EMBARGOED UNTIL MONDAY 7TH APRIL 09:20 CEST
SOCIOECONOMIC INEQUALITIES DRIVE SIGNIFICANT GAPS IN ACCESS TO MENTAL HEALTH CARE ACROSS THE EUROPEAN UNION
Monday 7 April 2025 – 09:20 CEST - A new study presented today at the European Psychiatric Association Congress 2025 reveals significant socioeconomic inequalities in unmet needs for mental health care across European Union countries, with financial barriers disproportionately affecting lower-income populations.
Across Europe, millions of people are affected by mental health conditions. OECD figures from 2018 suggest that around 17% of EU citizens live with a mental health condition.1 The economic burden of mental health is vast – mental ill-health is estimated to cost Member States over 4% of GDP per year.2
This retrospective, cross-sectional study highlights the varying impact of income, education, and urbanisation on unmet mental health care needs, underscoring the need for targeted policy interventions.
The research, led by João Vasco Santos from the University of Porto, analysed data from the 2019 European Health Interview Survey across 26 EU countries. The study focused on self-reported unmet needs for mental health care due to financial reasons, examining inequalities based on income, education, and degree of urbanisation.
Key findings from the study include:
The proportion of self-reported unmet need for mental health care ranged dramatically, from 1.1% in Romania to 27.8% in Portugal, with a median of 3.6%.
Nearly all countries showed a higher share of unmet need among inhabitants with the lowest income quintile. Greece exhibited the highest income-related inequality, with a ratio of 23.8.
15 out of 26 countries showed that less-educated inhabitants had higher unmet needs, with the most significant disparity observed in Bulgaria.
Rural areas generally reported lower unmet needs for mental health care, with Romania showing the highest rural-urban ratio.
"This study highlights the substantial and wide socioeconomic inequalities in unmet mental health care needs across the EU," stated João Vasco Santos, University of Porto and Lead Researcher. "While income inequality consistently impacts access, the role of education varies, and rural areas often report higher unmet needs. Policymakers must prioritise strategies to ensure access to mental health services, enhance mental health literacy, and improve service availability for vulnerable populations."
Dr. Julian Beezhold, the Secretary General of the European Psychiatric Association, commented, "This research provides critical insights into the disparities in mental health care access across the EU, revealing a complex interplay of socioeconomic factors that influence an individual's ability to seek and receive necessary care. It reinforces the importance of addressing these multifaceted socioeconomic factors, not just income, but also education and geographical location, to ensure truly equitable mental health services for all citizens. Furthermore, it highlights the urgent need for robust public health strategies that not only focus on increasing service availability, but also on dismantling the systemic barriers that prevent vulnerable populations from accessing those services. This includes tackling stigma, promoting mental health literacy, and fostering culturally sensitive approaches that resonate with diverse communities within the EU."
The European Congress of Psychiatry takes place from 5-8 April 2025 in Madrid, Spain, and represents Europe’s largest congress dedicated to psychiatry, with around 1,500 attendees: epa-congress.org.
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Full abstract:
Socioeconomic inequalities on unmet needs for mental health care: a cross-section analysis in European Union countries (EPA2025-ABS-3512)
Introduction: Mental health disorders are a leading cause of disability in European Union countries. Previous evidence highlighted the role of socioeconomic inequalities on unmet mental health care needs, varying by income or education. Being both reducing inequalities’ gaps and mental health promotion current goals of European Union (EU), it is essential to understand the differences between EU countries and the role of socioeconomic factors on this.
Objectives: The study aims to assess the socioeconomic inequalities on unmet needs for mental health care in EU countries in 2019.
Methods: This was a cross-sectional study using data from the 2019 European Health Interview Survey across 26 EU countries. The main outcome considered was the proportion of self-reported unmet needs for mental health care due to financial reasons. Inequalities for income, education and degree of urbanisation were assessed by calculating the rural city, primary-tertiary education and lowest-highest income quintiles, respectively.
Results: The proportion of self-reported unmet need for mental health care in 2019 ranged between 1.1% (Romania) and 27.8% (Portugal), with a median of 3.6%. Regarding income inequality, all countries except Hungary (ratio=0.88) showed highest share of unmet need among inhabitants with the lowest income quintile. The country with the highest inequality was Greece with a ratio of 23.8. Regarding education inequality, 15 out of 26 countries showed that less educated inhabitants had highest unmet needs of mental health care, with values ranging from 0.5 in the Netherlands and 7.2 in Bulgaria. As for degree of urbanisation, rurality showed lowest unmet needs for 21 out of 26 countries, with the highest ratio being 2 in Romania.
Conclusions: The study highlights significant and wide socioeconomic (income, education, and urbanization) inequalities in unmet mental health care needs across EU countries. While income inequality plays a similar role across EU countries with the poorer quintile showing higher unmet needs due to financial reasons, EU is divided on the role that education plays. On the opposite side, there is also a tendency across the EU for rural areas showing lower unmet needs for mental health care. Policymakers should prioritise strategies to ensure financial access to mental health services, as well as promoting mental health literacy and improve service availability for vulnerable populations.
Disclosure of Interest:
J. V. Santos: This article was supported by National Funds through FCT - Fundação para a Ciência e a Tecnologia, I.P., within CINTESIS, R&D Unit (reference UIDB/4255/2020)
V. Pinheiro: None Declared.
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