The effect of gender on mental health service use: an examination of mediation through material, social and health-relat
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ORIGINAL PAPER
The effect of gender on mental health service use: an examination of mediation through material, social and health‑related pathways Allison Milner1 · George Disney1 · Sean Byars1,2 · Tania L. King1 · Anne M. Kavanagh1 · Zoe Aitken1 Received: 4 August 2019 / Accepted: 3 February 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
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. Keywords Gender · Mental health service use · Counterfactual · Causal mediation analysis
Introduction Gender, defined as a “…social construct regarding culturebound conventions, roles, and behaviors, as well as relations between and among women and men” [1], is recognized as a critical social determinant of health [2]. Gender differences in mental health [3, 4] and use of mental health services [5, 6] are consistently observed. Access to high-quality mental health care can lead to improvements in mental health [7]; however, studies show that men are less likely to seek Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00127-020-01844-6) contains supplementary material, which is available to authorized users. * Zoe Aitken [email protected] 1
Disability and Health Unit, Melbourne School Population and Global Health, Centre for Health Equity, The University of Melbourne, Victoria 3010, Australia
Melbourne Disability Institute, The University of Melbourne, Victoria 3010, Australia
2
services for mental health problems than women [8–10]. This is despite the fact that men are clearly in need of mental health care, with suicide rates that are three to four times higher than women [11]. There are a range of possible explanations
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