564801 research-article2014
ISP0010.1177/0020764014564801International Journal of Social PsychiatryMatud et al.
E CAMDEN SCHIZOPH
Original Article
Gender differences in psychological distress in Spain
International Journal of Social Psychiatry 1–9 © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/0020764014564801 isp.sagepub.com
M Pilar Matud, Juan M Bethencourt and Ignacio Ibáñez
Abstract Background and aims: Epidemiological and community-based surveys consistently report gender differences in mental health. This study examines gender differences in psychological distress by analyzing the relevance of stress, coping styles, social support and the time use. Methods: Psychological tests were administered to a convenience sample of 1,337 men and 1,251 women from the Spanish general population, aged between 18 and 65 and with different socio-demographic characteristics, although both the women and men groups had similar age and educational levels. Results: Women had more psychological distress than men. Although psychological distress in the women and men groups have some common correlates such as more stress, more emotional and less rational coping and less social support, we find some gender differences. Work role dissatisfaction was more associated with distress in the men than in the women group. In addition, women’s distress was associated with more daily time devoted to childcare and less to activities they enjoy, and men’s distress was associated with more time devoted to housework and less to physical exercise. Conclusions: Social roles traditionally attributed to women and men – and the differences in the use of time that such roles entail – are relevant in gender differences in psychological distress. Keywords Gender, psychological distress, time use, coping styles, stress
Background Epidemiological and community-based surveys consistently report the existence of gender differences in mental health. Generally, women showed higher rates of anxiety and mood disorders than men, whereas men showed higher rates of impulse-control and substance use disorders than women (Eaton et al., 2012; Kessler et al., 2005; Seedat et al., 2009). A number of biologic, psychosocial and gender-role hypothesis has been proposed to account for these differences but results had been inconclusive. Depression and anxiety symptoms are the most frequent indicators of psychological distress (Cassidy, O’Connor, Howe, & Warden, 2004; Drapeau et al., 2010). They are two of the most prevalent mental health problems and they frequently co-occur (Brown, Harris, & Eales, 1996; Eaton et al., 2012). Other symptoms commonly included for the measure of psychological distress are insomnia and somatic symptoms (Kessler et al., 2002; Talala, Huurre, Aro, Martelin, & Prättälä, 2008). Psychological distress is a common indicator of mental health and psychopathology either in clinical and research settings and in public health (Drapeau et al., 2010) and often primary care patients present distress symptoms (Simms, Prisciandaro, Krueger, & Goldberg, 2012). Since
distress symptoms indicate the need for health care services, distress prevention may lead to a reduction in health care cost, plus a reduction of subjective suffering (Gadalla, 2009). Population surveys and epidemiological studies carried out in several countries indicate that women report a higher mean level of psychological distress than men (Cleary & Mechanic, 1983; Doherty & Kartalova-O’Doherty, 2010; Drapeau et al., 2010; Marchand, Drapeau, & BeaulieuPrévost, 2011; Mirowsky & Ross, 1995; Nurullah, 2010; Roberts, Abbott, & Mckee, 2010). But gender differences in distress decrease or eventually disappear in case of a high occupational grade (Marchand et al., 2011) and when women and men have similar socioeconomic conditions (Beasley, Thompson, & Davidson, 2003; Emslie, Hunt, & Department of Clinical Psychology, Psychobiology and Methodology, Faculty of Health Sciences, La Laguna University, La Laguna, Spain Corresponding author: M Pilar Matud, Department of Clinical Psychology, Psychobiology and Methodology, Faculty of Health Sciences, La Laguna University, Apartado 456, 38200 La Laguna, Spain. Email: [email protected]
Downloaded from isp.sagepub.com at University of Manitoba Libraries on September 2, 2015
2
International Journal of Social Psychiatry
Macintyre, 1999). Also, gender differences in distress may vary according to the particular context, the historical period or socio-cultural setting (Emslie et al., 2002). Thus, in a recent study with Chinese young adults, Kong, Zhao and You (2012) did not find statistical gender differences in mental distress as evaluated by a Chinese version of the 12-item General Health Questionnaire (GHQ). Several studies have found out the relation between social inequalities and psychological distress, people with lower educational and social status showing a higher number of symptoms (e.g. Byles, Gallienne, Blyth, & Banks, 2012; Myer, Stein, Grimsrud, Seedat, & Williams, 2008; Talala et al., 2008). Moreover, gender inequality in the domestic area seems to be an important determinant of psychological distress, both in women and men (Harryson, Novo, & Hammarström, 2012). Research carried out in several countries has revealed that women perform most of the unpaid household labor (Goñi-Legaz, Ollo-López, & Bayo-Morione, 2010; Hagqvist, Gådin, & Nordenmark, 2012; Harryson, Strandh, & Hammarström, 2012; Lachance-Grzela & Bouchard, 2010; Sullivan, 2000). While time spent on household chores has been associated with women’s psychological distress, evidence is inconclusive as some studies have found that other factors, such as the perception of housework-related stress, perceived fairness, assumption of responsibilities or the inequality in the division of domestic labor, appear to be more relevant drivers of distress than the amount of domestic labor (Bird, 1999; Claffey & Mickelson, 2009; Hagqvist et al., 2012; Harryson et al., 2012; Hughes & Galinsky, 1994). Psychological distress was also associated with stress (Bancila, Mittelmark, & Hetland, 2006; Heyman, Brennan, & Colarossi, 2010; Marchand et al., 2011). The link between stress and psychological dysfunction has been well established; however, the extent to which adversity has a direct influence on health is still in debate (Beasley et al., 2003). Coping is an important factor in the relation between stressful events and psychological symptoms (e.g. Folkman, Lazarus, Gruen, & DeLongis, 1986). Traditionally, coping is conceptualized ‘as a response or a reaction to stress that has occurred or is threatened’ (Folkman, 2008, p. 73). It includes various behaviors and strategies that have two major functions: dealing with the problem that is causing the distress, which is called problem-focusing coping, and regulating the emotional response to the stressor, referred as emotion-focused coping (Lazarus & Folkman, 1984). The existing literature generally shows that women report more stress than men (Nurullah, 2010), although gender differences in stress depend on the type of stressors considered (Hamaideh, 2010; Matud, 2004). Also, research in gender differences in coping has not been conclusive. In some, studies have been found that women used social support and emotionfocused coping more than men (Eaton & Bradley, 2008; González-Morales, Peiró, Rodríguez, & Greenglass, 2006;
Matud, 2004; Watson & Sinha, 2008). However, Folkman and Lazarus (1980) found that women use less problemfocused coping than men but there were no gender differences in emotion-focused coping. Nevertheless, Tamres, Janicki and Helgeson (2002) found, in a meta-analysis, that women were more likely than men to engage in most types of coping strategies, including the search for emotional support. When we analyze the relationship between stress and health, it is also important to recognize the existence of the hormonal stress response. The so-called stress hormones – norepinephrine, epinephrine and cortisol – have effects on various bodily systems and functions (such as the cardiovascular system, cell metabolism, fat distribution or the immune system) and are important for survival (Lundberg, 2005). As this author notes, achieving a balance between active life and resting periods (both short-term, such as an evening rest or a lunch break, and longer periods, such as vacation or weekends) is beneficial to health. Thus, in order to identify the relevant factors that explain the gender differences in distress, it is important to analyze both the psychosocial factors behind the individuals’ stress and coping styles and their use of time. The previous literature, however, has not combined both types of variables in the same analysis.
Objective To examine gender differences in psychological distress in the Spanish general population by analyzing the relevance of stress, coping styles, social support and the use of time in women’s and men’s psychological distress.
Material and methods Participants Study participants were 2,588 people from the Spanish general population (1,337 men and 1,251 women) aged between 18 and 65 and with similar educational levels for both women and men. The mean age for men was 30.8 (standard deviation (SD) = 11.1) and for women it was 31.8 (SD = 11.4). The 64.8% lived in urban areas and 35.2% lived in rural ones. In Table 1, we present the principal social-demographic characteristics of both groups. As it can be observed, although there are not statistically significant differences in education, we find some gender differences in occupation, marital status and number of children.
Measures Participants’ psychological distress was assessed by using the subscales of severe depression, anxiety and insomnia and somatic symptoms of the Scaled Version of the GHQ
Downloaded from isp.sagepub.com at University of Manitoba Libraries on September 2, 2015
3
Matud et al. Table 1. Demographic characteristics of the male and female groups. Men (n = 1,337)
n
%
n
%
327 453 545 12
24.46 33.88 40.76 0.90
309 402 534 6
24.70 32.12 42.68 0.50
0.56
315 407 333 261 0 21
23.56 30.44 24.91 19.52 0.00 1.57
298 300 248 250 132 23
23.82 23.98 19.83 19.98 10.55 1.84
158.48***
855 433 45 4
63.95 32.38 3.37 0.30
697 494 60 0
55.71 39.49 4.80 0.00
19.66***
966 136 181 54
72.25 10.17 13.54 4.04
808 147 195 101
64.59 11.75 15.59 8.07
26.44***
Education: Primary Secondary University No data Occupation: Student Skilled/unskilled manual Skilled non-manual Professional Homemaker No data Marital status: Never married Married/cohabiting Divorced/widowed No data Number of children: No children 1 2 3 or more
Women (n = 1,251)
χ2 value
Characteristic
***p
ISP0010.1177/0020764014564801International Journal of Social PsychiatryMatud et al.
E CAMDEN SCHIZOPH
Original Article
Gender differences in psychological distress in Spain
International Journal of Social Psychiatry 1–9 © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/0020764014564801 isp.sagepub.com
M Pilar Matud, Juan M Bethencourt and Ignacio Ibáñez
Abstract Background and aims: Epidemiological and community-based surveys consistently report gender differences in mental health. This study examines gender differences in psychological distress by analyzing the relevance of stress, coping styles, social support and the time use. Methods: Psychological tests were administered to a convenience sample of 1,337 men and 1,251 women from the Spanish general population, aged between 18 and 65 and with different socio-demographic characteristics, although both the women and men groups had similar age and educational levels. Results: Women had more psychological distress than men. Although psychological distress in the women and men groups have some common correlates such as more stress, more emotional and less rational coping and less social support, we find some gender differences. Work role dissatisfaction was more associated with distress in the men than in the women group. In addition, women’s distress was associated with more daily time devoted to childcare and less to activities they enjoy, and men’s distress was associated with more time devoted to housework and less to physical exercise. Conclusions: Social roles traditionally attributed to women and men – and the differences in the use of time that such roles entail – are relevant in gender differences in psychological distress. Keywords Gender, psychological distress, time use, coping styles, stress
Background Epidemiological and community-based surveys consistently report the existence of gender differences in mental health. Generally, women showed higher rates of anxiety and mood disorders than men, whereas men showed higher rates of impulse-control and substance use disorders than women (Eaton et al., 2012; Kessler et al., 2005; Seedat et al., 2009). A number of biologic, psychosocial and gender-role hypothesis has been proposed to account for these differences but results had been inconclusive. Depression and anxiety symptoms are the most frequent indicators of psychological distress (Cassidy, O’Connor, Howe, & Warden, 2004; Drapeau et al., 2010). They are two of the most prevalent mental health problems and they frequently co-occur (Brown, Harris, & Eales, 1996; Eaton et al., 2012). Other symptoms commonly included for the measure of psychological distress are insomnia and somatic symptoms (Kessler et al., 2002; Talala, Huurre, Aro, Martelin, & Prättälä, 2008). Psychological distress is a common indicator of mental health and psychopathology either in clinical and research settings and in public health (Drapeau et al., 2010) and often primary care patients present distress symptoms (Simms, Prisciandaro, Krueger, & Goldberg, 2012). Since
distress symptoms indicate the need for health care services, distress prevention may lead to a reduction in health care cost, plus a reduction of subjective suffering (Gadalla, 2009). Population surveys and epidemiological studies carried out in several countries indicate that women report a higher mean level of psychological distress than men (Cleary & Mechanic, 1983; Doherty & Kartalova-O’Doherty, 2010; Drapeau et al., 2010; Marchand, Drapeau, & BeaulieuPrévost, 2011; Mirowsky & Ross, 1995; Nurullah, 2010; Roberts, Abbott, & Mckee, 2010). But gender differences in distress decrease or eventually disappear in case of a high occupational grade (Marchand et al., 2011) and when women and men have similar socioeconomic conditions (Beasley, Thompson, & Davidson, 2003; Emslie, Hunt, & Department of Clinical Psychology, Psychobiology and Methodology, Faculty of Health Sciences, La Laguna University, La Laguna, Spain Corresponding author: M Pilar Matud, Department of Clinical Psychology, Psychobiology and Methodology, Faculty of Health Sciences, La Laguna University, Apartado 456, 38200 La Laguna, Spain. Email: [email protected]
Downloaded from isp.sagepub.com at University of Manitoba Libraries on September 2, 2015
2
International Journal of Social Psychiatry
Macintyre, 1999). Also, gender differences in distress may vary according to the particular context, the historical period or socio-cultural setting (Emslie et al., 2002). Thus, in a recent study with Chinese young adults, Kong, Zhao and You (2012) did not find statistical gender differences in mental distress as evaluated by a Chinese version of the 12-item General Health Questionnaire (GHQ). Several studies have found out the relation between social inequalities and psychological distress, people with lower educational and social status showing a higher number of symptoms (e.g. Byles, Gallienne, Blyth, & Banks, 2012; Myer, Stein, Grimsrud, Seedat, & Williams, 2008; Talala et al., 2008). Moreover, gender inequality in the domestic area seems to be an important determinant of psychological distress, both in women and men (Harryson, Novo, & Hammarström, 2012). Research carried out in several countries has revealed that women perform most of the unpaid household labor (Goñi-Legaz, Ollo-López, & Bayo-Morione, 2010; Hagqvist, Gådin, & Nordenmark, 2012; Harryson, Strandh, & Hammarström, 2012; Lachance-Grzela & Bouchard, 2010; Sullivan, 2000). While time spent on household chores has been associated with women’s psychological distress, evidence is inconclusive as some studies have found that other factors, such as the perception of housework-related stress, perceived fairness, assumption of responsibilities or the inequality in the division of domestic labor, appear to be more relevant drivers of distress than the amount of domestic labor (Bird, 1999; Claffey & Mickelson, 2009; Hagqvist et al., 2012; Harryson et al., 2012; Hughes & Galinsky, 1994). Psychological distress was also associated with stress (Bancila, Mittelmark, & Hetland, 2006; Heyman, Brennan, & Colarossi, 2010; Marchand et al., 2011). The link between stress and psychological dysfunction has been well established; however, the extent to which adversity has a direct influence on health is still in debate (Beasley et al., 2003). Coping is an important factor in the relation between stressful events and psychological symptoms (e.g. Folkman, Lazarus, Gruen, & DeLongis, 1986). Traditionally, coping is conceptualized ‘as a response or a reaction to stress that has occurred or is threatened’ (Folkman, 2008, p. 73). It includes various behaviors and strategies that have two major functions: dealing with the problem that is causing the distress, which is called problem-focusing coping, and regulating the emotional response to the stressor, referred as emotion-focused coping (Lazarus & Folkman, 1984). The existing literature generally shows that women report more stress than men (Nurullah, 2010), although gender differences in stress depend on the type of stressors considered (Hamaideh, 2010; Matud, 2004). Also, research in gender differences in coping has not been conclusive. In some, studies have been found that women used social support and emotionfocused coping more than men (Eaton & Bradley, 2008; González-Morales, Peiró, Rodríguez, & Greenglass, 2006;
Matud, 2004; Watson & Sinha, 2008). However, Folkman and Lazarus (1980) found that women use less problemfocused coping than men but there were no gender differences in emotion-focused coping. Nevertheless, Tamres, Janicki and Helgeson (2002) found, in a meta-analysis, that women were more likely than men to engage in most types of coping strategies, including the search for emotional support. When we analyze the relationship between stress and health, it is also important to recognize the existence of the hormonal stress response. The so-called stress hormones – norepinephrine, epinephrine and cortisol – have effects on various bodily systems and functions (such as the cardiovascular system, cell metabolism, fat distribution or the immune system) and are important for survival (Lundberg, 2005). As this author notes, achieving a balance between active life and resting periods (both short-term, such as an evening rest or a lunch break, and longer periods, such as vacation or weekends) is beneficial to health. Thus, in order to identify the relevant factors that explain the gender differences in distress, it is important to analyze both the psychosocial factors behind the individuals’ stress and coping styles and their use of time. The previous literature, however, has not combined both types of variables in the same analysis.
Objective To examine gender differences in psychological distress in the Spanish general population by analyzing the relevance of stress, coping styles, social support and the use of time in women’s and men’s psychological distress.
Material and methods Participants Study participants were 2,588 people from the Spanish general population (1,337 men and 1,251 women) aged between 18 and 65 and with similar educational levels for both women and men. The mean age for men was 30.8 (standard deviation (SD) = 11.1) and for women it was 31.8 (SD = 11.4). The 64.8% lived in urban areas and 35.2% lived in rural ones. In Table 1, we present the principal social-demographic characteristics of both groups. As it can be observed, although there are not statistically significant differences in education, we find some gender differences in occupation, marital status and number of children.
Measures Participants’ psychological distress was assessed by using the subscales of severe depression, anxiety and insomnia and somatic symptoms of the Scaled Version of the GHQ
Downloaded from isp.sagepub.com at University of Manitoba Libraries on September 2, 2015
3
Matud et al. Table 1. Demographic characteristics of the male and female groups. Men (n = 1,337)
n
%
n
%
327 453 545 12
24.46 33.88 40.76 0.90
309 402 534 6
24.70 32.12 42.68 0.50
0.56
315 407 333 261 0 21
23.56 30.44 24.91 19.52 0.00 1.57
298 300 248 250 132 23
23.82 23.98 19.83 19.98 10.55 1.84
158.48***
855 433 45 4
63.95 32.38 3.37 0.30
697 494 60 0
55.71 39.49 4.80 0.00
19.66***
966 136 181 54
72.25 10.17 13.54 4.04
808 147 195 101
64.59 11.75 15.59 8.07
26.44***
Education: Primary Secondary University No data Occupation: Student Skilled/unskilled manual Skilled non-manual Professional Homemaker No data Marital status: Never married Married/cohabiting Divorced/widowed No data Number of children: No children 1 2 3 or more
Women (n = 1,251)
χ2 value
Characteristic
***p
