Helen Sweeting

Gender differences in health : are things really as simple as they seem ?

It is conventional wisdom in medical sociology and social epidemiology that in industrialized societies men die earlier than women, but that women have poorer health than men. A number of explanations for these differences have been postulated and tested (for example, different biological risks, acquired risks, reporting biases and experiences of health care). Using two recent British data sets we find that the pattern of sex differences in morbidity is more complicated than the conventional wisdom often suggests. The direction and magnitude of sex differences in health vary according to the particular symptom or condition in question and according to the phase of the life cycle. Female excess is only consistently found across the life span for psychological distress and is far less apparent, or reversed, for a number of physical symptoms and conditions. Detailed inspection of papers on gender differences published in the last decade reveals that our findings are not unique, but that a relatively undifferentiated model of consistent sex differences has nevertheless continued to predominate in the literature. We believe that the topic of gender differences in health warrants periodic re-examination.

Peer Victimization and Depression in Early-Mid Adolescence: A Longitudinal Study.

BACKGROUND Despite considerable evidence for psychological distress among children and young people who experience peer victimization, cross-sectional studies cannot determine the direction of the relationship. Several recent studies have examined associations between victimization and distress. The majority find evidence for both directions but do not arbitrate between them; only one prior study has attempted to do this. AIMS To use longitudinal data to: (1) test competing hypotheses about the direction of the victimization-depression association; (2) investigate gender differences in the resulting models. SAMPLE Data were obtained from a Scottish school-based cohort (N=2,586). METHODS Self-completion questionnaires included a depression scale and questions on victimization at each age. RESULTS Despite shifts in and out of victim status, there was evidence of stability in both victimization and depression. Bivariate analyses showed positive relationships between victimization and depression. Structural equation modelling (SEM) showed that at age 13, this relationship was reciprocal, with a stronger path from victimization to depression than vice versa. However, at age 15, it was almost entirely due to a path from depression to victimization among boys. Models including cross-lagged paths fitted the data less well than those including simultaneous associations. CONCLUSIONS Current policy focuses on victimization as a cause of distress; however, professionals should be aware that vulnerable children and young people are likely to be the targets of victimization.

Adolescent Bullying, Relationships, Psychological Well-Being, and Gender-Atypical Behavior: A Gender Diagnosticity Approach

In this study we used a gender diagnostic (GD) approach to examine the associations between gender-atypical behavior and gender role (masculinity—M and femininity—F), bullying, peer relationships, and psychological well-being in a large community sample of 15-year-olds. GD showed little relationship with gender role. Irrespective of sex, M was positively, and F negatively associated with being a bully. “Gender atypical” boys reported more victimization, more loneliness, fewer male friends, and greater distress than their “gender typical” peers. After accounting for M and F, “femaleness” (“gender atypical” boys and “extremely gender-typed” girls) was associated with psychological distress. GD is an effective and unobtrusive method to identify a group whose vulnerability should be recognized by psychology, health, and education professionals.

Fifteen, female and stressed: changing patterns of psychological distress over time

BACKGROUND Despite a widespread view that the mental health of young people has deteriorated, the evidence base is limited by the lack of comparable datasets over time, and their capacity to test specific hypotheses about the causes of such change, in this case those particularly affecting young females. METHOD Two cohorts of 15-year-olds in the West of Scotland, surveyed in 1987 and 1999, were compared, using the 12-item version of the General Health Questionnaire to measure psychological distress (GHQ caseness, cut-off 2/3), together with items and indices of personal and performance worries. RESULTS Between 1987 and 1999, GHQ caseness increased significantly for females (from 19% to 33%), but not males (13% to 15%), a change particularly experienced by females from non-manual and skilled manual backgrounds. With one notable exception (unemployment), most worries also increased for both sexes, a gender gap emerging in respect of worries about school performance, females worrying more. While the effect of personal worries (e.g., looks and weight) on GHQ caseness persisted over time in both sexes, that of performance worries only emerged for females in 1999. Using survey date as an indicator, a relationship between proximity to exams and GHQ caseness was also only found among females in 1999. CONCLUSION The increase in levels of psychological distress among young females over this period may be explained by an increase in educational expectations, which together with more traditional concerns about personal identity, appear to have elevated levels of stress, with adverse consequences for mental health.

Being different: correlates of the experience of teasing and bullying at age 11

The public stereotype, largely supported by a rather diverse range of literature, is that bullied children differ from their peers in respect of attributes such as appearance, disability or school performance. In this paper we explore the characteristics of such victims in a way which is both more comprehensive than previous studies and in addition, considers and accounts for possible inter-relationships between variables. Self-report data on teasing and bullying (found to be strongly inter-related) were obtained from a large, school-based sample of 11 year-olds, with additional descriptions and ratings of the children from their parents, class teachers and nurses. Experience of teasing/bullying did not differ according to race, physical maturity or height, but was more likely among children who were less physically attractive, overweight, had a disability such as a sight, hearing or speech problem, and performed poorly at school. These factors were not only significant regardless of sex and social class, but also independent and thus additive in their effects. Characteristics of appearance, disability or ability which in themselves may be difficult to deal with also increase the likelihood that a child will experience the additional burden of being bullied.

Reversals of fortune? Sex differences in health in childhood and adolescence

This paper reviews findings on sex differences in health among children and adolescents, concentrating particularly on the ages 7-15 years. The overall picture is of a gradual emergence of excess morbidity in females over this life stage. In respect of overall levels of chronic illness, higher male rates in childhood are replaced by higher female rates which emerge in early-mid adolescence. This pattern is also seen in an examination of the rates of two common childhood conditions, asthma and migraine/headaches. An excess of psychological disturbance (largely neurotic disorders) among females emerges in early-mid adolescence, in comparison with younger ages where males predominate. Sex differences in the utilization of health services appear to mirror these patterns of excess morbidity. There is also evidence that with increasing age there is a strengthening in the sex patterning of illness behaviour. In contrast to the emphasis which has been given to explaining the emergence of a female excess in psychological disturbance and illness-related behaviours and attitudes during early adolescence, much less attention has been given to the understanding of the excess in physical complaints among females which also arises over this period. The paper suggests that this may be directly related to the relative lowering of their psychological well-being during early adolescence. Longitudinal studies are required in order to answer questions concerning age by sex interactions in respect of morbidity in childhood and adolescence.

Prevalence of deliberate self harm and attempted suicide within contemporary Goth youth subculture: longitudinal cohort study

Abstract Objective To investigate whether deliberate self harm is associated with contemporary Goth youth subculture. Design Longitudinal cohort study. Setting School and community based study of young people living in the Central Clydeside Conurbation, Scotland. Participants 1258 people aged 19, surveyed in 2002-4 and followed-up since age 11 (1994). Main outcome measures Lifetime prevalence of self harm and attempted suicide and their association with Goth youth subculture, before and after adjusting for confounders. Results Identification as belonging to the Goth subculture was strongly associated with lifetime self harm and attempted suicide, with a prevalence of 53% and 47%, respectively among the most highly identified group, and evidence for a dose-response relation. Adjusting for potential confounders did not significantly attenuate this association. Analysis of other youth subcultures showed that this effect was primarily associated with Goth subculture. Conclusions Identification as belonging to the Goth subculture was the best predictor of self harm and attempted suicide. Although based on small numbers, additional longitudinal analysis suggests both selection and modelling mechanisms are involved, selection mechanisms possibly being more likely.

Transition matters: pupils’ experiences of the primary–secondary school transition in the West of Scotland and consequences for well‐being and attainment

The importance of school transitions for pupil adjustment, particularly their impact on later well‐being and attainment, remains contested. This paper draws on data from a longitudinal, school‐based study of over 2000 Scottish pupils, first surveyed in 135 primary schools (age 11) in 1994, and followed up in 43 secondary schools (age 13 and 15) and again after leaving school (age 18/19) in 2002/3. The length of follow‐up makes this study unique in transition research. After a year in secondary school (age 13), the majority recalled having had difficulties of adjustment to both school and peer social systems at the beginning of secondary education. While the primary (but not secondary) school played a small part in accounting for different transition experiences, controlling for a wide range of sociodemographic and other factors, personal characteristics were much more important. Respondents of lower ability and lower self‐esteem experienced poorer school transitions; those who were anxious, less prepared for secondary school and had experienced victimisation, poorer peer transitions. Further analysis of the impact of school and peer transitions on well‐being and attainment revealed that each had specific independent effects both within and beyond secondary education. At age 15, a poorer school transition predicted higher levels of depression and lower attainment; a poorer peer transition, lower self‐esteem, more depression and lower levels of anti‐social behaviour. Although reduced in size, similar results extended to outcomes at age 18/19. These effects bear comparison with those associated with gender and school disengagement, clearly demonstrating the importance of successful transition for later well‐being and attainment.

Health at age 11: reports from schoolchildren and their parents

OBJECTIVE To present self reports by children and reports by parents on behalf of their children relating to general health, current conditions, and recent symptoms. DESIGN Questionnaires completed by children and parents as part of the longitudinal “West of Scotland 11 to 16 study: teenage health.” SETTING 135 primary schools in Central Clydeside. SUBJECTS 2586 children aged 11 years, surveyed from October 1994 to March 1995 (response rate 93%). Questionnaires also completed by parents of 86% of the sample. MAIN OUTCOME MEASURES Ratings of health over the past 12 months, presence of (limiting) longstanding illness, nine current conditions, and 11 recent symptoms. RESULTS Only 47% of children described their health as “good” in the previous year. Around 20% reported a longstanding illness and 8% a limiting illness; 20% reported migraine or headaches, 13% reported asthma. Recent stomach aches or sickness, colds or flu, and headaches were each reported by around 60%. “Malaise” (emotional) symptoms were common. Parents reported similar levels of (limiting) longstanding illness, but rates of conditions and symptoms reported by parents were lower than reported by their children. Parent–child agreement was greatest for the presence of longstanding illness and the conditions of asthma, diabetes, and skin problems. It was lower for recent symptoms, particularly those categorised as reflecting malaise. CONCLUSIONS These results challenge assumptions of good health and wellbeing at this age. Illness reporting depends on various factors, including saliency, social desirability, and definitions of normality. Parent–child discrepancies may reflect different definitions of illness or symptoms; they do not mean that one should be dismissed as “wrong.” Key messages Self reported health, conditions, and symptoms at age 11, and reports from parents on behalf of children, run counter to any assumption of youthful healthiness. Symptoms of malaise, such as irritability, anxiety, and unhappiness, were each reported by over one third of children. Parents were less likely to report both conditions and symptoms than children themselves. Parent–child agreement was highest for conditions that are common, visible, or diagnosed. Greatest disagreement occurred in respect of a child’s emotional state.

Cohort Profile: West of Scotland Twenty-07 Study: Health in the Community

The West of Scotland Twenty-07 Study (Twenty-07 for short) was set up in 1986 by Sally Macintyre, Patrick West, Ellen Annandale, Kate Hunt, Graeme Ford, Rex Taylor, Sheila MacIver, Russell Ecob and Rory Williams at the Medical Research Council (MRC) Medical Sociology Unit, Glasgow (now the MRC Social and Public Health Sciences Unit). The aim of the Twenty-07 Study is to investigate, longitudinally, the social processes producing or maintaining inequalities in health by six key social positions: social class (defined, as was traditional at the time, as the main occupation of the head of household), gender, age, area of residence, marital status (now broadened to encompass family structure) and, in collaboration with other Unit programmes, ethnicity. Figure 1 illustrates the basic design of the study—it involves three cohorts 20 years apart—born around 1932 (dotted line), 1952 (dashed line) and 1972 (gray line)—with a planned follow-up period of 20 years, to provide information on 60 years of the life course. In the initial sweep, in 1987/88, the study members were thus approximately 15, 35 and 55 years of age and in the final planned round of face-to-face data collection, in 2007/08, they are approximately 35, 55 and 75 years. The study was designed to examine critical points in the lifespan; we are tracking the three cohorts as they make the transition from adolescence to working life (line a), through the main part of working life (line b) and from working life to retirement (line c). It was also designed to explore the effect of the historical context of people’s lives on their health and circumstances by comparing the different cohorts at the same age at different points in time (i.e. line d; 35-year-olds in 1987 and 2007, and line e; 55-year-olds in 1987 and 2007).