Well-being and mental stress in the Population Study of Women in Gothenburg, Sweden: Cohort comparisons from 1980 to 2016 of 36-year trends and socioeconomic disparities in 38-and 50-year old women

Well-being and mental stress in the Population Study of Women in Gothenburg, Sweden: Cohort comparisons from 1980 to 2016 of 36-year trends and socioeconomic disparities in 38-and 50-year old women | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research article Well-being and mental stress in the Population Study of Women in Gothenburg, Sweden: Cohort comparisons from 1980 to 2016 of 36-year trends and socioeconomic disparities in 38-and 50-year old women Maria Waller, Lauren Lissner, Dominique Hange, Valter Sundh, Ann Blomstrand, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-60007/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 12 You are reading this latest preprint version Abstract Background Women`s life situations has dramatically changed in recent decades. Self-reported health in women has been reported significantly lower than in men in all age groups 18-70 years. In Sweden, the National Public Health Report 2005 showed that stressful work environments have become more common especially for women. The purpose of the study was to monitor trends in well-being and mental stress in the populations of 38- and 50-year-old women and to examine associations with socioeconomic position (SEP). Subjects Population-based cohorts of 38- and 50-year-old women as a part of the Prospective Population Study of Women in Gothenburg were invited in 1980, 2004 and 2016 to health examinations, with similar protocols on each occasion Methods Cohort comparisons between three representative samples of 38- and 50-year-old women. Well-being (scale 1-7) and perceived mental stress (scale 1-6) based on questionnaires were the main outcomes studied in relation to time. Socioeconomic position (SEP) based on socio-occupational group, i.e. occupational and educational level combined were examined as correlates well-being and mental stress at different points in time. Results Perception of good well-being increased in 50-year-old women between 1980 to 2016, but no significant time trends were seen in 38-year-old women. Perception of high mental stress increased between 1980 and 2016, for both 38-and 50-year-old women. Belonging to a low socio-occupational group was associated with lower perceived well-being in 1980 but not in 2016. Belonging to a low socio-occupational group was not associated with perceived mental stress at any examination. Conclusions Contemporary women of today have generally higher perceptions of well-being and higher mental stress regardless of belonging to low or high socio-occupational group. Associations between poor well-being and belonging to a low socio-occupational group that were observed in 1980 disappeared in 2016. Trial registration The Prospective Population Study of Women in Gothenburg, Sweden was approved by the ethics committee of University of Gothenburg (Dnr 65-80; Ö564-03; 258-16). The studies comply with the Declaration of Helsinki and informed consent has been obtained from the subjects. Health Economics & Outcomes Research Health Policy Well-being mental stress socioeconomic position women trends over time cohort comparisons. Figures Figure 1 Figure 2 Full Text Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Major revision 17 Jan, 2021 Review # 3 received at journal 13 Jan, 2021 Reviewer # 3 agreed at journal 06 Jan, 2021 Reviewer # 2 agreed at journal 22 Nov, 2020 Review # 2 received at journal 22 Nov, 2020 Review # 1 received at journal 09 Sep, 2020 Reviewer # 1 agreed at journal 28 Aug, 2020 Reviewers invited by journal 25 Aug, 2020 Editor assigned by journal 17 Aug, 2020 Submission checks completed at journal 16 Aug, 2020 Editor invited by journal 16 Aug, 2020 First submitted to journal 14 Aug, 2020 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-60007","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research article","associatedPublications":[],"authors":[{"id":1675253,"identity":"69cd5528-1a02-4c93-8559-9734adc0e582","order_by":0,"name":"Maria Waller","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA3UlEQVRIiWNgGAWjYJCCAyCCjx1IfCBJCxszAwPjDJKsAmlh5iFGpW772YcHfjAclmdjZj722ebXYQb59gb8WszOpBsc7GE4bNjGzJY8O7fvMIPBmQMEtBxIYzjAw3CbsY2Zx5g5tweoRSKBgJbzzxgO/mG4bd/GzP+Z2RKoRX7+AwJabqQxHAbakgi0hZmZ4cdhBoYb+HUAtTxjOCxj8D8Z6Bdjxt6GdB6DMwQdlsb88U1Fmm0/e/Njhh9/rOXk2w8QsAYMDKA0YxsDUVGDDP6QqmEUjIJRMApGAgAAp4BALwi8macAAAAASUVORK5CYII=","orcid":"https://orcid.org/0000-0001-6871-1667","institution":"Sahlgrenska Academy","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Maria","middleName":"","lastName":"Waller","suffix":""},{"id":1675254,"identity":"bb01c011-2834-49b2-873c-4c02779e9b63","order_by":1,"name":"Lauren Lissner","email":"","orcid":"","institution":"Sahlgrenska Academy,","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Lauren","middleName":"","lastName":"Lissner","suffix":""},{"id":1675255,"identity":"97116dbb-85f6-4295-bd08-e6fbd446fe96","order_by":2,"name":"Dominique Hange","email":"","orcid":"","institution":"Sahlgrenska Academy","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Dominique","middleName":"","lastName":"Hange","suffix":""},{"id":1675256,"identity":"4377b8b2-90d4-4679-813c-ab6d2b2d79a4","order_by":3,"name":"Valter Sundh","email":"","orcid":"","institution":"Sahlgrenska Academy","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Valter","middleName":"","lastName":"Sundh","suffix":""},{"id":1675257,"identity":"1a7c0fd6-1eb2-49fa-b4d1-d71c5481995e","order_by":4,"name":"Ann Blomstrand","email":"","orcid":"","institution":"Sahlgrenska Academy","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Ann","middleName":"","lastName":"Blomstrand","suffix":""},{"id":1675258,"identity":"0efa35a3-0b8b-4c40-b86b-5a93afd29b31","order_by":5,"name":"Cecilia Björkelund","email":"","orcid":"","institution":"Sahlgrenska Academy","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Cecilia","middleName":"","lastName":"Björkelund","suffix":""}],"badges":[],"createdAt":"2020-08-15 10:13:23","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-60007/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-60007/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":2088651,"identity":"f4b69123-bbff-489f-aee5-3e1cc9e58597","added_by":"auto","created_at":"2020-08-26 16:32:32","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":74551,"visible":true,"origin":"","legend":"Description of the six 38- and 50-year-old cohorts examined in the Population Study of Women examinations in 1980, 2004 and 2016, respectively. 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Self-reported health in women has been reported significantly lower than in men in all age groups 18-70 years. In Sweden, the National Public Health Report 2005 showed that stressful work environments have become more common especially for women. The purpose of the study was to monitor trends in well-being and mental stress in the populations of 38- and 50-year-old women and to examine associations with socioeconomic position (SEP). \u003c/p\u003e\u003cp\u003e\u003cstrong\u003eSubjects\u003c/strong\u003e Population-based cohorts of 38- and 50-year-old women as a part of the Prospective Population Study of Women in Gothenburg were invited in 1980, 2004 and 2016 to health examinations, with similar protocols on each occasion \u003c/p\u003e\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e Cohort comparisons between three representative samples of 38- and 50-year-old women. Well-being (scale 1-7) and perceived mental stress (scale 1-6) based on questionnaires were the main outcomes studied in relation to time. Socioeconomic position (SEP) based on socio-occupational group, i.e. occupational and educational level combined were examined as correlates well-being and mental stress at different points in time. \u003c/p\u003e\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e Perception of good well-being increased in 50-year-old women between 1980 to 2016, but no significant time trends were seen in 38-year-old women. Perception of high mental stress increased between 1980 and 2016, for both 38-and 50-year-old women. Belonging to a low socio-occupational group was associated with lower perceived well-being in 1980 but not in 2016. Belonging to a low socio-occupational group was not associated with perceived mental stress at any examination. \u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e Contemporary women of today have generally higher perceptions of well-being and higher mental stress regardless of belonging to low or high socio-occupational group. Associations between poor well-being and belonging to a low socio-occupational group that were observed in 1980 disappeared in 2016. \u003c/p\u003e\u003cp\u003e\u003cstrong\u003eTrial registration \u003c/strong\u003eThe Prospective Population Study of Women in Gothenburg, Sweden was approved by the ethics committee of University of Gothenburg (Dnr 65-80; Ö564-03; 258-16). The studies comply with the Declaration of Helsinki and informed consent has been obtained from the subjects.\u003c/p\u003e","manuscriptTitle":"Well-being and mental stress in the Population Study of Women in Gothenburg, Sweden: Cohort comparisons from 1980 to 2016 of 36-year trends and socioeconomic disparities in 38-and 50-year old women","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2020-08-26 16:00:08","doi":"10.21203/rs.3.rs-60007/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Major revision","date":"2021-01-18T00:00:00+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2021-01-14T00:00:00+00:00","index":3,"fulltext":"Recommendation: Major revisions required\nForm responses:\n---\n\nComments to Author:\n---\nPEER REVIEWER ASSESSMENTS:\n\nOBJECTIVE - Full research articles: is there a clear objective that addresses a testable research question(s) (brief or other article types: is there a clear objective)?\nNo - there are minor issues\n\nDESIGN - Is the current approach (including controls and analysis protocols) appropriate for the objective?\nNo - there are major issues\n\nEXECUTION - Are the experiments and analyses performed with technical rigor to allow confidence in the results?\nNo - there are major issues\n\nSTATISTICS - Is the use of statistics in the manuscript appropriate?\nNo - there are issues with the statistics in the study\n\nINTERPRETATION - Is the current interpretation/discussion of the results reasonable and not overstated?\nNo - there are major issues\n\nOVERALL MANUSCRIPT POTENTIAL - Is the current version of this work technically sound? If not, can revisions be made to make the work technically sound?\nMaybe - with major revisions\n\nPEER REVIEWER COMMENTS:\n\nGENERAL COMMENTS:\nThank you for the opportunity to review this paper. I have provided feedback for each section of the manuscript. I am happy to review the revised manuscript once the authors have had the opportunity to revise their submission. Overall, this is a well designed study that used a classical approach to examining stress and mental health among women using a longitudinal cohort in Sweden.\n\nAbstract\nThe first sentence of the abstract is very broad. Please revise it. \"Women`s life situations has dramatically changed in recent decades.\" What is it exactly about their life situations that has changed?\n\nIn the subjects heading, please add the word Sweden after Gothenburg for the benefit of an international readership.\n\nIntroduction\nThe first line needs to be more specific.\n\nFor the following sentence, \"Perceived health, well-being and mental stress are closely related factors (5) \", please follow up with a sentence or two that explains how they are related with the appropriate citations.\nMethods\n\nThe aim of the paper should be before the methods section. Please move this to the background section right before the start of the methods section.\n\nYou should provide the WHO's definition of health in your methods section as well as the citation. Would you please report the high reliability statistics?\n\nWould you report the reliability of the previous study that used the mental stress based questionnaire items?\n\nWhat software was used for the analysis?\nResults\n\nWhere the study odds ratios adjusted? If not, please provide a rationale\n\nDiscussion\n\nThere should be a greater integration of the study findings into the broader literature about sleep, health and well-being.\n\nThe authors should expand the future studies statement and include how women's stress and mental health should be examined, especially within the context of the global pandemic.\n\nREQUESTED REVISIONS:\nI have provided suggestions to improve the quality of this suggestion. I suggest that the authors kindly review these recommendations and prepare a revised manuscript. I would be delighted to review their changes.* Publons Reviewer Recognition. Springer Nature can send verification of this review directly to Publons (a subsidiary of Clarivate Analytics). If you would like to take advantage of this service, please click on the “Yes” option below. Your name, email address, title of the reviewed manuscript, name of the journal, and date of your review submission (the “Review Data”) will then be transmitted to Publons upon publication of the manuscript. If you have already registered at Publons, they will notify you of the receipt of this review and update your profile as per your settings and their policy. If you are not registered with Publons, you will receive an email from them asking you to register in order for them to be able to recognize your review on your new profile page. Publons may use the Review Data to generate derivative metadata for the benefit of Publons and you as a reviewer, carefully considering the sensitivity of such information. For example, Publons may verify your record as a reviewer by updating your profile published on its webservice if you have registered for such service or help editors to identify candidate reviewers. Please find the details of processing in Publons’ privacy policy https://publons.com/about/terms: **No**\n* Declaration of competing interests: **This reviewer has been recruited by a partner organization, Research Square. Reviewers with declared or apparent competing interests are not utilized for these reviews. This reviewer has agreed to publication of their comments online under a Creative Commons Attribution License attributed to Research Square and was paid a small honorarium for completing the review within a specified timeframe. Honoraria for reviews such as this are paid regardless of the reviewer recommendation.**\n* Reviewer Publication Consent. I agree for my report to be made available under an Open Access Creative Commons CC-BY License (http://creativecommons.org/licenses/by/4.0) if this manuscript is accepted for publication. Any comments that I do not wish to be included in the published report have been included as confidential comments to the editor, which will not be published.: **I agree to the terms of the CC-BY 4.0 license; please do not publish my name with my report. (default)**\n* Is the study design appropriate to answer the research question (including the use of appropriate controls), and are the conclusions supported by the evidence presented?: **No**\n* Are the methods sufficiently described to allow the study to be repeated?: **No**\n* Is the use of statistics and treatment of uncertainties appropriate?: **No**\n* Is the presentation of the work clear?: **Yes**\n* Are the images in this manuscript (including electrophoretic gels and blots) free from apparent manipulation?: **Yes**\n"},{"type":"reviewerAgreed","content":"","date":"2021-01-07T00:00:00+00:00","index":3,"fulltext":""},{"type":"reviewerAgreed","content":"","date":"2020-11-23T00:00:00+00:00","index":2,"fulltext":""},{"type":"editorInvitedReview","content":"","date":"2020-11-23T00:00:00+00:00","index":2,"fulltext":"Recommendation: Major revisions required\nForm responses:\n---\n\nComments to Author:\n---\nThis is a potentially very interesting study dealing with an issue of great public health importance, the development of health and health inequalities over time with a special focus on middle-aged women.\nThe authors conclude: \"Women of today perceive both high well-being and high mental stress irrespective of belonging to low or high SEP group\".\nHowever, from Swedish national register information, we know that although overall life expectancy has improved considerably for Swedish women during the studied period, health inequality regarding life expectancy has increased over the studied period. It has been shown that women with the lowest level of education has only marginally increased their life expectancy, while survival rates have increased among women with middle and high level of education.\n\nThe results and conclusions of this study only partially corroborates this picture. It strongly supports the overall improvement of life expectancy over time among 50-year old women (but not among 38-year old women), since self-rated health is a well-accepted marker of overall health. However, it fails to show the expected influence of socioeconomic position, i.e. an expected widening of life expectancy between low and high/middle social position.\n\nThe study also shows that the experience of high mental stress has increased considerably in both age cohorts.\n\nHowever, there are at least two major weaknesses in this study which need to be better explored for a fair understanding of the validity of the results.\n\nFirstly, the non-participation rate increased substantially over time. It is also mentioned by the authors that non-participants had lower income (a reliable SEP-marker) than participants. This means that the loss of participants seems differential and could very well hide the circumstance that health inequalities increased over time. This phenomenon has also been observed in several Scandinavian general cohort studies. The authors need to convince the reader that this is not the major explanation for not showing increasing health inequalities in their study. This could be done, for example, by investigating the increasing non-participation stratified for SEP, and making appropriate sensitivity estimates based on that.\n\nSecondly, the numbers are comparatively small for computing interaction. Unfortunately, is not clearly stated how this was done. The authors need to clarify their methods for calculating interaction and they also need to produce a power calculation showing that a reasonable change in SEP inequality actually could be shown. (This is a bit hypothetical, since selectively SEP-differential non-participation may have completely obscured the picture).\n\nMoreover, the exposure to stress does not seem to seem to be measured by an internationally well-established instrument. It seems to have been developed by earlier members of the research group and the reference regarding it's validation is from 1973. Therefore, a recent additional validation against modern stress measures is strongly calleds for.\n\nThe use in the title and throughout the manuscript of t he term \"cohort\" is slightly confusing, since the study is not one of a cohort design. It is a comparison over time of three cross-sectional assessments of two birth cohorts. It is therefore suggested that \"cohort\" is substituted by the term \"birth cohorts\" in applicable places.\n\nIt is not clear whether there is any overlap of individuals from the birth cohort of 1966, since a sample of this was assessed as 38-year old individuals in 2004 and as 50-year old I individuals in 2016.\n\nShort descriptions regarding the definitions/measurements of the covariates smoking, BMI and leisure time physical activity should be presented.\n\nSome of introductory text discussing differences in trends between men and women could be omitted, since this study only deals with women.\n* Publons Reviewer Recognition. Springer Nature can send verification of this review directly to Publons (a subsidiary of Clarivate Analytics). If you would like to take advantage of this service, please click on the “Yes” option below. Your name, email address, title of the reviewed manuscript, name of the journal, and date of your review submission (the “Review Data”) will then be transmitted to Publons upon publication of the manuscript. If you have already registered at Publons, they will notify you of the receipt of this review and update your profile as per your settings and their policy. If you are not registered with Publons, you will receive an email from them asking you to register in order for them to be able to recognize your review on your new profile page. Publons may use the Review Data to generate derivative metadata for the benefit of Publons and you as a reviewer, carefully considering the sensitivity of such information. For example, Publons may verify your record as a reviewer by updating your profile published on its webservice if you have registered for such service or help editors to identify candidate reviewers. Please find the details of processing in Publons’ privacy policy https://publons.com/about/terms: **No**\n* Declaration of competing interests: **I declare that I have no competing interests.**\n* Reviewer Publication Consent. I agree for my report to be made available under an Open Access Creative Commons CC-BY License (http://creativecommons.org/licenses/by/4.0) if this manuscript is accepted for publication. Any comments that I do not wish to be included in the published report have been included as confidential comments to the editor, which will not be published.: **I agree to the terms of the CC-BY 4.0 license; please do not publish my name with my report. (default)**\n* Is the study design appropriate to answer the research question (including the use of appropriate controls), and are the conclusions supported by the evidence presented?: **No**\n* Are the methods sufficiently described to allow the study to be repeated?: **No**\n* Is the use of statistics and treatment of uncertainties appropriate?: **No**\n* Is the presentation of the work clear?: **Yes**\n* Are the images in this manuscript (including electrophoretic gels and blots) free from apparent manipulation?: **Yes**\n"},{"type":"editorInvitedReview","content":"","date":"2020-09-09T12:00:00+00:00","index":1,"fulltext":"Recommendation: Accept after minor essential revisions\nForm responses:\n---\n\nComments to Author:\n---\nThis is an interesting paper, however, it needs to be copy edited by a native/near native speaker of English.\nIn the introduction you suggest that the delay in having children may be a relevant factor in explaining differences in subject health status between the cohorts but you do not mention this again in the conclusions. In the abstract you refer to 'mental' stress but the measure of stress is the self report of women saying they feel stressed. You also that your subjective wellbeing measure, measures physical and mental health. This would seem to be at odds with the conclusion that subjective health has improved while perception of being stressed has increased. Can you clarify these apparent discrepancies'? Also the possible reasons for the changes seem contradictory and without more discussion of why they may explain the changes remain as correlations. The reference to the Helsinki study (ls27-33 p12) seems out of place. It needs to be integrated into the argument of the conclusions.\nThe Bacround would also repay being redrafted so that the srgument comes across more coherently.* Publons Reviewer Recognition. Springer Nature can send verification of this review directly to Publons (a subsidiary of Clarivate Analytics). 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For example, Publons may verify your record as a reviewer by updating your profile published on its webservice if you have registered for such service or help editors to identify candidate reviewers. Please find the details of processing in Publons’ privacy policy https://publons.com/about/terms: **Yes**\n* Declaration of competing interests: **I eclare th\\at I have no competing interests.**\n* Reviewer Publication Consent. I agree for my report to be made available under an Open Access Creative Commons CC-BY License (http://creativecommons.org/licenses/by/4.0) if this manuscript is accepted for publication. Any comments that I do not wish to be included in the published report have been included as confidential comments to the editor, which will not be published.: **I agree to the terms of the CC-BY 4.0 license; please do not publish my name with my report. 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