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. 2020 Sep 4;20(1):434.
doi: 10.1186/s12888-020-02820-9.

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

Caroline Hasselgren  1   2 , Hans Ekbrand  3 , Björn Halleröd  3   4 , Madeleine Mellqvist Fässberg  4 , Anna Zettergren  4 , Lena Johansson  4 , Ingmar Skoog  4 , Lotta Dellve  3   4
Affiliations

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

Caroline Hasselgren et al. BMC Psychiatry. .

Abstract

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.

Keywords: Dementia; Education; Gender inequity; Prospective population study; Psychological distress; Structural equation modelling.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Conceptual model. Testing whether the effect of female sex on dementia is mediated by differences in 1) educational attainment and 2) general psychological distress
Fig. 2
Fig. 2
Final structural model. Unstandardized WLSMV (probit) estimates. Standard errors in parentheses
See this image and copyright information in PMC

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