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Int. J. Environ. Res. Public Health 2013, 10(4), 1324-1341; doi:10.3390/ijerph10041324

Welfare State Regimes, Gender, and Depression: A Multilevel Analysis of Middle and High Income Countries

1 Department of Health Care Management, Korea University, Seoul 136-703, Korea 2 Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 1P8, Canada 3 Institute for Work & Health, Toronto, ON M5G 2E9, Canada 4 Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg 405 30, Sweden 5 Health Inequalities Research Group (GREDS), Employment Conditions Network (EMCONET), University of Pompeu Fabra, Barcelona 08003, Spain 6 Public Health Agency of Barcelona (ASPB), Barcelona 08023, Spain 7 CIBER of Epidemiology and Public Health (CIBERESP), Barcelona 08036, Spain 8 Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON M5T 1P8, Canada
* Author to whom correspondence should be addressed.
Received: 17 February 2013 / Revised: 15 March 2013 / Accepted: 18 March 2013 / Published: 28 March 2013
(This article belongs to the Special Issue Social and Economical Determinants of Health)
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Using the 2002 World Health Survey, we examine the association between welfare state regimes, gender and mental health among 26 countries classified into seven distinct regimes: Conservative, Southeast Asian, Eastern European, Latin American, Liberal, Southern/Ex-dictatorship, and Social Democratic. A two-level hierarchical model found that the odds of experiencing a brief depressive episode in the last 12 months was significantly higher for Southern/Ex- dictatorship countries than for Southeast Asian (odds ratio (OR) = 0.12, 95% confidence interval (CI) 0.05–0.27) and Eastern European (OR = 0.36, 95% CI 0.22–0.58) regimes after controlling for gender, age, education, marital status, and economic development. In adjusted interaction models, compared to Southern/Ex-dictatorship males (reference category), the odds ratios of depression were significantly lower among Southeast Asian males (OR = 0.16, 95% CI 0.08–0.34) and females (OR = 0.23, 95% CI 0.10–0.53) and Eastern European males (OR = 0.41, 95% CI 0.26–0.63) and significantly higher among females in Liberal (OR = 2.00, 95% CI 1.14–3.49) and Southern (OR = 2.42, 95% CI 1.86–3.15) regimes. Our results highlight the importance of incorporating middle-income countries into comparative welfare regime research and testing for interactions between welfare regimes and gender on mental health.
Keywords: welfare state regime; multilevel; global mental health; depression; gender welfare state regime; multilevel; global mental health; depression; gender
This is an open access article distributed under the Creative Commons Attribution License (CC BY) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Chung, H.; Ng, E.; Ibrahim, S.; Karlsson, B.; Benach, J.; Espelt, A.; Muntaner, C. Welfare State Regimes, Gender, and Depression: A Multilevel Analysis of Middle and High Income Countries. Int. J. Environ. Res. Public Health 2013, 10, 1324-1341.

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