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Social inequalities in mental health: results from the EU contribution to the World Mental Health Surveys Initiative



The objective of the present study was to provide updated data from nine European countries about the impact of social inequalities in the prevalence of common mental disorders.


Cross-sectional household survey of a representative sample of the adult general population of Belgium, Bulgaria, Germany, Italy, The Netherlands, Northern Ireland, Portugal, Romania and Spain. In total, 34,395 individuals were included. Social inequalities in 12-month mood, anxiety and alcohol-related disorders were evaluated.


In Europe, income seems not to be related to the prevalence of mental disorders. Unemployment and disablement are associated with mental disorders. Lower educational level augments the risk for mood disorders. Living in small (rural) areas decreases the risk for mood disorders and living in urban settings increases it. Northern Ireland, Portugal and Belgium are the countries with the highest risks for mental disorders.


Despite some contradictions with previous literature, in Europe there are social inequalities in the prevalence of mental disorders. However, income showed not to be associated with inequalities in mental health. Being younger, unemployed or disabled, with no education or incomplete primary studies, living in urban settings, and in Northern Ireland, Portugal or Belgium were associated to an augmented prevalence of mental disorders. Policy makers could focus on mental health promotion and mental disorders prevention programmes for risk groups such as unemployed/disabled individuals. Support to vulnerable groups (unemployed or those with less education) and mental health literacy can improve European citizens’ mental health.

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The World Health Organisation World Mental Health (WMH) Survey Initiative is supported by the National Institute of Mental Health (NIMH; R01 MH070884), the John D. and Catherine T MacArthur Foundation, the Pfizer Foundation, the US Public Health Service (R13-MH066849, R01-MH069864, and R01 DA016558), the Fogarty International Centre (FIRCA R03-TW006481), the Pan American Health Organisation, Eli Lilly and Company, Ortho-McNeil Pharmaceutical, Inc., GlaxoSmithKline, and Bristol-Myers Squibb. The ESEMeD project was funded by the European Commission (Contracts QLG5-1999-01042, SANCO 2004123 and EAHC 20081308), the Piedmont Region (Italy), Fondo de Investigación Sanitaria, Instituto de Salud Carlos III, Spain (FIS 00/0028), Ministerio de Ciencia y Tecnología, Spain (SAF 2000-158-CE), Departament de Salut, Generalitat de Catalunya, Spain, Instituto de Salud Carlos III (CIBER CB06/02/0046, RETICSRD06/0011 REM-TAP). The analysis for this paper was carried out in conjunction with the World Health Organization WMH Survey Initiative. We thank the WMH staff for assistance with instrumentation, fieldwork and data analysis. This project was co-funded by the Executive Agency for Health and Consumers and the European Commission (2008/1308 EU WMH). Information about the funding of WMH can be found here: http://www.hcp.med.harvard.edu/wmh/.

Conflict of interest

The authors declare that they have no conflict of interest.

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Correspondence to Alejandra Pinto-Meza.

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Pinto-Meza, A., Moneta, M.V., Alonso, J. et al. Social inequalities in mental health: results from the EU contribution to the World Mental Health Surveys Initiative. Soc Psychiatry Psychiatr Epidemiol 48, 173–181 (2013). https://doi.org/10.1007/s00127-012-0536-3

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  • Social inequalities
  • Mental health
  • Europe
  • Risk factors
  • General population