Social protection spending and inequalities in depressive symptoms across Europe

Purpose
Common mental disorders are an increasing global public health concern. The least advantaged in society experience a greater burden of mental illness, but inequalities in mental health vary by social, political and economic contexts. This study investigates whether spending on different types of social protection alters the extent of social inequality in depressive symptoms.

Methods
Data were obtained from the 2006 and 2012 cross-sectional waves of the European Social Survey, which included 48,397 individuals from 18 European countries. Depressive symptoms were measured using the Center for Epidemiologic Studies - Depression Scale (CES-D 8). Statistical interactions between country-level social protection spending and individuals’ education level, employment and family status were explored using multilevel regression models.

Results
Higher spending on active labour market programmes was related to narrower inequality in depressive symptoms by education level. Compared to men with high education, the marginal effect of having low education was 1.67 (95% CI: 1.46 to 1.87) among men in countries with lower spending and 0.85 (95% CI: 0.66 to 1.03) in higher spending countries. Single parents exhibited fewer depressive symptoms as spending on family policies increased. Little evidence was found for an overall association between spending on unemployment benefits and employment-related inequalities in depressive symptoms, but in 2012 unemployment spending appeared beneficial for mental health among the unemployed.

Conclusions
Greater investment in social protection may act to reduce inequalities in depressive symptoms. Reductions in spending levels or increased conditionality may adversely affect the mental health of disadvantaged social groups.