Understanding the gender gap in mental health service use; is stigma a gendered phenomenon? A European cross-national study.

Background: Men less often consult mental health care services than women. Explanations have been suggested but are rarely tested. The gender role theory suggests that men experience a gender role conflict when seeking help, as the male gender role prescribes emotional control and self-reliance. Therefore, we wonder whether the gender gap in help seeking and stigma differs according to the country’s gender equity index (GEI).

Methods: The European countries under study (ranging from high to lower GEI) are Iceland, Germany, Great Britain, Hungary and Cyprus. The ‘Stigma in a Global Context – Mental Health Study’ (2005), interviewed representative samples of the general population (N=3,519), using the vignettes major depression and schizophrenia. Both the gender of the respondent and vignette person and their mutual interaction are considered. Help seeking is addressed by (un)prompted treatment suggestions. Stigma refers to social exclusion after treatment. Linear and logistic regression models are estimated in SPSS19.

Results: Men attach less importance to specialist care in Iceland, Germany, Great Britain and Cyprus and informal care in Iceland and Germany, while they are more likely to recommend self care in Iceland and Cyprus. Men are more susceptible to stigma in Iceland and Hungary, whereas they are less stigmatized in Cyprus.

Discussion: Strikingly, even in a country with a high GEI, the traditional male gender role seems to deter help seeking and trigger stigma.

Conclusion: Health policy should develop alternative therapies that are more in accordance with masculine norms to tackle the taboo surrounding mental health service use for men.