Department of Sociology and Work Science, University of Gothenburg, Box 720, 405 30, Gothenburg, Sweden.
Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Centre for Ageing and Health - AgeCap, University of Gothenburg, Mölndal, Sweden.
BMC Psychiatry. 2020 Sep 4;20(1):434. doi: 10.1186/s12888-020-02820-9.
Old-age dementias are known to disproportionally affect women as well as individuals with low educational attainment. The higher lifetime risk of dementia among women is usually attributed to their longer life expectancy. However, the impact of sex, and subsequent gender inequity, is likely to be more multifaceted than this explanation implies. Not least because of historical inequities in access to education between the sexes and the gender and socio-economic gradients in risk factors such as stress, depression and social isolation. Consequently, the present study sought to test whether differences in educational attainment and experiences of general psychological distress mediate the association between female sex and dementia.
The study utilizes data obtained through the Gothenburg H70 Birth Cohort Study and the Prospective Populations Study on Women (n = 892). Data were analysed using Confirmatory Factor Analysis (CFA) and Structural Equation Modelling (SEM) with Weighted Least Squares Means and Variance adjusted (WLSMV) estimation. General psychological distress was indicated by a latent variable and constructed from five manifest items (previous depression, stress, self-esteem, chronic loneliness and satisfaction with social situation) that were all measured at baseline.
While the results could not corroborate that education directly mediates the effect of sex on dementia, level of distress was predicted by both female sex (0.607, p < .001) and education (- 0.166, p < .01) and, in turn, shown to be significantly associated with dementia (0.167, p < .05), also after controlling for confounders. When time from baseline to diagnosis was increased through sequential exclusion of dementia cases, the effect of distress on dementia was no longer significant.
The overall findings suggest that social (dis) advantage predicts general psychological distress, which thereby constitutes a potential, and rarely acknowledged, pathway between female sex, education, and dementia. They further underline the importance of attending to both education and distress as 'gendered' phenomena when considering the nature of their associations with dementia. However, the possibility of reverse causality bias must be acknowledged and the need for longitudinal studies with longer follow-up stressed.
老年痴呆症已知会不成比例地影响女性和受教育程度较低的人群。女性患痴呆症的终身风险较高通常归因于她们的预期寿命更长。然而，性别影响及其随后的性别不平等，可能比这一解释所暗示的更为复杂。不仅因为历史上男女在接受教育方面存在不平等，而且在压力、抑郁和社会隔离等风险因素方面存在性别和社会经济梯度。因此，本研究旨在测试教育程度差异和一般心理困扰经历是否在女性性别与痴呆症之间的关联中起中介作用。
本研究利用哥德堡 H70 出生队列研究和女性前瞻性人群研究（n=892）获得的数据。使用验证性因素分析（CFA）和结构方程模型（SEM）以及加权最小二乘法均值和方差调整（WLSMV）估计分析数据。一般心理困扰由五个显式项目（既往抑郁、压力、自尊、慢性孤独和对社会状况的满意度）组成的潜变量表示，这些项目均在基线时进行测量。
虽然结果不能证实教育直接介导性别对痴呆症的影响，但性别（0.607，p<0.001）和教育（-0.166，p<0.01）都可以预测困扰程度，并且困扰程度与痴呆症显著相关（0.167，p<0.05），即使在控制了混杂因素后也是如此。当通过逐步排除痴呆症病例来增加从基线到诊断的时间时，困扰对痴呆症的影响不再显著。
总体研究结果表明，社会（不利）优势预测一般心理困扰，这是女性性别、教育和痴呆症之间潜在的、很少被承认的途径。它们进一步强调了在考虑教育和困扰与痴呆症之间关联的性质时，将两者视为“性别化”现象的重要性。然而，必须承认存在反向因果关系偏差的可能性，并强调需要进行具有更长随访时间的纵向研究。
