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“An equal share, that’s my medicine”. Work, gender relations and mental illness in a Swedish context.
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine. Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS).
2013 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Women and men in Sweden are in paid work to almost the same extent, but are found in different occupations and positions in the labour market. Still, women perform the bulk of the unpaid domestic work at home. Gendered inequalities in these respects leave women and men exposed to different work environments and responsibilities, which in turn can have gendered health consequences. In public health research there is a lack of studies on domestic work that include women and men, as well as a lack of qualitative studies exploring individuals’ experiences of domestic work and mental health. At the workplace level, few attempts have been made to analyse how several dimensions of gender equality at workplaces are related to health status and there is a lack of studies with a contextual approach combining many different variables that are at play simultaneously. Because of the cross-sectional design of previous studies on paid and domestic work there is a lack of analyses taking possible health-related selection into account, which makes it difficult to ascertain whether gender equality leads to better health or if good health is a prerequisite for gender equality.

Aim: The aim of this thesis was to analyse gender relations of work (at workplaces and at home) in relation to mental illness among women and men.

Methods: The thesis was based on data from the Northern Swedish Cohort. The baseline survey was conducted in 1981 when the participants were 16 years old (n= 1080, 574 boys and 506 girls), with follow-up at age 18, 21, 30 and 42. The response rate was 94 % throughout the last follow-up in 2007. Data from the Northern Swedish Cohort were supplemented with register data about the employees at the participants’ workplaces. The analysis methods for the questionnaire and register data were logistic regression analysis and cluster analysis. Interviews were performed with four women and four men in the Northern Swedish Cohort and were analysed with a Grounded Theory approach.

Results: Women had overall greater responsibility for domestic work. Gender inequality in responsibility for domestic work and perceptions of gender inequality in the couple relationship (after adjustments for background variables and previous psychological distress) were associated with psychological distress among women and men. However, among men the relation between domestic work inequalities and psychological distress was affected by socioeconomic position relative to the partner. Having less responsibility for domestic work and a partner with higher socioeconomic position was associated with psychological distress among men. The qualitative analysis showed that gender relations were an important part of how the domestic work was unequally organised and related to experiences of mental illness among women and men. Among women the high burden of domestic work was experienced as an obstacle to experiencing good health. Among men the experience of being trapped in an outmoded masculinity was related to feelings of stress. At the workplace level, patterns of gender inequality were associated with psychological distress among women, but not among men. However, the most gender-equal pattern was related to lower as well as more similar levels of mental illness among women and men, which supports a convergence in health when women’s and men’s work conditions become more similar.

Conclusion: Gender equality at home and at work is central for reducing mental illness among both women and men, but also for achieving a good average health status in the population, which is a central public health target. When investigating social inequalities in health, gender perspectives are of great importance for deepening the understanding of how and why gender inequalities in paid and domestic work are related to mental illness. Integrating gender perspectives into public health policy could be a way to acknowledge power relations that hinder good public health.

Abstract [sv]

Bakgrund: Kvinnor och män i Sverige yrkesarbetar i nästan samma sträckning, men återfinns i olika yrken och positioner på arbetsmarknaden. Samtidigt utför kvinnor merparten av det obetalda arbetet i hemmet. Könade orättvisor i dessa avseenden innebär att kvinnor och män utsätts för olika arbetsmiljöer och ansvarsområden, vilket kan medföra könade hälsokonsekvenser. Dock är det få folkhälsovetenskapliga studier om obetalt arbete i hemmet och hälsa som inkluderar både kvinnor och män. Det är också en brist på kvalitativa studier som undersöker individers upplevelser av det obetalda arbetet i hemmet och psykisk hälsa. På arbetsplatsnivå har det gjorts få försök att analysera hur olika dimensioner av jämställdhet på arbetsplatser är relaterade till hälsostatus, och det är en brist på studier med en kontextuell metod som tar hänsyn till hur flera olika variabler samspelar. Tidigare folkhälsovetenskapliga studier som undersökt förvärvsarbete och hemarbete har framförallt använt sig av en tvärsnittsdesign, vilket gjort det svårt att utreda riktningen av samband mellan jämställdhet och psykisk hälsa, det vill säga om jämställdhet leder till bättre hälsa eller om god hälsa är en förutsättning för jämställdhet.

Syfte: Syftet med denna avhandling var att analysera genusrelationer i arbete (på arbetsplatser och i hemmet) i förhållande till självskattad psykisk ohälsa bland kvinnor och män.

Metod: Avhandlingen bygger på data från Luleåkohorten. Baslinjeundersökningen genomfördes år 1981 då deltagarna var 16 år (n=1080, 574 pojkar och 506 flickor). Uppföljningar har genomförts vid 18, 21, 30 och 42 års ålder och svarsfrekvensen var 94% under det senaste uppföljningen år 2007. Data från Luleåkohorten kompletterades med registerdata om anställda på deltagarnas arbetsplatser. Analysmetoder för enkät- och registerdata var logistisk regressionsanalys och klusteranalys. Intervjuer har genomförts med fyra kvinnor och fyra män i kohorten och analyserats med grundad teori.

Resultat: Kvinnor hade totalt sett ett större och män ett mindre ansvar för det obetalda arbetet i hemmet. Upplevelse av bristande jämställdhet i ansvar för obetalt arbete i hemmet och i parrelationen hade ett samband med psykisk ohälsa bland kvinnor och män (även efter justering för bakgrundsvariabler och tidigare psykisk ohälsa). Att ha mindre ansvar för det obetalda arbetet i hemmet och en partner med högre socioekonomisk klass hade även ett samband med psykisk ohälsa bland män. Den kvalitativa analysen visade att genusrelationer var en viktig del i en ojämställd organisering av hemarbete och relaterade till upplevelser av psykisk ohälsa bland kvinnor och män. En hög belastning av hemarbete var ett hinder för kvinnor att uppleva en god hälsa. Upplevelser av att vara instängd i en omodern maskulinitet innebar en stressfull situation bland män. Mönster av ojämställdhet på arbetsplatser hade ett samband med psykisk ohälsa för kvinnor, men inte för män. Däremot visade sig de mest jämställda arbetsplats-mönstern vara relaterade till lägre och mer liknande nivåer av psykisk ohälsa bland kvinnor och män, vilket stödjer en konvergens i hälsa när kvinnor och mäns arbetsplats förhållanden är likvärdiga.

Slutsats: Jämställdhet på arbetsplatser och i hemmet är viktigt för att minska psykisk ohälsa både bland kvinnor och män, men också för att uppnå en god genomsnittlig hälsa i befolkningen, något som är ett centralt folkhälsomål. Vid analyser av social ojämlikhet i hälsa är genusperspektiv av stor betydelse för att fördjupa förståelsen om hur och varför ojämställdhet i på arbetsplatser och i hemmet är relaterat till psykisk ohälsa. Att integrera genusperspektiv i folkhälsopolicy kan vara ett sätt att ta hänsyn till de maktrelationer som förhindrar en god folkhälsa.

Place, publisher, year, edition, pages
Umeå: Umeå Universitet , 2013. , 94 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1556
Keyword [en]
Gender relations, gender equality, workplace, domestic work, mental illness, logistic regression, cluster analysis, grounded theory
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Public health
Identifiers
URN: urn:nbn:se:umu:diva-67119ISBN: 978-91-7459-569-7 (print)OAI: oai:DiVA.org:umu-67119DiVA: diva2:610895
Public defence
2013-04-12, Sal 135, byggnad 9A, ingång x1, Norrlands Universitetssjukhus, Umeå, 13:00 (Swedish)
Opponent
Supervisors
Funder
FAS, Swedish Council for Working Life and Social Research, Dnr 2007-2073
Available from: 2013-03-22 Created: 2013-03-13 Last updated: 2013-03-22Bibliographically approved
List of papers
1. Is gender inequality in the domestic sphere associated with psychological distress among women and men? Results from the Northern Swedish Cohort.
Open this publication in new window or tab >>Is gender inequality in the domestic sphere associated with psychological distress among women and men? Results from the Northern Swedish Cohort.
2012 (English)In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 66, no 3, 271-276 p.Article in journal (Refereed) Published
Abstract [en]

Aim The aim of this study was to analyse whether gender inequality in the domestic sphere was associated with psychological distress among women and men.

Methods In a cohort study, all pupils in the last year of compulsory school in a middle-sized industrial town in northern Sweden were followed until the age of 42. For this study a sample of cohabiting participants (n¼372 women, 352 men) was selected. Gender inequality was measured as perceptions of gender inequality in the couple relationship, time spent on household work, responsibility for domestic work and childcare, and was analysed in relation to psychological distress, after taking possible background variables as well as earlier health status into account.

Results In the multivariate analyses, perception of gender inequality in the couple relationship was associated with psychological distress for both women (OR 2.23, CI 1.20 to 4.18) and men (OR 3.51, CI 1.69 to 7.31). For women only, taking whole responsibility for domestic work was associated with the outcome (OR 2.17, CI 1.05 to 4.48). For men, taking less than half of the responsibility for domestic work was associated with psychological distress (OR 2.25, CI 1.24 to 3.91).

Conclusions Gender inequality in the domestic sphere seems to be an important determinant of psychological distress for both women and men.

Place, publisher, year, edition, pages
London: BMJ Publishing Group, 2012
National Category
Environmental Health and Occupational Health
Identifiers
urn:nbn:se:umu:diva-41372 (URN)10.1136/jech.2010.109231 (DOI)000300039600013 ()
Available from: 2011-03-23 Created: 2011-03-23 Last updated: 2017-12-11
2. Domestic work and psychological distress: what is the importance of relative socioeconomic position and gender inequality in the couple relationship?
Open this publication in new window or tab >>Domestic work and psychological distress: what is the importance of relative socioeconomic position and gender inequality in the couple relationship?
2012 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 7, no 6, e38484- p.Article in journal (Refereed) Published
Abstract [en]

Aims: The aim of this study was to investigate whether the relation between responsibility for domestic work and psychological distress was influenced by perception of gender inequality in the couple relationship and relative socioeconomic position.

Methods: In the Northern Swedish Cohort, all pupils who studied in the last year of compulsory school in a northern Swedish town in 1981 have been followed regularly until 2007. In this study, participants living with children were selected (n = 371 women, 352 men). The importance of relative socioeconomic position and perception of gender inequality in the couple relationship in combination with domestic work for psychological distress was examined through logistic regression analysis.

Results: Two combinations of variables including socioeconomic position ('having less than half of the responsibility for domestic work and partner higher socioeconomic position' and 'having more than half the responsibility for domestic work and equal socioeconomic position') were related to psychological distress. There were also higher ORs for psychological distress for the combinations of having 'less than half of the responsibility for domestic work and gender-unequal couple relationship' and 'more than half the responsibility for domestic work and gender-unequal couple relationship'. Having a lower socioeconomic position than the partner was associated with higher ORs for psychological distress among men.

Conclusions: This study showed that domestic work is a highly gendered activity as women tend to have a greater and men a smaller responsibility. Both these directions of inequality in domestic work, in combination with experiencing the couple relationship as gender-unequal, were associated with psychological distress There is a need for more research with a relational approach on inequalities in health in order to capture the power relations within couples in various settings.

National Category
Sociology
Identifiers
urn:nbn:se:umu:diva-57362 (URN)10.1371/journal.pone.0038484 (DOI)000305341900032 ()
Available from: 2012-07-17 Created: 2012-07-16 Last updated: 2017-12-07Bibliographically approved
3. Patterns of gender equality at workplaces and psychological distress
Open this publication in new window or tab >>Patterns of gender equality at workplaces and psychological distress
2013 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 8, no 1, e53246- p.Article in journal (Refereed) Published
Abstract [en]

Research in the field of occupational health often uses a risk factor approach which has been criticized by feminist researchers for not considering the combination of many different variables that are at play simultaneously. To overcome this shortcoming this study aims to identify patterns of gender equality at workplaces and to investigate how these patterns are associated with psychological distress. Questionnaire data from the Northern Swedish Cohort (n=715) have been analysed and supplemented with register data about the participants’ workplaces. The register data were used to create gender equality indicators of women/men ratios of number of employees, educational level, salary and parental leave. Cluster analysis was used to identify patterns of gender equality at the workplaces. Differences in psychological distress between the clusters were analysed by chi-square test and logistic regression analyses, adjusting for individual socio-demographics and previous psychological distress. The cluster analysis resulted in six distinctive clusters with different patterns of gender equality at the workplaces that were associated to psychological distress for women but not for men. For women the highest odds of psychological distress was found on traditionally gender unequal workplaces. The lowest overall occurrence of psychological distress as well as same occurrence for women and men was found on the most gender equal workplaces. The results from this study support the convergence hypothesis as gender equality at the workplace does not only relate to better mental health for women, but also more similar occurrence of mental ill-health between women and men. This study highlights the importance of utilizing a multidimensional view of gender equality to understand its association to health outcomes. Health policies need to consider gender equality at the workplace level as a social determinant of health that is of importance for reducing differences in health outcomes for women and men.

Keyword
gender equality, workplace, psychological distress, cluster analysis, gender, work
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Public health
Identifiers
urn:nbn:se:umu:diva-63972 (URN)10.1371/journal.pone.0053246 (DOI)
Funder
FAS, Swedish Council for Working Life and Social Research, Dnr 2007-2073
Available from: 2013-01-11 Created: 2013-01-09 Last updated: 2017-12-06Bibliographically approved
4. “An equal share, that’s my medicine”. Experiences of domestic work, health and illness from a gender relational perspective.
Open this publication in new window or tab >>“An equal share, that’s my medicine”. Experiences of domestic work, health and illness from a gender relational perspective.
(English)Manuscript (preprint) (Other academic)
Abstract [en]

Introduction: Gender inequalities in domestic work have been shown to be related to mental illness among both women and men. The aim of this study was to analyse experiences of domestic work, health and illness among women and men from a gender relational perspective. Methods: A strategic section from the Northern Swedish Cohort of four women and four men living in couple relationships with children was included in the study. The strategic selection included variation socioeconomic class and perception of gender equality in the couple relationship. Interviews were conducted in 2012 when the participants were 47 years old. Data collection and analysis was performed with a Grounded Theory approach. Results: We identified three categories. “Living with the burden of domestic work –an obstacle for women’s health” was built on women’s experiences of having the main responsibility for everyday domestic work as burdensome, stressful and something that caused sleeping and mental illness problems. “Being trapped in an outmoded masculinity – a stressful situation” was built on men’s experiences of domestic work such as fixing things that were broken at home as well as having responsibility for the seasonal outdoor work, something that was connected to feelings of stress. “Negotiating gender equality” included women’s and men’s experiences of striving for gender equality in the couple relationship as a possible way to improved health. Conclusions: Gender relations are an important part of how the domestic work is unequally organized and related to experiences of mental illness. We found that gender constructions in the domestic sphere included various dimensions of gender inequality that were constantly negotiated in order to improve health.

Keyword
domestic work, gender relations, mental illness, health experiences, gender equality
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Public health
Identifiers
urn:nbn:se:umu:diva-66822 (URN)
Projects
Lisa Harryson. "An equal share that's my medicine" Work, gender relations and mental illness in a Swedish context. 2013
Funder
FAS, Swedish Council for Working Life and Social Research, Dnr 2007-2073
Available from: 2013-03-05 Created: 2013-03-05 Last updated: 2013-03-28Bibliographically approved

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