9 General Introduction of autism spectrum disorders and attention deficit hyperactivity disorder (ADHD). Bipolar disorders and schizophrenia vary the least with gender [2]. Last, and most important for this thesis, mental disorders are known to be strongly concentrated among those of low socioeconomic status, measured either at the individual level (income, education, socioeconomic position, employment [8-12]) or through area-based measures (neighbourhood socioeconomic conditions, social capital, built environment. [13, 14]). The quality of the evidence varies considerably in the literature, often reporting associations and less frequently causation. Inequalities driven by socioeconomic status have been mostly documented for common mental disorders, namely depression [13, 15, 16]. There is also evidence of disparities in suicide and suicidal behaviour [13, 14, 17-19]. The evidence of socioeconomic disparities for the severe conditions such as schizophrenia and bipolar disorders is the least consistent, particularly because some early findings were not robust to methodological progress on measurement and analysis [20-23]. Shocks negatively impacting socioeconomic status such as substantial reductions in household income or becoming unemployed have also been shown to increase the risk of mental disorders, especially mood disorders [24]. Life shocks seem responsible for a part of existing mental health disparities: exposure to financial hardship and adverse life events such as separation from spouse, personal injury or jail resulted in a greater risk of mental disorders for the most disadvantaged socioeconomic groups [25]. Another part of adulthood disparities will follow from early stages in life. Children and adolescents at socioeconomic disadvantage are two to three times more likely to develop mental disorders. Among several indicators of socioeconomic status, low parental education and household income substantially impact children and youth mental health [26]. LOW AND UNEQUAL ACCESS TO CARE The substantial treatment gap between those needing mental treatment and those receiving it is a major challenge to mental health policy. This gap persists worldwide, including in high-income countries where service uptake has increased since the 1990s. Estimates from 2001-2012 show that only 37% of all individuals with anxiety, mood, and substance use disorders had received treatment in the past year [27]. Worryingly, the literature suggests that countries with a reduction of the treatment gap in the last decades did not achieve the expected decline in the prevalence of common mental disorders. Among several hypotheses explaining this limited impact is a potential “quality gap”, per which the treatment provided would not meet the minimal standards of clinical practice guidelines or be optimally targeted to those in greatest need [28]. The treatment gap is unequally distributed within countries, being the largest for population groups at socioeconomic disadvantage. The literature on disparities in access 1
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