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Gender and HealthGender and Health

Vicki S. HelgesonVicki S. Helgeson

Carnegie Mellon UniversityCarnegie Mellon University

2006 PMBC Summer 2006 PMBC Summer InstituteInstitute

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Number of Deaths per 100,000 Number of Deaths per 100,000 in 2003in 2003

AgeAge MaleMale FemaleFemale Male:FemalMale:Female ratioe ratio

01-401-4 3535 2828 1.251.25

10-1410-14 2323 1515 1.531.53

20-2420-24 140140 5050 2.802.80

30-3430-34 149149 7373 2.042.04

40-4440-44 304304 179179 1.691.69

50-5450-54 661661 381381 1.731.73

60-6460-64 14621462 929929 1.571.57

70-7470-74 34293429 22572257 1.511.51

80-8480-84 85148514 60366036 1.411.41

85 and over85 and over 1579415794 1406314063 1.121.12

Source: National Vital Statistics Reports (2006)

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Life Expectancies Over the Life Expectancies Over the Twentieth CenturyTwentieth Century

MenMen WomenWomenWhite White menmen

White White womenwomen

Black Black menmen

Black Black womenwomen

20042004 75.275.2 80.480.4 75.775.7 80.880.8 69.869.8 76.576.5

20002000 74.174.1 79.579.5 74.874.8 80.080.0 67.267.2 74.774.7

19901990 71.871.8 78.878.8 72.772.7 79.479.4 64.564.5 73.673.6

19801980 70.070.0 77.577.5 70.770.7 78.178.1 63.863.8 72.572.5

19701970 67.167.1 74.774.7 68.068.0 75.675.6 60.060.0 68.368.3

19601960 66.666.6 73.173.1 67.467.4 74.174.1 61.161.1 66.366.3

19501950 65.665.6 71.171.1 66.566.5 72.272.2 59.159.1 62.962.9

19401940 60.860.8 65.265.2 62.162.1 66.666.6 51.551.5 54.954.9

19301930 58.158.1 61.661.6 59.759.7 63.563.5 47.347.3 49.249.2

19201920 53.653.6 54.654.6 54.454.4 55.655.6 45.545.5 45.245.2

19101910 48.448.4 51.851.8 48.648.6 52.052.0 33.833.8 37.537.5

19001900 46.346.3 48.348.3 46.646.6 48.748.7 32.532.5 33.533.5Source: National Center for Health Statistics (2006)

Note: The figures from 1900 to 1960 for black people reflect “black and other” people

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Sex Differences in Mortality Sex Differences in Mortality ↑ Over the 20↑ Over the 20thth Century Century

Sex Sex DifferencDifferenc

eeMaleMale FemaleFemale

19001900 2 years2 years 46.346.3 48.348.3

19801980 7.5 years7.5 years 70.070.0 77.577.5

20002000 5.4 years5.4 years 74.174.1 79.579.5

20042004 5.2 years5.2 years 75.275.2 80.480.4

What are the leading causes of What are the leading causes of death?death?

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Age-Adjusted Death Rates (per 100,000) for the Leading Age-Adjusted Death Rates (per 100,000) for the Leading Causes of Death in 2003Causes of Death in 2003

Cause of DeathCause of Death AllAll M/FM/F B/WB/W H/WH/W

Heart DiseaseHeart Disease 235.235.66 1.51.5 1.31.3 0.80.8

CancerCancer 191.191.55 1.51.5 1.21.2 0.70.7

Cerebrovascular diseaseCerebrovascular disease 54.254.2 1.01.0 1.51.5 0.80.8

Chronic lower respiratory diseaseChronic lower respiratory disease 43.543.5 1.41.4 0.70.7 0.40.4

AccidentsAccidents 37.637.6 2.22.2 1.01.0 0.80.8

Diabetes mellitusDiabetes mellitus 25.525.5 1.31.3 2.12.1 1.61.6

Pneumonia and influenzaPneumonia and influenza 22.422.4 1.41.4 1.11.1 0.80.8

Alzheimer’s diseaseAlzheimer’s disease 21.821.8 0.80.8 0.80.8 0.60.6

Kidney diseaseKidney disease 14.614.6 1.41.4 2.32.3 1.01.0

SepticemiaSepticemia 11.711.7 1.21.2 2.32.3 0.80.8

SuicideSuicide 10.810.8 4.34.3 0.40.4 0.40.4

Liver diseaseLiver disease 9.59.5 2.22.2 0.90.9 1.61.6

Hypertension and renal diseaseHypertension and renal disease 7.57.5 1.01.0 2.82.8 1.01.0

Parkinson’s diseaseParkinson’s disease 6.26.2 2.22.2 0.40.4 0.50.5

HomicideHomicide 6.16.1 3.63.6 5.75.7 2.92.9

Source: National Vital Statistics (2006)Source: National Vital Statistics (2006)

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Paradox:Paradox:

Women live longer than men but…Women live longer than men but…

……women report worse health than men.women report worse health than men.

Men have higher rates of mortality.Men have higher rates of mortality.

Women have higher rates of morbidity.Women have higher rates of morbidity.

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Classes of ExplanationsClasses of Explanations1.1. BiologyBiology

– GenesGenes– Immune systemImmune system– HormonesHormones

2.2. Health behaviorsHealth behaviors

3.3. Stressful life Stressful life eventsevents

4.4. Social rolesSocial roles

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Artifacts: Physician BiasArtifacts: Physician Bias

I.I. DepressionDepression• Women are 2x likely to be depressed as menWomen are 2x likely to be depressed as men• Clinicians more likely to classify symptoms as Clinicians more likely to classify symptoms as

depression in women than mendepression in women than men• Clinicians less likely to detect depression in Clinicians less likely to detect depression in

men than womenmen than women• PCP’s detection of depression compared to PCP’s detection of depression compared to

independent screening of 19,000 patients (Borowsky et independent screening of 19,000 patients (Borowsky et al., 2000)al., 2000)

• Clinicians more likely to provide medication to Clinicians more likely to provide medication to women than men, when symptoms are similarwomen than men, when symptoms are similar

• Due to patient?Due to patient?• Due to provider?Due to provider?

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0

2

4

6

8

10

12

14DepressiDepressionon

Also, response bias in the area Also, response bias in the area ofof depressiondepression::

Depression Hassles Depression Hassles Depression HasslesDepression Hassles

Male Male FemaleFemaleSource: Adapted from Page & Bennesch (1993)

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Artifacts: Physician BiasArtifacts: Physician BiasII.II. Coronary Heart DiseaseCoronary Heart Disease

FACT: men have higher rates of heart disease FACT: men have higher rates of heart disease than womenthan women

FACT: heart disease is #1 killer of women, tooFACT: heart disease is #1 killer of women, too

FACT: onset of heart disease occurs later in FACT: onset of heart disease occurs later in women than menwomen than men

FACT: once diagnosed, women’s disease is more FACT: once diagnosed, women’s disease is more advanced than men advanced than men even when controlling for even when controlling for ageage

FACT: women have more complications from FACT: women have more complications from treatment and higher mortality rates than mentreatment and higher mortality rates than men

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Are women treated Are women treated differently than men?differently than men?

• Same symptoms more likely to be attributed to Same symptoms more likely to be attributed to CHD in men than womenCHD in men than women– Partly because men and women have different Partly because men and women have different

symptoms symptoms men have “classic” chest painmen have “classic” chest pain

• Men more likely than women to be referred Men more likely than women to be referred for:for:– CatheterizationCatheterization– Cholesterol-lowering medicationCholesterol-lowering medication– Invasive treatment (PTCA, CABG)Invasive treatment (PTCA, CABG)

These relations generally hold when controlling for These relations generally hold when controlling for age age

• Men fare better following invasive treatment Men fare better following invasive treatment than womenthan women

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• Alcohol: men moreAlcohol: men more• Smoking: men more (but…)Smoking: men more (but…)• Diet: possibly women better Diet: possibly women better

(but…)(but…)• Exercise: men moreExercise: men more• Preventive health care: women Preventive health care: women

moremore• Sleep: ???Sleep: ???

Classes of Explanations….Classes of Explanations….

Health Health BehaviorsBehaviors

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Stressful Life EventsStressful Life Events• Meta-analysis (Davis, Matthews & Meta-analysis (Davis, Matthews &

Twamley, 1999)Twamley, 1999)– Females > Males: d = .12Females > Males: d = .12

• Moderator: type of ratingModerator: type of rating– Stress exposure: d = +.08Stress exposure: d = +.08– Stress impact: d = +.18Stress impact: d = +.18

• Moderator: type of eventModerator: type of event– Interpersonal: d = +.17Interpersonal: d = +.17– Personal: d = +.07Personal: d = +.07

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Sex Comparisons of Interpersonal Sex Comparisons of Interpersonal Stress and Non-interpersonal Stress Stress and Non-interpersonal Stress Among Preadolescents and AdolescentsAmong Preadolescents and Adolescents

0

2

4

6

8

10

12

14

Female Male

Preadolescent

Adolescent

0

2

4

6

8

10

12

14

Female Male

PreadolescentAdolescent

Inte

rpers

on

al

stre

ssIn

terp

ers

on

al

stre

ss

Non

-in

terp

ers

on

al

Non

-in

terp

ers

on

al

stre

ssst

ress

Source: Adapted from Rudolph & Hammen (1999)

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Differential Differential Exposure? Exposure?

or or Differential Differential

Vulnerability?Vulnerability?

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Social Role: MenSocial Role: Men

• Hazardous jobsHazardous jobs• Drive moreDrive more• Risk-taking behaviorRisk-taking behavior

– Own gunsOwn guns– Leisure activities (hunting, skydiving, Leisure activities (hunting, skydiving,

skiing, mountain climbing)skiing, mountain climbing)– Participation in risky sports (football, Participation in risky sports (football,

wrestling) [and playing while wrestling) [and playing while injured]injured]

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Encouragement of Risk-Taking Encouragement of Risk-Taking Behavior in BoysBehavior in Boys

• Parent watched video of boy/girl on playground Parent watched video of boy/girl on playground (ages 6-10)(ages 6-10)

• Stop tape and report what they would sayStop tape and report what they would sayBoysBoys GirlsGirls

NeutralNeutral .1.1 .1.1

No RiskNo Risk 1.11.1 .8.8

RiskRisk 1.21.2 4.4 *4.4 *

- Attn getting- Attn getting 2.52.5 3.8 *3.8 *

+ Attn getting+ Attn getting .4.4 .3.3

• Verbalization during risk-takingVerbalization during risk-takingBoysBoys GirlsGirls

EncouragemenEncouragementt

3.03.0 .5 *.5 *

Directives to Directives to stopstop

.6.6 9.3 *9.3 *

CautionCaution .7.7 3.9 *3.9 *Source: Morrongiello & Dawber Source: Morrongiello & Dawber (2000)(2000)

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Social Role: WomenSocial Role: Women• Social network double-edged sword:Social network double-edged sword:

– Provides support and potential to reduce Provides support and potential to reduce stressstress

– Provides people to take care ofProvides people to take care of

• Nurturant Role Hypothesis (Gove & Nurturant Role Hypothesis (Gove & Hughes, 1979)Hughes, 1979)– Exposed to more infectious agentsExposed to more infectious agents– Caretaking leads to fatigue and vulnerability Caretaking leads to fatigue and vulnerability

to illnessto illness– Time spent caring for others leads to less Time spent caring for others leads to less

time spent caring for selftime spent caring for self

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Gender-Related Traits: Gender-Related Traits: FemaleFemale

♀♀

COMMUNIONCOMMUNION

Self-NeglectSelf-Neglect

OverinvolvOverinvolved in ed in

Other’s Other’s ProblemsProblems

Focus on OthersFocus on Others

UNMITIGATEUNMITIGATED D COMMUNIOCOMMUNIONN

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Links to Well-BeingLinks to Well-Being

• CommunionCommunion– Provides social supportProvides social support– Linked to social skillsLinked to social skills– Unrelated to psychological distressUnrelated to psychological distress

• Unmitigated communionUnmitigated communion– Linked to psychological distressLinked to psychological distress– Linked to self-neglectLinked to self-neglect– Linked to rumination about othersLinked to rumination about others– Linked to poor adjustment to diseaseLinked to poor adjustment to disease– Linked to poor metabolic controlLinked to poor metabolic control

♀♀

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UC Laboratory StudiesUC Laboratory Studies• Exposed to person who self-discloses Exposed to person who self-discloses

problemproblem– Study 1: FriendStudy 1: Friend– Study 2: StrangerStudy 2: Stranger

Fritz & Helgeson (1998)Fritz & Helgeson (1998)

Intrusive Intrusive thoughts thoughts

about about problemproblem

Study 1Study 1 Study 2Study 2

Unmitigated Unmitigated CommunionCommunion .46 **.46 ** .35 *.35 *

CommunionCommunion .24.24 .08.08

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Adolescents with Adolescents with DiabetesDiabetes

• T1 interviewT1 interview• T2 interview (4 months later)T2 interview (4 months later)• Early adolescents (13-14)Early adolescents (13-14)• Middle adolescents (15-17)Middle adolescents (15-17)

Helgeson & Fritz (1996)Helgeson & Fritz (1996)

ß ß

UC UC T2 Distress T2 Distress .36 *.36 *

.30 (control for T1).30 (control for T1)

Sex Sex UC UC DistressDistress

Metabolic ControlMetabolic Control

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-1

-0.5

0

0.5

1

1.5

2Poor Poor Metabolic Metabolic ControlControl

-1 SD +1 SD

__ Early Adolescence

__ Middle Adolescence

Unmitigated CommunionUnmitigated Communion

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UnmitigatedUnmitigatedCommunionCommunion

RelationshipRelationshipStressorsStressors

MetabolicMetabolicControlControl

PsychologicalPsychologicalDistressDistress

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More on Adolescents with More on Adolescents with DiabetesDiabetes

• n = n = 132 adolescents with diabetes132 adolescents with diabetes• nn = 131 healthy adolescents = 131 healthy adolescents• Average age = 12 (11-13)Average age = 12 (11-13)• Interviewed annuallyInterviewed annually

• UC → UC → ↑ ↑ distressdistress ↓ ↓ self-esteemself-esteem ↓ ↓ metabolic controlmetabolic control

• UC → ↑ eating disturbancesUC → ↑ eating disturbances

• UC → eating disturbances → distressUC → eating disturbances → distress self-esteemself-esteem metabolic controlmetabolic control

Helgeson et al. (under revision)Helgeson et al. (under revision)

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Gender-Related Traits: Gender-Related Traits: MaleMale

♂♂Self-AbsorptionSelf-Absorption

Distrust of Distrust of OthersOthersFocus on SelfFocus on Self

UNMITIGATEUNMITIGATED AGENCYD AGENCYAGENCYAGENCY

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Links to Well-BeingLinks to Well-Being• AgencyAgency

– Linked to good health behavior (exercise)Linked to good health behavior (exercise)– Linked to self-efficacy, perceptions of controlLinked to self-efficacy, perceptions of control– Linked to high self-esteemLinked to high self-esteem– Linked to reduced stressLinked to reduced stress

• Unmitigated agencyUnmitigated agency– Linked to psychological reactanceLinked to psychological reactance– Linked to poor health behaviorLinked to poor health behavior– Linked to noncomplianceLinked to noncompliance– Linked to problem behaviors (delinquency, Linked to problem behaviors (delinquency,

smoking, etc.)smoking, etc.)– Linked to hostilityLinked to hostility

♂♂

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UAUA

Change inChange in

Self-EfficacySelf-Efficacy

Change in Change in Prostate-specific Prostate-specific

FunctionFunction

Change in Change in Mental Mental HealthHealth

BowelBowel UrineUrine

MCSMCS DepressionDepression

-.29** .51*** .68***

-.30*

.66 .67

.88 -.81 Intrusive Intrusive thoughtsthoughts

Helgeson & Lepore (2004)Helgeson & Lepore (2004)

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Change in Change in Self-EsteemSelf-EsteemAgencyAgency

Change in Change in Prostate-Prostate-specific specific FunctionFunction

DepressionDepression

BowelBowel UrineUrine

.76 .61

-.55***.48***.23*

.31*

Helgeson & Lepore (2004)Helgeson & Lepore (2004)

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Which explanation accounts Which explanation accounts for the “Gender Paradox”?for the “Gender Paradox”?

Health Behaviors Health Behaviors Men’s Men’s mortalitymortality

Social Role Factors Social Role Factors Women’s Women’s morbiditymorbidity