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The effect of gender on mental health service use: an examination of mediation through material, social and health-related pathways

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Abstract

Purpose

We aimed to understand how much of the gender difference in mental health service use could be due to the joint mediation of employment, behavioural and material factors, social support and mental health need.

Methods

We used data from employed individuals aged 18–65 years who participated in the 2015–2017 waves of the Household, Income and Labour Dynamics in Australia survey. The exposure (male, female) and confounders were measured in 2015, mediators in 2016 and the outcome—whether a person had seen a mental health professional in the previous year—was measured in 2017. We estimated natural mediation effects using weighted counterfactual predictions from a logistic regression model.

Results

Men were less likely to see a mental health care provider than women. The total causal effect on the risk difference scale was  − 0.045 (95% CI  − 0.056,  − 0,034). The counterfactual of men taking the mediator values of women explained 28% (95% CI 1.7%, 54%) of the total effect, with the natural direct effect estimated to represent an absolute risk difference of  − 0.033 (95% CI  − 0.048,  − 0.018) and the natural indirect effect  − 0.012 (95% CI  − 0.022,  − 0.0027).

Conclusion

Gendered differences in the use of mental health services could be reduced by addressing inequalities in health, employment, material and behavioural factors, and social support.

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Acknowledgement

We honour the memory of Associate Professor Allison Milner whose intellect, quirk, drive and vitality will never be forgotten. This paper uses unit record data from the Household, Income and Labour Dynamics in Australia HILDA) Survey. The HILDA Project was initiated and is funded by the Australian Government Department of Social Services DSS) and is managed by the Melbourne Institute of Applied Economic and Social Research Melbourne Institute). The findings and views reported in this paper, however, are those of the author and should not be attributed to either DSS or the Melbourne Institute. The data used in this paper was extracted using the Add-On Package PanelWhiz for Stata. PanelWhiz (https://www.PanelWhiz.eu) was written by Dr. John P. Haisken-DeNew (john@PanelWhiz.eu).

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Correspondence to Zoe Aitken.

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Milner, A., Disney, G., Byars, S. et al. The effect of gender on mental health service use: an examination of mediation through material, social and health-related pathways. Soc Psychiatry Psychiatr Epidemiol 55, 1311–1321 (2020). https://doi.org/10.1007/s00127-020-01844-6

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