Umeå University Medical Dissertations, New Series No 1377 __________________________________________________ Close to the edge Discursive, embodied and gendered stress in modern youth Maria Wiklund Department of Public Health and Clinical Medicine, Epidemiology and Global Health and Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Sweden Umeå 2010 Responsible publisher under Swedish law: the Dean of the Medical Faculty This work is protected by the Swedish Copyright Legislation (Act 1960:729) ISBN: 978-91-7459-093-7 ISSN: 0346-6612-1377 Cover: Maria Wiklund screenprint Elektronisk version tillgänglig på http://umu.diva-portal.org/ Printed by: Arkitektkopia Umeå, Sweden 2010 To my family: Vera, Manne, Tord, Katja, Rita, Susanna, Ronnie, Rolle, Christina, Birgit, Sture, Elna, Staffan & Co. Mamma förstår ingenting. ‘Habitos’ är inte mammas språk (Vera 3 år) Är du inte klar med den där boken snart? (Vera 10 år) Manne gillar inte rosa. Bara stora pojkar gillar rosa (Manne 3 år) Men mamma vet du, ingen läser så där långt i en tidning! (Manne 13 år) Contents Abstract .................................................................................... 7 Svensk sammanfattning ............................................................ 9 Original papers ........................................................................ 10 Introduction ............................................................................ 13 Mental health problems in youth – a global health concern ............. 14 Age and gender in subjective health ................................................ 15 Gender and body .............................................................................. 16 Young people’s own experiences and perspectives .......................... 16 Rationale .......................................................................................... 17 Aim ......................................................................................... 18 Overall aim ...................................................................................... 18 Theoretical and conceptual framework ................................... 19 Ontology and epistemology – my position and perspectives ............ 19 Positivism .......................................................................................... 20 Social constructionism ......................................................................... 21 Feminism ........................................................................................... 22 Phenomenology .................................................................................. 22 Bio-psycho-social aspects of health in youth ................................... 23 Psychosomatics .................................................................................. 24 Stress and stressors ............................................................................ 25 Affects and emotions ........................................................................... 28 Theorising the body ......................................................................... 29 Body is not only biology – but also biology ............................................. 29 Physical and physiological body ............................................................ 29 Lived body and body-self ..................................................................... 30 Social and gendered body .................................................................... 31 Contextualising young people’s stress and health ........................... 32 The agency – structure relationship ....................................................... 32 Gender and gender perspectives ........................................................... 33 Femininity and masculinity ................................................................... 33 Methods .................................................................................. 35 The overall research setting and design ........................................... 35 The qualitative interview study (Papers I-III) ................................. 36 Qualitative research methodology ......................................................... 36 Research setting ................................................................................. 36 Procedure and participants ................................................................... 37 Research interviews ............................................................................ 38 Analysis (Papers I-III) ......................................................................... 38 The school survey (Paper IV) ........................................................... 41 Participants and sampling procedure ..................................................... 41 Measurements .................................................................................... 42 Statistical analysis .............................................................................. 44 Ethics ............................................................................................... 46 Trustworthiness and validity ............................................................ 47 Results .................................................................................... 48 Young women face multiple and intersecting stressors of modernity, gender orders and youth (Paper I) .................................................. 48 The stressors of modernity ................................................................... 50 The stressors of gender orders ............................................................. 50 The stressors of youth ......................................................................... 50 Living close to the edge. Dimensions of distress, distrust and disempowerment (Paper II) ............................................................ 51 Exposure to oppression and violence (Paper III) ............................. 53 Multiple young femininities (Paper I-III) ........................................ 54 Gender differences in perceived stress and subjective health (Paper IV) ................................................................................................... 55 Group sociodemographics .................................................................... 55 The hierarchal mixed model analysis ..................................................... 55 Perceived stress ................................................................................. 56 Subjective health complaints ................................................................ 56 Anxiety and depression........................................................................ 56 Perceived stress correlates with subjective health complaints and anxiety ............................................................................................. 58 Discussion ............................................................................... 59 Doing gender – doing stress ............................................................ 60 Embodied stress and subjective health ............................................ 62 Stress and pain: the suffering body-self ................................................. 62 Stress and anxiety: the worrying and anxious body-self .......................... 63 Pressure and demands in school and education ...................................... 63 Converging and correlated stress .......................................................... 64 The existential dimension of stress; the existential self ............................ 65 Discursive and gendered stress ....................................................... 66 Gendered modernity – gendered individualism ....................................... 66 New-old gender orders within modernity ................................................ 67 Competing versus caring selves ............................................................ 68 Subjective social status and the creation of a ‘subject of value’................. 68 Stress in socio-political landscapes ........................................................ 70 Public health relevance .................................................................... 71 Gendered healthism ............................................................................ 71 The continuum and normalization of subordination and violence ............... 73 Processes of (dis)empowerment ........................................................... 74 Methodological considerations ................................................ 77 Conclusion ............................................................................... 79 Future research and implications for action ............................ 81 Locating myself ....................................................................... 83 Acknowledgements ................................................................. 85 References .............................................................................. 88 Abstract Background Adolescent subjective health and mental problems have become a public health concern not only in Sweden but worldwide. The overall aim of this thesis is to deepen and widen the understanding of young peoples’ subjective health, psychosomatic and stress-related problems. A special focus is put on experienced stress among adolescent girls and young women. The study setting is one youth health centre, and three upper secondary schools in Umeå, a university town in northern