Gender perspectives on psychosocial risk factors : conditions governing women's lives in relation to stress and coronary heart disease

The overall aim of this thesis was to shed light on womens psychosocial perceived stress as it is shaped within a gender-structured reality. By using a gender theoretical and social psychological approach the thesis aims to elucidate patterns concerning women's work, stress and living conditions that might affect their health and the progress of coronary heart disease (CHD). The aim is also to display ways in which women's health can be improved, with optimal prevention, treatment and rehabilitation. Furthermore, the aim is to contribute to a wider understanding of how to be able to perceive, measure, change relevant factors, and to give relevant help to women in stressful situations.

Four empirical studies based on quantitative and qualitative methods are presented. A questionnaire (The Stress Profile) was answered by 538 rehabilitation participants (97 women, 441 men), and a reference group (5308 women, 5177 men), aged 40-65 years. Indepth interviews were also conducted with 25 women suffering from CHD.

Findings from the interviews gave a deeper understanding of how gender and genderinfluenced structures influence women's workload, perceived stress and behaviour patterns. Analyses showed that stress is so much more than just job-related. More than ten fields of stress factors were identified, indicating four phenomena, each of which contributed in different ways to enlarging perspectives on stress and living conditions, in terms both of variety and duration: exposed position, caring and curing, consideration and disquiet, and frustration and setbacks. Findings also showed consequences on financial situation, health and awareness of warning signs.

When comparing women's and men's results from the Stress Profile, women generally reported higher levels of stress than men did. Significant differences appeared concerning five areas: work content, workload and control, physical stress reactions, emotional stress reactions and burnout. Women also appear to be more sensitive than men with respect to psychosocial risk factors for CHD, and the predictive ability of psychosocial risk factors is shown to be of great importance. Most interesting, however, are the patterns of differences that emerged when women and men were compared in different subgroups. Women with upper secondary school education and women in white-collar positions reported significantly higher levels of external stress than men did, in the respective groups. When comparing women with CHD and healthy matched women, women with CHD reported a significantly higher level of burnout than the healthy matched group. Interesting patterns of differences emerged when comparing coping abilities in different subgroups.

The construction of femininity and masculinity in our society gives women and men different roles and positions. A consequence of this is that the living conditions of women and men are different, which perhaps leads to differences in (ill) health, symptoms and perceptions of causes of ill health. When identifying, measuring and considering women's stress, there is an obvious need to look at living conditions in a gender perspective, using gender theory. However, social-structural problems cannot be solved by individual change in thoughts and actions alone; measures to prevent and deal with unhealthy psychosocial conditions are recommended. Both future CHD patients and others might benefit from such preventive actions.

List of scientific papers

I. Hallman T, Burell G, Setterlind S, Oden A, Lisspers J (2001). Psychosocial risk factors for coronary heart disease, their importance compared with other risk factors and gender differences in sensitivity. J Cardiovasc Risk. 8(1): 39-49.
https://pubmed.ncbi.nlm.nih.gov/11234725

II. Hallman T, Perski A, Burell G, Lisspers J, Setterlind S (2002). Perspectives on differences in perceived external stress: A study of women and men with coronary heart disease. Stress and Health. 18: 105-18.

III. Hallman T, Thomsson H, Burell G, Lisspers J, Setterlind S (2003). Stress, burnout and coping - differences between women with coronary heart disease and healthy matched women. Journal of Health Psychology 8(3). [Accepted]

IV. Hallman T, Thomsson H (2003). What can Swedish women with coronary heart disease tell us about stress? - An interview study concerning living conditions for women in a lifetime perspective. [Submitted]