Carita Bengs

Gaps Between Patients, Media, and Academic Medicine in Discourses on Gender and Depression: A Metasynthesis:

For reasons that are not yet fully understood, depression affects women twice as often as men. In this article we describe an investigation of how depression is understood in relation to men and women by the patients themselves, the media, and the medical research establishment. We do this by undertaking a metasynthesis of data from three different sources: interviews with depressed patients, media portrayals of depressed individuals in Sweden, and international medical articles about depression. The findings reveal that there are differences in (a) the recognition of depression, (b) the understanding of the reasons for depression, and (c) the contextualization of depression. Although women and men describe different symptoms and reasons for falling ill, these gendered expressions are not acknowledged in articles coming from Western medical settings. We discuss the implications of these findings and conclude that an integrated model for understanding biological, gender, and cultural aspects of depression has yet to be developed.

Gender-related explanatory models of depression : a critical evaluation of medical articles

OBJECTIVES Although research has consistently shown a higher prevalence of depression among women compared with men, there is a lack of consensus regarding explanatory factors for these gender-related differences. The aim of this paper was to analyse the scientific quality of different gender-related explanatory models of depression in the medical database PubMed. STUDY DESIGN Qualitative and quantitative analyses of PubMed articles. METHODS In a database search in PubMed for 2002, 82 articles on gender and depression were selected and analysed with qualitative and quantitative content analyses. In total, 10 explanatory factors and four explanatory models were found. The ISI Web of Science database was searched in order to obtain the citation number and journal impact factor for each article. RESULTS The most commonly used gender-related explanatory model for depression was the biomedical model (especially gonadal hormones), followed by the sociocultural and psychological models. Compared with the other models, the biomedical model scored highest on bibliometric measures but lowest on measures of multifactorial dimensions and differences within the group of men/women. CONCLUSION The biomedical model for explaining gender-related aspects of depression had the highest quality when bibliometric methods were used. However, the sociocultural and psychological models had higher quality than the biomedical model when multifactoriality and intersectionality were analysed. There is a need for the development of new methods in order to evaluate the scientific quality of research.

“My Greatest Dream is to be Normal”: The Impact of Gender on the Depression Narratives of Young Swedish Men and Women

Depression is common among young people. Gender differences in diagnosing depression appear during adolescence. The study aim was to explore the impact of gender on depression in young Swedish men and women. Grounded theory was used to analyze interviews with 23 young people aged 17 to 25 years who had been diagnosed with depression. Their narratives were marked by a striving to be normal and disclosed strong gender stereotypes, constructed in interaction with parents, friends, and the media. Gender norms were upheld by feelings of shame, and restricted the acting space of our informants. However, we also found transgressions of these gender norms. Primary health care workers could encourage young men to open up emotionally and communicate their personal distress, and young women to be daring and assertive of their own strengths, so that both genders might gain access to the positive coping strategies practiced respectively by each.

“He Messed Me Up”: Swedish Adolescent Girls’ Experiences of Gender-Related Partner Violence and Its Consequences Over Time

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.

He just has to like ham - The centrality of meat in home and consumer studies.

This study aimed to describe Discourses on meat in the school subject Home and Consumer Studies in five different northern Swedish schools. Fifty-nine students and five teachers from five different schools were recorded and in some cases video-taped during lessons. Results indicate that meat was seen as central to nutritional health, sensory experience, culture and social relationships. This positive view was challenged by an alternative Discourse where meat was threatening to health, sensory experience and psychological comfort, but this was not strong enough to affect centrality. Even when participants sought to promote the health advantages of reducing meat consumption, the dominant centrality Discourse was strengthened. This implies that the possible tension between physical and psychosocial/emotional health can make the benefits of a reduction difficult both to convey and accept. A form of critical food literacy may help teachers deconstruct the arbitrary power of the centrality Discourse, but it may also strengthen meat-eater identities because the social norms that guide food choice become salient. A redesign of Discourses might facilitate a reduction in meat consumption, but such a paradigm shift is dependent on the development of society as a whole, and can only be briefly touched upon within the limited time frames and resources of Home and Consumer Studies.

Living Close to the Edge: Embodied Dimensions of Distress During Emerging Adulthood

Although self-reported stress-related problems are common among Swedish adolescent girls and young women, few qualitative studies have been carried out of young people’s own understandings and descriptions of their lived embodied experiences of stress-related illness. The aim of the present study, therefore, was to explore and analyze the lived embodied experiences of stress among adolescent girls and young women who had sought help at a youth health center. Interviews with 40 girls and young women aged 16 to 25 were analyzed with qualitative content analysis. “Living close to the edge” was interpreted as the common theme running through all of the interviews and representing the participants’ sometimes unbearable situations. The theme contains embodied dimensions of physical, emotional, cognitive, social, and existential distress, as well as dimensions of distrust and disempowerment. The findings highlight the importance of addressing these dimensions in youth health interventions, and the importance of contextualizing young women’s distress is emphasized. These young women’s experiences of stress and illness were multifaceted, which place high demands on health facilities and intervention programs. It is important to integrate context- and gender-sensitive models and approaches in youth health as well as in primary care settings.

The Western gaze : An analysis of medical research publications concerning the expressions of depression, focusing on ethnicity and gender

Our aim of this study was to explore how authors of medical articles wrote about different symptoms and expressions of depression in men and women from various ethnic groups as well as to analyze the meaning of gender and ethnicity for expressions of depression. A database search was carried out using PubMed. Thirty articles were identified and analyzed using qualitative content analysis. Approaches differ with regard to how depression is described and interpreted in different cultures in relation to illness complaints, illness meaning, and diagnosis of depression. Articles often present issues based on a Western point of view. This may lead to “cultural or gender gaps,” which we refer to as “the Western gaze,” which may in turn influence the diagnosis of depression.

Well, I'm healthy, but…--lay perspectives on health among people with musculoskeletal disorders.

Abstract Purpose: The purpose was to investigate lay perspectives on health among people with musculoskeletal disorders. Method: Semi-structured interviews were performed with 39 women and 30 men, (aged 22–63 years) with long-term, non-specific musculoskeletal disorders in the neck, shoulder and/or low back. Data was analysed using qualitative content analysis. Results: These people experienced health as “having resources and opportunities to lead the life one wants”. Three categories, “a good enough physical and psychological functioning, freedom of action, and a positive state of emotion and an enriching life”, illustrate the different resources and opportunities that the informants described as important for them to perceive themselves as healthy. The informants also reflected on “being ill” and “being well” and what makes the difference. Five aspects influenced the dynamics of their health experiences: “body and soul, prognosis, character of symptoms, physical and social activity, and emotional state”. Consequently, the informants expressed a holistic view of health, where the focus lies on the opportunity and the ability to lead their lives the way they want. Conclusions: This study points at the value of taking lay perspectives on health into account, as it might increase the opportunity to design effective, personalized rehabilitation strategies. Implications for Rehabilitation Musculoskeletal disorders (MSDs) are difficult to cure and actions to alleviate suffering are of most importance to increase wellbeing and thereby work ability. Research on lay perspectives can contribute towards a deepened understanding of the health experiences of the affected, and thereby the development of the goals and activities of rehabilitation. Our models, that present the view of health and aspects important for achieving wellness among people with MSDs, can contribute in the development of multimodal rehabilitation. The results can also be useful as a base in the evaluation of clinical practice.

Absence, deviance and unattainable ideals – Discourses on vegetarianism in the Swedish school subject Home and Consumer Studies:

Objective: This study aimed to describe Discourses on vegetarian food in the Swedish school subject Home and Consumer Studies. Design: The study involved the observation of naturally occurring classroom talk, with audio recording and in some cases video-taping. Setting: The study was conducted during Home and Consumer Studies lessons in five different northern Swedish schools. Method: Fifty-nine students and five teachers were observed, recorded and in some cases video-taped. The resulting data were analysed with a focus on big ‘D’ Discourses. Results: Results indicated that gendered Discourses of absence, deviance and unattainability restricted some students’ access to vegetarian food. The absence of meat was constructed as simultaneously healthy and unhealthy, a lack of cultural familiarity with vegetarian cooking made finding recipes difficult and students perceived the loss of taste as very negative. The vegetarian was seen as deviant, with vegetarianism being conceptually equated with sickness. Access to meat-free food required a commitment to a vegetarian lifestyle, and this was seen as a sacrifice and as too much work, not only for the individual but also for others. Conclusion: To counteract the restricted access to vegetarian food, Home and Consumer Studies teachers can redesign activities in the subject with the help of critical food literacy. For example, cooking could focus on popular plant-based dishes instead of ‘empty’ vegetarian themes, all students could be allowed to share vegetarian dishes instead of reserving them for vegetarians, the possibly strict rules of vegetarianism could be relaxed for those who do not wish to commit to them and vegetarian food could be deliberately connected to strength and masculinity. However, this presupposes sufficient economic resources and ample food storage space.

Experiences of the gender climate in clinical training – a focus group study among Swedish medical students

BackgroundResearch shows that medical education is characterized by unequal conditions for women and men, but there is a lack of qualitative studies investigating the social processes that enable and maintain gender inequalities that include both male and female students. In this focus group study, we therefore explored male as well as female medical students’ experiences of the gender climate – i.e., how beliefs, values, and norms about gender were communicated – during clinical training and how the students dealt with these experiences.MethodsFocus group interviews were conducted with 24 medical students (nine men) at Umeå University, Sweden. The interviews were structured around personal experiences in clinical training where the participants perceived that gender had mattered. Data were analysed using qualitative content analysis.ResultsThe students described gender-stereotyped expectations, discriminatory treatment, compliments, comments, and demeaning jargon. Female students gave more personal and varied examples than the men. The students’ ways of handling their experiences were marked by efforts to fit in, for example, by adapting their appearance and partaking in the prevailing jargon. They felt dependent on supervisors and staff, and due to fear of repercussions they kept silent and avoided unpleasant situations and people rather than challenging humiliating jargon or supervisors who were behaving badly.ConclusionsEveryday communication of gender beliefs combined with students’ adaptation to stereotyped expectations and discrimination came across as fundamental features through which unequal conditions for male and female students are reproduced and maintained in the clinic. Because they are in a dependent position, it is often difficult for students to challenge problematic gender attitudes. The main responsibility for improvements, therefore, lies with medical school leadership who need to provide students and supervisors with knowledge about gendered processes, discrimination, and sexism and to organize reflection groups about the gender climate in order to improve students’ opportunities to discuss their experiences, and hopefully find ways to protest and actively demand change.