Sperlich Stefanie, Geyer Siegfried
Medical Sociology, Hannover Medical School, Germany.
Medical Sociology, Hannover Medical School, Germany.
Soc Sci Med. 2015 Apr;131:58-65. doi: 10.1016/j.socscimed.2015.03.001. Epub 2015 Mar 3.
Occupational stress as a key determinant for explaining health inequalities has been well established while the impact of stress related to family work has rarely been considered. This study investigates whether stress in household and family work may contribute to health inequalities in women. We used a population-based sample of German mothers (n = 3129) to determine the total, direct and indirect effects of education on somatic complaints by means of OLS regression-based mediation models. Inference about indirect effects was determined by 95% bias corrected bootstrap confidence intervals. Education was assessed by a measure combining school education and vocational training. Stress was measured using the adopted effort-reward-imbalance (ERI) questionnaire for household and family work. The von Zerssen list of somatic complaints was used as measure of subjective health. We found a significant total effect of education on somatic complaints (p ≤ 0.001) as well as significant indirect effects through 'effort' (p = 0.006) and 'reward' in household and family work (p ≤ 0.001). However, the subscales of ERI pointed into different directions: while levels of 'effort' increased with women's educational attainment, levels of distress related to low 'reward' decreased with higher levels of education. Our findings suggest that the effect of women's education on somatic complaints is mediated through stress related to low reward for household and family work. In particular, lack of 'societal esteem' for household and family work contributed to health disadvantages in lower educated mothers. We conclude that research on health inequality would benefit from taking stressful experiences in household and family work greater into account.
职业压力作为解释健康不平等的关键决定因素已得到充分证实，而与家庭工作相关的压力影响却很少被考虑。本研究调查家庭和家务工作中的压力是否可能导致女性的健康不平等。我们使用了一个以德国母亲为基础的样本（n = 3129），通过基于OLS回归的中介模型来确定教育对躯体不适的总效应、直接效应和间接效应。通过95%偏差校正的自助置信区间来确定间接效应的推断。教育程度通过结合学校教育和职业培训的一项指标来评估。压力使用针对家庭和家务工作采用的努力-回报失衡（ERI）问卷来测量。使用冯·泽尔森躯体不适清单作为主观健康的测量指标。我们发现教育对躯体不适有显著的总效应（p≤0.001），以及通过家庭和家务工作中的“努力”（p = 0.006）和“回报”产生的显著间接效应（p≤0.001）。然而，ERI的子量表指向不同方向：虽然“努力”水平随着女性教育程度的提高而增加，但与低“回报”相关的苦恼水平随着教育程度的提高而降低。我们的研究结果表明，女性教育对躯体不适的影响是通过与家庭和家务工作低回报相关的压力来介导的。特别是，家庭和家务工作缺乏“社会尊重”导致受教育程度较低的母亲在健康方面处于劣势。我们得出结论，健康不平等研究将受益于更多地考虑家庭和家务工作中的压力经历。
