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Close to the edge: discursive, gendered and embodied stress in modern youth
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
2010 (English)Doctoral thesis, comprehensive summary (Other academic)Alternative title
Nära gränsen : diskursiv, könad och förkroppsligad stress hos dagens ungdomar (Swedish)
Abstract [en]

Background Adolescent subjective health and mental problems have become a public health concern not only in Sweden but worldwide. The overall aim of this thesis is to deepen and widen the understanding of young peoples’ subjective health, psychosomatic and stress-related problems. A special focus is put on experienced stress among adolescent girls and young women. The study setting is one youth health centre, and three upper secondary schools in Umeå, a university town in northern Sweden. The research design combines qualitative and quantitative methods with the main focus on qualitative methods. An interdisciplinary theoretical synthesis is utilised, primarily based on bio-psycho-social, phenomenological, and social constructionist approaches.

The three qualitative papers (I-III) are based on the same sample of 40 young women who had sought help at the youth health centre because of their stress-related problems. Paper I explores the stressors experienced by the young women, whereas Paper II explores the lived experiences of stress. Paper III examines the young women’s experiences of living in a violent partner relationship as young teenagers, and how this has affected their lives and health over time. Paper IV investigates perceived stress and subjective health complaints among older adolescents in upper secondary school.

 

Methods Data was derived from: a) a qualitative interview study with 40 adolescent girls and young women, aged between 16–25 years, who had sought help at the youth health centre for stress problems. Qualitative content analysis was used in combination with discourse-orientated analysis (Paper I); a phenomenological approach (Paper II), and narrative method (Paper III); b) a school-based survey with a sample of 16–18-year-old boys and girls (n=1027), in upper secondary school, grades 1 and 2, from different educational programs at three schools. Perceived stress, self-rated health, subjective health complaints, anxiety, and depression, were measured with a questionnaire including a set of instruments. Statistical analyses were descriptive and analytical.

 

Results Paper I identified multiple stressors of modernity, gender orders and youth. Contextual factors, including social constructions and practices of gender, played an important role for the stress experienced by these young women. The results revealed that multiple and intersecting stressors and demands connected to essential life spheres, contributed not only to experiences of distress but also to feelings of constraint. Moreover, the roles of excessive taking of responsibility and failing adult support were revealed.

Paper II illuminated multidimensional lived and embodied experiences of distress. ‘Living close to the edge’ emerged as the common theme running through all of the interviews and captured the young women’s sometimes unbearable situations. The theme contains dimensions of physical, emotional, cognitive, social, and existential distress, as well as dimensions of distrust and disempowerment.

Paper III examined two Swedish adolescent girls’ experiences of living in a violent relationship as teenagers, and how this has affected their lives and health over time. The analysis revealed violation, stress, trauma, coping, and agency during adolescence and the transition into adulthood.

Paper IV showed a high level of perceived stress, and subjective health and stress complaints among boys and girls. High pressure and excessive demands from school were experienced by a majority of boys and girls. Perceived stress was correlated with subjective health and stress complaints and anxiety. There was a clear gender difference: two to three times as many girls than boys reported subjective health complaints, e.g. headaches, tiredness and sleeping difficulties, musculoskeletal pain, sadness and anxiety.

 

Conclusion Several issues of relevance to public health were raised throughout the thesis. According to the interview results, the young women face multiple and intersecting stressors of modernity, gender orders and being young, which correspond to their multidimensional experiences of ‘living close to the edge’. Their experiences of stress are multidimensional, and include physical, emotional, cognitive, social and existential dimensions. Findings from the qualitative study were also mirrored in the findings from the larger group of adolescents in the school survey, where a high proportion of older adolescents, particularly girls, reported perceptions of stress. Moreover, perceived stress correlated to a variety of subjective health complaints and anxiety. The results can be understood and explained from a variety of perspectives. The experience of ‘managing alone’ indicated perceptions of inadequate social support. The overall results indicated a risk of more negative health development, particularly among adolescent girls and young women. Stressors of modernity, gender orders and youth were prominent. The continuation and normalisation of oppression and violence are also discussed as a severe gendered stressor in young women’s lives. This calls for a broad contextualised and gender-sensitive approach to young people’s stress and health problems. In conclusion, the age and gender gap in adolescent health needs to be further explored, and processes of distress, distrust and disempowerment have to be taken more seriously.

Abstract [sv]

Under det senaste decenniet har medier och flertalet nationella forskningsrapporter informerat om ökande psykisk ohälsa och stress bland barn och unga i Sverige. Denna avhandlings syfte är att med hjälp av en utforskande och tvärvetenskaplig ansats fördjupa förståelsen av subjektiva ohälsoproblem och upplevd stress bland unga i Sverige, med speciellt fokus på flickors och unga kvinnors upplevda stressproblem.

Avhandlingen har en explorativ och flexibel studiedesign som kombinerar kvalitativa och kvantitativa forskningsmetoder med särskild tyngdpunkt på de kvalitativa metoderna. Datainsamling har genomförts med a) kvalitativa forskningsintervjuer med en grupp flickor och unga kvinnor (16–25 år) som sökt hjälp för stressrelaterade problem på en ungdomshälsomottagning i Umeå, och b) en skolbaserad enkätunder-sökning med totalt 1027 pojkar och flickor, 16–18 år, i åk 1–2 på tre kommunala gymnasieskolor i Umeå.

Forskningsintervjuerna har huvudsakligen analyserats med kvalitativ innehållsanalys. Innehållsanalysen har i de olika delarbetena sedan kombinerats med diskursorienterad analys (Artikel I), med fenomenologisk ansats (Artikel II) och med narrativ metod (Artikel III). Skolenkäten har analyserats med deskriptiva och analytiska statistiska metoder (Artikel IV).

Resultaten från den kvalitativa intervjuundersökningen med unga kvinnor belyser a) multipla stressorer som kan hänföras till flera parallella områden i livet – men även till samhälleliga diskurser: modernitetens stressorer, genusordningarnas stressorer och ungdoms-årens stressorer, b) multidimensionella, levda och förkroppsligade erfarenheter av stress och ”att leva på gränsen” som innefattar fysiska, emotionella, kognitiva, sociala och existentiella dimensioner och c) erfarenheter av våld och kontroll i partnerrelationer samt deras konsekvenser.

Resultaten från enkätundersökningen med gymnasielever visar att en stor andel av ungdomarna rapporterar subjektiva hälso- och stressbesvär av olika slag inklusive oro och ångest. Jämfört med pojkarna så är det två till tre gånger fler flickor som rapporterar besvär och denna skillnad är signifikant. En majoritet av ungdomarna håller ett högt tempo och upplever sig också pressade av krav från skolan samt av egna inre krav. Upplevelserna av stress i form av högt tempo och höga krav korrelerar med de subjektiva hälso- och stressbesvären samt med ångest.

 

Sammanfattningsvis visar avhandlingen att ungas stressrelaterade och subjektiva hälsobesvär bör förstås i ett vidare socialt sammanhang som inkluderar ett genusperspektiv. Kontext- och genusspecifika interventionsmodeller behöver utvecklas för att möta dessa hälsoproblem, men stress bland unga behöver också diskuteras och studeras vidare i relation till hur samhällsutvecklingen och dess värdegrunder påverkar unga av idag.

 

Place, publisher, year, edition, pages
Umeå: Umeå universitet , 2010. , 109 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1377
Keyword [en]
Sweden, adolescent, youth, young women, stress, distress, health, psychosomatic, subjective health, body, embodiment, lived experience, gender, modernity, discourse, qualitative method, content analysis, interviews, school survey, questionnaire, epidemiology
Keyword [sv]
Sverige, ungdomar, tonår, unga vuxna, tonårsflickor, stress, ångest, subjektiv hälsa, kropp, förkroppsligande, levd erfarenhet, genus, modernitet, kvalitativ metod, kvalitativ innehållsanalys, intervjuer, skolenkät, frågeformulär, epidemiologi
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Public health
Identifiers
URN: urn:nbn:se:umu:diva-37157ISBN: 978-91-7459-093-7 (print)OAI: oai:DiVA.org:umu-37157DiVA: diva2:358206
Public defence
2010-11-12, Norrlands universitetssjukhus, Tandläkarhögskolan, Sal B, 9 tr, Norrlands universitetssjukhus, Umeå, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2010-10-23 Created: 2010-10-21 Last updated: 2015-04-29Bibliographically approved
List of papers
1. Young women facing multiple and intersecting stressors of modernity, gender orders and youth
Open this publication in new window or tab >>Young women facing multiple and intersecting stressors of modernity, gender orders and youth
2010 (English)In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 71, no 9, 1567-1575 p.Article in journal (Refereed) Published
Abstract [en]

This article aims to explore stressors experienced by Swedish adolescent girls and young women, specifically understood in relation to social context and gender theory. Interviews were conducted with 40 young Swedish women, aged 16–25 years, who had sought help at a youth health centre for stress problems. Using qualitative content analysis we identified three clusters of stressors: “the stressors of modernity”, “the stressors of gendered orders”, and “the stressors of youth”. The results revealed that multiple and intersecting discourse-shaped stressors and demands connected to essential life spheres contribute not only to experiences of distress but also to feelings of constraint. Gendered individualism and healthism proved to be essential in understanding the young women’s experienced stress. Failing social support from adults, gendered demands and responsibility taking were also illuminated. This calls for a broad contextualized and gender-sensitive approach to young women’s stress and health problems.

Place, publisher, year, edition, pages
Elsevier Ltd, 2010
Keyword
Sweden; Stress; Adolescents; Young women; Gender; Femininity; Youth health; Qualitative content analysis; Qualitative method
Identifiers
urn:nbn:se:umu:diva-36738 (URN)10.1016/j.socscimed.2010.08.004 (DOI)000283702400005 ()20846769 (PubMedID)
Available from: 2010-10-11 Created: 2010-10-11 Last updated: 2017-12-12Bibliographically approved
2. Living close to the edge: embodied dimensions of distress during emerging adulthood
Open this publication in new window or tab >>Living close to the edge: embodied dimensions of distress during emerging adulthood
2014 (English)In: SAGE Open, ISSN 2158-2440, E-ISSN 2158-2440, Vol. 2, no 4, 1-17 p.Article in journal (Refereed) Published
Abstract [en]

Although self-reported stress-related problems are common among Swedish adolescent girls and young women, few qualitative studies have been made of young people’s own understandings and descriptions of their situation. The aim of our present study, therefore, is to explore and analyze the lived experiences of stress among adolescent girls and young women who had sought help at a youth health center. Interviews were conducted with 40 girls and young women, aged 16-25 years. The interviews were analyzed by qualitative content analysis. “Living close to the edge” is interpreted as the common theme running through all of the interviews and represents the participants’ sometimes unbearable situations. The theme contains dimensions of physical, emotional, cognitive, social, and existential distress, as well as dimensions of distrust and disempowerment. Findings highlight the importance of addressing these dimensions in youth health interventions. The importance of contextualizing young women’s distress is furthermore emphasized.

Place, publisher, year, edition, pages
SAGE Open, 2014
Keyword
stress, mental health, adolescents, youth, gender, embodiment, qualitative method, interviews, medical sociology, stress, psykisk hälsa, ångest, depression, ungdomar, flickor, unga kvinnor, genus, genusteori, fenomenologi, medicinsk sociologi, förkroppsligande, levd kropp, kvalitativ metod, kvalitativ innehållsanalys, intervjuer
National Category
Public Health, Global Health, Social Medicine and Epidemiology Physiotherapy
Research subject
Physiotherapy; Public health
Identifiers
urn:nbn:se:umu:diva-37134 (URN)10.1177/2158244014537083 (DOI)
Projects
Stress and Health in Youth (Umeå SHY)
Funder
Swedish Research Council, 521-2005-4848Swedish Research Council, 344-2011-5478Forte, Swedish Research Council for Health, Working Life and Welfare, 2006-1512
Note

Published in the thesis with the title "Living close to the edge: dimensions of distress, distrust and disempowerment in young women".

Available from: 2010-10-20 Created: 2010-10-20 Last updated: 2017-12-12Bibliographically approved
3. "He messed me up": Swedish adolescent girls' experiences of gender-related partner violence and its consequences over time
Open this publication in new window or tab >>"He messed me up": Swedish adolescent girls' experiences of gender-related partner violence and its consequences over time
2010 (English)In: Violence against Women, ISSN 1077-8012, E-ISSN 1552-8448, Vol. 16, no 2, 207-232 p.Article in journal (Refereed) Published
Abstract [en]

This article illuminates two Swedish adolescent girls' experiences of living in a violent relationship as teenagers and how this has affected their lives and health over time. Interviews were conducted in a youth health center. A combination of qualitative content analysis and narrative analysis describes violation, stress, trauma, coping, and agency during the period of adolescence and transition into adulthood. Despite Swedish progressive public policies on men's violence against women, teenage girls are exposed to male partners' violation, a severe gendered stressor. There is a need for the development of health policy and gender-responsive interventions geared specifically toward adolescent girls.

Place, publisher, year, edition, pages
Sage, 2010
Keyword
feminist narrative, posttraumatic stress, youth health policy
National Category
Medical and Health Sciences
Research subject
Physiotherapy; Medicine
Identifiers
urn:nbn:se:umu:diva-30607 (URN)10.1177/1077801209356347 (DOI)000273344800006 ()20053948 (PubMedID)
Available from: 2010-01-12 Created: 2010-01-08 Last updated: 2017-12-12Bibliographically approved
4. Subjective health complaints in older adolescents are related to perceived stress, anxiety and gender: a cross-sectional school study in Northern Sweden
Open this publication in new window or tab >>Subjective health complaints in older adolescents are related to perceived stress, anxiety and gender: a cross-sectional school study in Northern Sweden
Show others...
2012 (English)In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 12, no 993Article in journal (Refereed) Published
Abstract [en]

Purpose: Adolescent subjective health has become a public health concern in Sweden and worldwide. The purpose of this study is to investigate perceived stress and subjective health complaints among older adolescents.

Methods: Data were derived from a school-based survey with a sample consisting of 16–18 year olds (n=1027), boys and girls, in high school grades 1 and 2, from different educational programs in three public high schools within a university municipality in northern Sweden. Perceived stress, self-rated health, subjective health complaints, anxiety, and depression, were measured with a questionnaire including a set of instruments.

Results: A large proportion of both girls and boys reported health complaints and perceived stress. There was a clear gender difference; girls reported two to three-fold higher proportions of subjective health complaints such as headache, tiredness and sleeping difficulties, musculoskeletal pain, as well as sadness and anxiety. Pressure and demands correlated strongly with psychosomatic symptoms (r=0.71) and anxiety (r=0.71).

Conclusions: The results indicate that subjective health complaints are prevalent during adolescence, especially in girls, and furthermore that perceived stress and demands may be important explanatory factors. Future studies should pay attention to the balance between gender-related demands, perceived control and social support, particularly in the school environment, in order to prevent negative strain and stress-related ill-health. The gender gap in adolescent health needs to be further explored.

Keyword
adolescent, high school students, mental health, stress, psychosomatic, pain, anxiety, depression, sleep, Sweden/epidemiology, tonår, ungdomar, gymnasieelever, kön, genus, psykisk hälsa, skolhälsovård, elevhälsa, stress, psykosomatiska besvär, huvudvärk, värk, smärta, sömn, sömnproblem, ångest, depression
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Public health
Identifiers
urn:nbn:se:umu:diva-37136 (URN)10.1186/1471-2458-12-993 (DOI)
Projects
Stress and Health in Youth (Umeå SHY)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2006-1512Swedish Research Council, 521-2005-4848
Available from: 2013-01-03 Created: 2010-10-20 Last updated: 2017-12-12Bibliographically approved

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