# The role of education as a socialization mechanism in addressing the social gradient in depression treatment in Belgium (2004–2018)

## TL;DR

This study shows that education, not income, is a key factor in how depression is treated in Belgium, with more educated people using more effective treatments.

## Contribution

The study introduces a novel framework distinguishing education's unique role from income in shaping depression treatment patterns.

## Key findings

- Income is not significantly related to depression treatment, but educational inequalities persist over time.
- Higher education is associated with greater use of psychotherapy or combined treatments.
- Lower education is linked to reliance on pharmaceutical treatment alone.

## Abstract

Previous studies have identified socioeconomic inequalities in the treatment of depression. However, these studies often take a narrow approach, focusing on a single treatment type and lacking a comprehensive theoretical framework. Moreover, income and education are frequently used interchangeably as indicators of disadvantage, without distinguishing their unique impacts. This study argues that relying solely on income to explain treatment inequalities is overly simplistic, suggesting instead that education influences treatment through two distinct pathways. The study’s objectives are twofold: first, to investigate the presence of a social gradient in depression treatment, and second, to examine how this gradient is manifested.

This study utilizes data from the Belgian Health Interview Survey (BHIS), covering four successive waves: 2004, 2008, 2013, and 2018. The weighted data represent a sample of the adult Belgian population. Multinomial regression models are used to address the research aims, and models are plotted to detect trends over time using marginal means post-estimation.

Findings indicate that income is not significantly related to depression treatment, while persistent educational inequalities in treatment are observed over time. Individuals with longer educational attainment are more likely to use psychotherapy alone or a combination treatment, whereas individuals with shorter educational attainment are more likely to use pharmaceutical treatment alone.

This study demonstrates that education plays a critical role in fostering health-related knowledge and reasoning, making individuals with longer education more likely to engage in rational health behaviors and choose more effective treatments, even when these treatments require more effort and competencies. The findings underscore the importance of considering education as a key determinant of depression treatment inequalities.