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Sex differences in dementia: on the potentially mediating effects of educational attainment and experiences of psychological distress

BACKGROUND: 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 lik...

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Autores principales: Hasselgren, Caroline, Ekbrand, Hans, Halleröd, Björn, Mellqvist Fässberg, Madeleine, Zettergren, Anna, Johansson, Lena, Skoog, Ingmar, Dellve, Lotta
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2020
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Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7487622/
https://www.ncbi.nlm.nih.gov/pubmed/32887574
http://dx.doi.org/10.1186/s12888-020-02820-9
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author Hasselgren, Caroline
Ekbrand, Hans
Halleröd, Björn
Mellqvist Fässberg, Madeleine
Zettergren, Anna
Johansson, Lena
Skoog, Ingmar
Dellve, Lotta
author_facet Hasselgren, Caroline
Ekbrand, Hans
Halleröd, Björn
Mellqvist Fässberg, Madeleine
Zettergren, Anna
Johansson, Lena
Skoog, Ingmar
Dellve, Lotta
author_sort Hasselgren, Caroline
collection PubMed
description BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.
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spelling pubmed-74876222020-09-16 Sex differences in dementia: on the potentially mediating effects of educational attainment and experiences of psychological distress Hasselgren, Caroline Ekbrand, Hans Halleröd, Björn Mellqvist Fässberg, Madeleine Zettergren, Anna Johansson, Lena Skoog, Ingmar Dellve, Lotta BMC Psychiatry Research Article BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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. BioMed Central 2020-09-04 /pmc/articles/PMC7487622/ /pubmed/32887574 http://dx.doi.org/10.1186/s12888-020-02820-9 Text en © The Author(s) 2020 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research Article
Hasselgren, Caroline
Ekbrand, Hans
Halleröd, Björn
Mellqvist Fässberg, Madeleine
Zettergren, Anna
Johansson, Lena
Skoog, Ingmar
Dellve, Lotta
Sex differences in dementia: on the potentially mediating effects of educational attainment and experiences of psychological distress
title Sex differences in dementia: on the potentially mediating effects of educational attainment and experiences of psychological distress
title_full Sex differences in dementia: on the potentially mediating effects of educational attainment and experiences of psychological distress
title_fullStr Sex differences in dementia: on the potentially mediating effects of educational attainment and experiences of psychological distress
title_full_unstemmed Sex differences in dementia: on the potentially mediating effects of educational attainment and experiences of psychological distress
title_short Sex differences in dementia: on the potentially mediating effects of educational attainment and experiences of psychological distress
title_sort sex differences in dementia: on the potentially mediating effects of educational attainment and experiences of psychological distress
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7487622/
https://www.ncbi.nlm.nih.gov/pubmed/32887574
http://dx.doi.org/10.1186/s12888-020-02820-9
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