial strain and income. Eur J Public Health 25(5):801–806. doi:10.1093/eurpub/ckv108 CrossRefPubMed

29.

ESS Round 3: European Social Survey Round 3 Data (2006) Data file edition 3.5. Norwegian Social Science Data Services, Norway—Data Archive and distributor of ESS data

30.

ESS Round 6: European Social Survey Round 6 Data (2012) Data file edition 2.1. Norwegian Social Science Data Services, Norway—Data Archive and distributor of ESS data

31.

European Social Survey Sampling (2015) http://www.europeansocialsurvey.org/methodology/sampling.html. Accessed 19 Jan 2015

32.

European Social Survey Fieldwork Summary and Deviations (2015) http://www.europeansocialsurvey.org/data/deviations_index.html. Accessed 19 Jan 2015

33.

European Union (2015) Smarter, greener, more inclusive? Indicators to support the Europe 2020 strategy. Eurostat, Luxembourg

34.

Adema W, Fron P, Ladaique M (2011) Is the European welfare state really more expensive? Indicators on social spending, 1980–2012; and a manual to the OECD social expenditure database (SOCX). OECD Publishing

35.

Radloff LS (1977) The CES-D scale a self-report depression scale for research in the general population. Appl Psychol Meas 1(3):385–401CrossRef

36.

Van de Velde S, Bracke P, Levecque K, Meuleman B (2010) Gender differences in depression in 25 European countries after eliminating measurement bias in the CES-D 8. Soc Sci Res 39(3):396–404CrossRef

37.

Andresen EM, Malmgren JA, Carter WB, Patrick DL (1994) Screening for depression in well older adults: evaluation of a short form of the CES-D. Am J Prev Med 10(2):77–84PubMed

38.

United Nations Educational Scientific and Cultural Organization (2014) ISCED: International Standard Classification of Education http://www.uis.unesco.org/Education/Pages/international-standard-classification-of-education.aspx. Accessed 11 May 2015

39.

Friedli L, Stearn R (2015) Positive affect as coercive strategy: conditionality, activation and the role of psychology in UK government workfare programmes. Med Humanit 41(1):40–47. doi:10.1136/medhum-2014-010622 CrossRefPubMedPubMedCentral

40.

Sjöberg O (2010) Social insurance as a collective resource: unemployment benefits, job insecurity and subjective well-being in a comparative perspective. Soc Forces 88(3):1281–1304. doi:10.1353/sof.0.0293 CrossRef

41.

Stewart-Brown S, Samaraweera PC, Taggart F, Kandala N-B, Stranges S (2015) Socioeconomic gradients and mental health: implications for public health. Br J Psychiatry 206(6):461–465. doi:10.1192/bjp.bp.114.147280 CrossRefPubMed

42.

Nordenmark M, Strandh M, Layte R (2006) The impact of unemployment benefit system on the mental well-being of the unemployed in Sweden, Ireland and Great Britain. Eur Soc 8(1):83–110. doi:10.1080/14616690500491415 CrossRef

43.

Zambon A, Boyce W, Cois E, Currie C, Lemma P, Dalmasso P, Borraccino A, Cavallo F (2006) Do welfare regimes mediate the effect of socioeconomic position on health in adolescence? A cross-national comparison in Europe, North America, and Israel. Int J Health Serv 36(2):309–329CrossRefPubMed

44.

Mitchell RJ, Richardson EA, Shortt NK, Pearce JR (2015) Neighborhood environments and socioeconomic inequalities in mental well-being. Am J Prev Med 49(1):80–84. doi:10.1016/j.amepre.2015.01.017 CrossRefPubMed

45.

Lewinsohn PM, Solomon A, Seeley JR, Zeiss A (2000) Clinical implications of “subthreshold” depressive symptoms. J Abnorm Psychol 109(2):345CrossRefPubMed

46.

Evans-Lacko S, Knapp M, McCrone P, Thornicroft G, Mojtabai R (2013) The mental health consequences of the recession: economic hardship and employment of people with mental health problems in 27 European Countries. PLoS One 8(7):e69792. doi:10.1371/journal.pone.0069792 CrossRefPubMedPubMedCentral

Title: Social protection spending and inequalities in depressive symptoms across Europe
Authors: Claire L. Niedzwiedz
Richard J. Mitchell
Niamh K. Shortt
Jamie R. Pearce
Publication date: 01-07-2016
Publisher: Springer Berlin Heidelberg
Published in: Social Psychiatry and Psychiatric Epidemiology / Issue 7/2016
Print ISSN: 0933-7954
Electronic ISSN: 1433-9285
DOI: https://doi.org/10.1007/s00127-016-1223-6

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Social protection spending and inequalities in depressive symptoms across Europe

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 7/2016

The application of virtual reality technology to understanding psychosis

Depression symptoms across cultures: an IRT analysis of standard depression symptoms using data from eight countries

Prescribed psychiatric medication among multiple sclerosis patients before and after disability pension: a register study with matched controls

Neighbourhood level social deprivation and the risk of psychotic disorders: a systematic review

Prevalence and treatment coverage for depression: a population-based survey in Vidarbha, India

Novel methods in psychiatric epidemiology