<p>Gender inequalities in psychological distress have been found in various populations, including occupational groups and countries. There is a lack of studies that compare regions in a uniform operationalisation of distress and integrate occupational groups. 67,641 participants from 36 countries of the European Working Conditions Survey 2021 were analysed. High psychological distress was operationalized using the WHO-5 Well-Being Index. Using predicted probabilities and multilevel regression analysis, gender inequalities between countries, regions and occupational subgroups were calculated. Across most countries, women reported higher psychological distress. The magnitude of gender differences varied between countries, regions and occupations. However, overlapping confidence intervals limit the conclusiveness of the results. When stratifying for both region and occupation type, in the Southern European region and in blue-collar low-skilled occupations gender inequalities were highest. In the significant interaction model, white-collar occupations in Western Europe and blue-collar low-skilled occupations in Southern Europe had the highest gender inequalities. This study demonstrates heterogeneity in the magnitude of gender differences in high psychological distress across Europe and occupational groups. White-collar high-skilled occupations in Western Europe and blue-collar low-skilled occupations in Southern Europe were identified as vulnerable groups. The findings underscore the importance of considering regional patterns when addressing gender-based mental health inequalities in the European workforce.</p>