Gender differences in well-being in older ageGender differences in well-being in older age

James Nazroo and Anne McMunn

UCL

www.ucl.ac.uk/epidemiology

Gender inequalities in depressionGender inequalities in depression

Women have between 1.5 and twice the rate of men

Differences appear to develop around puberty and be greatest during the reproductive years

At their peak in the early 30s and greatest among the married?

This has led to a focus on: Biological differences, related to childbearing and reproductive hormones Gendered roles, which become more concrete around puberty, and the

experiences, stresses and expectations that surround them Need to consider more than role occupation, also gender differences in role

‘quality’ – role strain, the cost of caring, and the identity-salience of stressful events

Little data on gender differences in depression for the period post menopause/child rearing (ONS surveys)

Gender inequalities at older agesGender inequalities at older ages

Financial resources: pensions and housing wealth (legacy of roles earlier in life)

Paid and unpaid labour Paid work in years leading up to state pension age Responsibilities for providing informal care

Marriage and widowhood

Gendered roles in the household

All leading to gender differences in the opportunity to be a ‘Third ager’

The English Longitudinal Study of AgeingThe English Longitudinal Study of Ageing

A panel study of 11,500 people aged 50 and older, drawn from the Health Survey for England and interviewed every two years (since 2002)

Health trajectories, disability and healthy life expectancy

The relationship between economic position and health

The determinants of economic position in later life

Timing of retirement and post retirement labour market activity

Social participation, productivity, networks and support

Economic, social and health inequalities

Questionnaire coverage and outcomesQuestionnaire coverage and outcomes

Demographics Health and disability Cognitive function Psychosocial factors and well-being Social and civic participation Housing Employment and earnings Pensions and retirement Income, assets and consumption Expectations for the future Performance and biomedical measures Links to administrative data

Depression symptoms (Center for Epidemiological Studies Depression scale (CESD8))

Psychological well-being (General Health Questionnaire (GHQ12))

Quality of Life(Control, Autonomy, Self-realisation and Pleasure scale (CASP-19))

Gender differences in depressionGender differences in depression(CES-D)(CES-D)

0%

4%

8%

12%

16%

20%

50-54 55-59 60-64 65-69 70-74 75-79 80+

Men Women

Gender differences in psychological distressGender differences in psychological distress(GHQ12)(GHQ12)

0%

4%

8%

12%

16%

20%

50-54 55-59 60-64 65-69 70-74 75-79 80+

Men Women

Gender differences in quality of lifeGender differences in quality of life(CASP19)(CASP19)

0%

4%

8%

12%

16%

20%

50-54 55-59 60-64 65-69 70-74 75-79 80+

Men Women

Gender differences in employment statusGender differences in employment status

0%

10%

20%

30%

40%

50%

Working Routine normalretirement

Involuntaryearly retirement

Voluntary earlyretirement

Long term sickor unemployed

Looking afterhome or family

Men Women

Gender differences in providing informal careGender differences in providing informal care

Percent caring in the last week

0%

10%

20%

30%

Men Women

Median no of hours caringin the last week

0

10

20

30

Men Employed Retired Homemaking

Women

Gender differences in recipients of careGender differences in recipients of care

0%

10%

20%

30%

40%

50%

Partner Child Grandchild Parent/in-law Other relative Friend/neighbour

Men Women

Gender differences in household incomeGender differences in household income

0%

5%

10%

15%

20%

25%

Top quintile 2nd quintile 3rd quintile 4th quintile Bottom quintile

Men Women

Gender differences in marital status by ageGender differences in marital status by age

Age 50-59

0%

10%

20%

30%

40%

50%

60%

70%

80%

Re/m

arrie

d

Divorc

ed/S

ep

Wido

wed

Never

mar

ried

Age 75 or older

Re/m

arrie

d

Divorc

ed/S

ep

Wido

wed

Never

mar

ried

Age 60-74

Re/m

arrie

d

Divorc

ed/S

ep

Wido

wed

Never

mar

ried

Gender differences in social participationGender differences in social participation

0%

10%

20%

30%

40%

Cinema Eat out Museums Theatre Belong to noorganisations

Men Women

Per cent who want to go but cannot

Factors associated with depression – women (1)Factors associated with depression – women (1)

0%

10%

20%

30%

40%

Emplo

yed

Retire

d

Unem

ploye

d/ill

Homem

aker

Top w

ealth

quin

tile

2nd

quint

ile

3rd

quint

ile

4th

quin

tile

Botto

m q

uintile

Re/m

arrie

d

Never

mar

ried

Divorc

ed/se

p

Wido

wed

Factors associated with depression – men (1)Factors associated with depression – men (1)

0%

10%

20%

30%

40%

Emplo

yed

Retire

d

Unem

ploye

d/ill

Homem

aker

Top w

ealth

quin

tile

2nd

quint

ile

3rd

quint

ile

4th

quin

tile

Botto

m q

uintile

Re/m

arrie

d

Never

mar

ried

Divorc

ed/se

p

Wido

wed

Factors associated with depression – women (2)Factors associated with depression – women (2)

0%

10%

20%

30%

40%

High co

ntro

l

Low co

ntro

l

Low d

eman

ds

High d

eman

ds

Close

to p

artn

er

Not cl

ose

Mem

ber o

f 2+

orgs

Mem

ber o

f 1 o

rg

Not a

mem

ber

Goes t

o cin

ema

Does n

ot

Eats o

ut

Does n

ot

Factors associated with depression – men (2)Factors associated with depression – men (2)

0%

10%

20%

30%

40%

High co

ntro

l

Low co

ntro

l

Low d

eman

ds

High d

eman

ds

Close

to p

artn

er

Not cl

ose

Mem

ber o

f 2+

orgs

Mem

ber o

f 1 o

rg

Not a

mem

ber

R man

ages

finan

ces

P man

ages

Man

age

joint

ly

Man

age

sepa

rate

ly

1

1.2

1.4

1.6

1.8

2

Ageadjusted

+Physicalfunctioning

+Wealth +Workstatus

+Caring +Maritalstatus

Odds ratio

The influence of role occupation on gender The influence of role occupation on gender inequality in depression in older age inequality in depression in older age

1

1.2

1.4

1.6

1.8

2

Age adjusted +Previous slide(roles)

+F mngment,cntrl & demnd

+ Marital quality + Socialparticipation

Odds ratio

The influence of role occupation on gender The influence of role occupation on gender inequality in depression in older age inequality in depression in older age

0.6

0.8

1

1.2

Age adjusted +Physicalfunctioning

+Wealth +Workstatus

+Caring +Maritalstatus

Odds ratio

The influence of role occupation on gender The influence of role occupation on gender inequality in quality of life in older age inequality in quality of life in older age

0.6

0.8

1

1.2

Age adjusted +Previousslide (roles)

+F mngment,cntrl & demnd

+ Maritalquality

+ Socialparticipation

Odds ratio

The influence of role occupation on gender The influence of role occupation on gender inequality in quality of life in older age inequality in quality of life in older age

Conclusions (1)Conclusions (1)

Gender inequality in depression persists into older age, but not for a measure of quality of life

Material circumstances, role occupation and role quality relate to depression for both men and women Income/wealth and economic activity Marital status (widowhood) and quality of marriage Control and demands, and social participation

Gender differences in marital status and quality, and social participation contribute to higher rates of depression for women, and when accounted for suggest that older women have better quality of life than older men

But we need better measures of role occupation and quality if we are to understand this better

Conclusions (2)Conclusions (2)

And we need to be very aware of cohort and period effects ELSA is a study of people born before (and around) the second world war

(gender roles, welfare state and economic depression) 1960s, 1970s and onwards presented significant opportunities (education,

birth control, divorce, anti-discrimination legislation etc.), which may change gender inequalities in material outcomes

Associated cultural changes may also influence how gendered identities are taken up

However, there remain differentials in career progression, economic rewards, and gendered roles (for example, part-time work) – institutional lag?

And younger women’s participation in paid work may create gendered grand-parenting responsibilities