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Women's subjective and objective health over time: the role of psychosocial conditions and physiological stress responses
Stockholm University, Faculty of Social Sciences, Department of Psychology.
2004 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Today, health problems are likely to have a complex and multifactorial etiology, whereby psychosocial factors interact with behaviour and bodily responses. Women generally report more health problems than men. The present thesis concerns the development of women’s health from a subjective and objective perspective, as related to psychosocial living conditions and physiological stress responses. Both cross-sectional and longitudinal studies were carried out on a representative sample of women. Data analysis was based on a holistic person-oriented approach as well as a variable approach. In Study I, the women’s self-reported symptoms and diseases as well as self-rated general health status were compared to physician-rated health problems and ratings of the general health of the women, based on medical examinations. The findings showed that physicians rated twice as many women as having poor health compared to the ratings of the women themselves. Moreover, the symptom ”a sense of powerlessness” had the highest predictive power for self-rated general health. Study II investigated individual and structural stability in symptom profiles between adolescence and middle-age as related to pubertal timing. There was individual stability in symptom reporting for nearly thirty years, although the effect of pubertal timing on symptom reporting did not extend into middle-age. Study III explored the longitudinal and current influence of socioeconomic and psychosocial factors on women’s self-reported health. Contemporary factors such as job strain, low income, financial worries, and double exposure in terms of high job strain and heavy domestic responsibilities increased the risk for poor self-reported health in middle-aged women. In Study IV, the association between self-reported symptoms and physiological stress responses was investigated. Results revealed that higher levels of medically unexplained symptoms were related to higher levels of cortisol, cholesterol, and heart rate. The empirical findings are discussed in relation to existing models of stress and health, such as the demand-control model, the allostatic load model, the biopsychosocial model, and the multiple role hypothesis. It was concluded that women’s health problems could be reduced if their overall life circumstances were improved. The practical implications of this might include a redesign of the labour market giving women more influence and control over their lives, both at and away from work.

Place, publisher, year, edition, pages
Stockholm: Psykologiska institutionen , 2004. , 66 p.
Keyword [en]
health, medically unexplained symptoms, females, longitudinal, psychosocial, stress
National Category
Psychology
Identifiers
URN: urn:nbn:se:su:diva-124ISBN: 91-7265-853-3 (print)OAI: oai:DiVA.org:su-124DiVA: diva2:189678
Public defence
2004-05-07, David Magnussonsalen (U31), hus 8, Frescati hagväg 8, Stockholm, 14:00
Opponent
Supervisors
Available from: 2004-04-23 Created: 2004-04-23Bibliographically approved
List of papers
1. Self-and physician-rated general health in relation to symptoms and diseases among women
Open this publication in new window or tab >>Self-and physician-rated general health in relation to symptoms and diseases among women
2003 (English)In: Psychology, health and medicine, ISSN 1354-8506, Vol. 8, no 2, 123-135 p.Article in journal (Refereed) Published
Abstract [en]

Self-rated general health has been demonstrated as an important predictor of future morbidity and mortality, but the determinants of perceived good or poor general health are less clear. The aim of the present study was to investigate self- and physician-rated general health status in relation to self-reported symptoms and diseases (n = 488) as well as to physician-reported health problems based on medical examinations (n = 369) among 43-year-old women representing the general population of a Swedish community. Although most women had good general health as reflected by their own as well as by the physicians' ratings, the physicians rated about twice as many women (12%) to have poor health compared to the women themselves (6%). The agreement between the womens' self-reported general health and the physicians' ratings was significant but low (22%). Bivariate correlations showed that many of the symptoms and diseases in the present sample were significantly associated with both self- and physician-rated general health, but the explained variance was low, varying from 1 to 12%. The exception was for a self-reported sense of powerlessness that explained 20% of the variance in self-rated general health. When taken together and analysed by multivariate logistic regression, it was found that only self-reported symptoms predicted the self-rated general health of the women, contributing to 24% of the variance (p < 0.001). In contrast, both physician-reports of health problems (11%) and self-reports of symptoms (13%), respectively, significantly predicted the physician-rated general health of the women, together contributing to 24% of the variance (p < 0.001). Self-reported diseases did not predict either the self-rated or the physician-rated general health of the women. The findings from the present study support the notion that general health status, when rated by a physician or by the woman herself, is a complex and multidimensional concept that is only partly...

National Category
Psychology
Identifiers
urn:nbn:se:su:diva-22881 (URN)
Available from: 2004-04-23 Created: 2004-04-23 Last updated: 2011-01-04Bibliographically approved
2. Symptom development and timing of menarche: A longitudinal study
Open this publication in new window or tab >>Symptom development and timing of menarche: A longitudinal study
2004 (English)In: International Journal of Methods in Psychiatric Research, ISSN 1049-8931, E-ISSN 1557-0657, Vol. 13, no 1, 40-53 p.Article in journal (Refereed) Published
Abstract [en]

Self-reported somatic complaints among females were studied cross sectionally at age 15 and 43, and longitudinally between these two ages. Specifically, the relationship between symptom development and timing of menarche was considered. The sample consisted of 477 females representing the general Swedish population. All the included symptoms were significantly related to each other at both ages. There was also longitudinal correlational stability for all the studied symptoms. Moreover, symptoms at age 15 were associated with early menarcheal timing. Pattern analyses of the studied symptoms were conducted with roots in person-oriented methodology. These results revealed structural as well as individual stability in patterns of symptom reporting for nearly 30 years. That is, similar configurations of symptoms were found at both ages, and it was the same females who reported being either symptom free or reporting a high symptom load at both ages. At age 15 fewer early maturing females than expected by chance reported being symptom free, whereas more of the late maturing females than expected reported being symptom free. However, there were no effects of menarcheal timing on symptom reporting at age 43.

Keyword
biological maturation, somatic complaints, methodology, females
National Category
Psychology
Identifiers
urn:nbn:se:su:diva-22882 (URN)
Available from: 2004-04-23 Created: 2004-04-23 Last updated: 2017-12-13Bibliographically approved
3. Symptom reporting and self-rated health among women in mid-life: the role of work characteristics and family responsibilities
Open this publication in new window or tab >>Symptom reporting and self-rated health among women in mid-life: the role of work characteristics and family responsibilities
2006 (English)In: International Journal of Behavioral Medicine, ISSN 1070-5503, E-ISSN 1532-7558, Vol. 13, no 1, 1-7 p.Article in journal (Refereed) Published
Abstract [en]

This study investigated how socioeconomic factors and psychosocial conditions are related to self-reported health among 43-year-old women representing the general Swedish population (N = 569). Odds ratios and multiple logistic regression analyses were used for associations and effect modification, adjusted for symptom reporting in adolescence. Poor self-reported health was predicted by low income, financial worries, and job strain, as well as combined exposure to a high level of unpaid household work and job strain (double burden). In conclusion, poor psychosocial conditions related to working life, as well as to the combined impact of paid and unpaid work were revealed to be risk factors for poor self-reported health among middle-aged women. These results highlight the need for improving women's work conditions, as well as designing family policies that promote a better sharing of unpaid household tasks and responsibilities between spouses.

Keyword
common symptoms, females, job strain, double exposure
National Category
Psychology
Identifiers
urn:nbn:se:su:diva-22883 (URN)10.1207/s15327558ijbm1301_1 (DOI)
Available from: 2004-04-23 Created: 2004-04-23 Last updated: 2017-12-13Bibliographically approved
4. Medically unexplained symptoms in women as related to physiological stress responses
Open this publication in new window or tab >>Medically unexplained symptoms in women as related to physiological stress responses
2005 (English)In: Stress and Health, ISSN 1532-3005, E-ISSN 1532-2998, Vol. 21, no 1, 45-52 p.Article in journal (Refereed) Published
Abstract [en]

The present, cross-sectional study explored whether self-reported symptoms are related to physiologicalstress indicators in a group of 43-year-old women representing the general populationin Sweden. Analyses were performed both on raw scores of physiological indicators and on a multisystemsummary index of allostatic load as a measure of cumulative biological burden. Participantsanswered a health questionnaire and underwent a medical examination including bloodpressure, heart rate measurements, determination of blood lipids and stress hormones. Urinaryepinephrine and norepinephrine were measured both on a working day and a work free day athome. In addition, salivary morning cortisol was measured on a non-work day. The physiologicalprofiles based on raw scores from 222 women showed that women with a high symptom loadhad significantly higher levels of cortisol (p < 0.05), and higher heart rate (p < 0.05) than didthose with a low symptom load. In contrast, women with a low symptom load had significantlyhigher levels of epinephrine on a work free day than did women with a high symptom load (p <0.05). No significant differences were found in norepinephrine responses. When analysing thesummary measure of allostatic load in relation to symptom prevalence no significant differencebetween the symptom groups emerged. One possible explanation for this result could be that amajority of the study population was healthy, reporting a low level of symptoms in general.However, the results support the notion that common, medically unexplained symptoms amongwomen are associated with certain biological parameters known to play a role in the developmentof ill health.

Keyword
unexplained symptoms, physiological stress, stress responses, self reported symptoms
National Category
Psychology
Identifiers
urn:nbn:se:su:diva-22884 (URN)10.1002/smi.1037 (DOI)
Available from: 2004-04-23 Created: 2004-04-23 Last updated: 2017-12-13Bibliographically approved

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