An article by Anna Hallgren, Mireia Jimenez and Khorambanoo Askari
Sweden has been regarded as a leading example of gender equality around the world, but when it comes to work-related stress, things are far from equal. New statistics from Försäkringskassan (an insurance authority in Sweden) show that between January 2010 and January 2022 the total number of people who are on sick leave because of stress increased from 6.662 to 37.357 people, which is an increase of 30.695 people. In January 2022, 78.6% of these were women.
Our team spoke with analysts, researchers and healthcare professionals to explain the different causes of this great gap between genders. Among several reasons, three were especially emphasised: Gender segregation at the workplace, homecare inequality and unequal treatment within healthcare.
The new statistics from Försäkringskassan define stress as the diagnosis F43, which is the code for Reaction to severe stress and adjustment disorders. The diagnosis includes various kinds of stress reactions, for example exhaustion syndrome which is a diagnosis only existent in Sweden. Women’s stress at the workplace is also a global reality, despite definitions of stress being very different depending on the country.
Gender segregation in the workplace still exists in Sweden
Photographer: Lars Ingels
Ulrik Lidwall, analyst at Försäkringskassan and Doctor within Medicine and Insurance Medicine said occupations within healthcare, welfare and education are areas where women prevail.
“This kind of work is hard to just drop and they often take the work home with them, becoming a job without ‘limits’.” he said.
Gunnel Hensing, Professor in Social Medicine at the University of Gothenburg, as well as researcher, agreed with Lindwall. Hensing was a participant when forming a questionnaire to assess work-related stress in women in 2009. Horizontal and vertical gender segregation at work, and women having more demands were pointed as causes. Horizontal segregation is defined by the European Observatory of Working Life as “the concentration of men and women in different kinds of jobs”, while vertical segregation is “opportunities for career progression for a particular gender within a company or sector are limited.” Hensing thinks these same issues persist today.
“Women more often work in communication-intensive occupations, occupations where you relate to other people and your own person is involved in the work, while men more often work in administrative and technical occupations. I think the horizontal segregation of the Swedish labour market, and also in the Scandinavian countries as a whole, is one reason why we find these big gender differences.” she said.
Picture courtesy of Gunnel Hensing
Hensing also mentioned how the pandemic impacted women more negatively, since their occupations are less likely to be able to be done remotely.
She stated, “You need to be at the hospital if you work in healthcare, you have to be at the daycare centre if it’s open. That is where women work.”
According to her, reports show that if a man works in a female-dominated area, they tend to develop the same type of symptoms as women.
“It’s not particularly that you are a woman or the female biology, but rather that you are exposed to a work environment where it’s easy to develop stress.”
Lindwall adds to this, “You can have it easier or more difficult depending on your gender. For instance, in the priest-occupation women have been working against all odds. They face complications and get other tasks than men in the same workplace. Women tend to get the administrative tasks and men the more technical ones.”
Unequal work-share in Swedish households - still there
Lidwall also pointed to women's unequal work-share within home care as a big cause of stress. He said “Women tend to take more responsibility, which contributes to a higher risk of stress related mental health issues.”
A 2021 report by Hensing and student Varsha Rajagopalan for Jämställdhetsmyndigheten focusing on women’s unpaid work at home care established that there are connections between different aspects of unpaid work and sick leave. The difficulties when measuring the personal challenges that women face has resulted in a great lack of research in this field.
Ida Ahl, Rehab Coordinator at health centres in Västra Götaland region and former Försäkringskassan insurance investigator, also mentions inequalities regarding home care as a reason for the increasing gap.
“We still don’t have an accurate workload in the home. Even if there have been changes, there are probably many families where the woman clearly takes a bigger responsibility when it comes to her private life.”
Differences in treatment within Swedish healthcare - a gender issue
Riksrevisionen did a report in 2019 with a conclusion that showed that men and women can be treated differently within health care, based on their gender.
Hensing, who has previous research experience regarding the impact of masculinity in men’s sexual health care, explained,
“A reason for the gender gap may be that women have higher stress, but it could also be that men have lower stress. One reason would be that men do not seek care for their mental health issues, and if they don’t seek help they do not get their diagnosis or sickness absence note.”
Ahl also shared how she experienced the impact on gender when seeking healthcare at her workplace.
“I believe, and I want to emphasise ‘believe’, that men seek health care less than women. I have noticed that when men seek help at our place, they often refer to a relative, boss or someone else that has pushed them to seek help in health care. My thoughts are that maybe the difficulties that come with an exhaustion diagnosis are not always corresponding with the role of the man. Maybe because of this, there is a bigger resistance to confess the difficulties and an even bigger resistance to actually seek help for it.” she said.
Other reasons why women are more stressed at work
In addition to all this, Ahl includes two other reasons why the F43 diagnosis is on the rise.
The first one is self-diagnosis by the patient, which complicates the doctor’s process towards an objective diagnosis.
“When they (patients) call the health centre for the first time, they say that they have exhaustion syndrome. That makes it more difficult for us, because it might be that the patients does not at all meet the criteria for the diagnosis, but still have made that conclusion themselves that they have it”, Ahl said.
The second one is an extended definition of sickness that is not always accurate or helpful to the patient's.
“My perception is that a lot of patients seeking help have pretty normal reactions to different kinds of loads in life and that we maybe a little bit too often put a sickness-label on things that don't have sickness value." she added.
According to a report by Jämställdhetsmyndigheten, women from minority groups are more affected by discrimination than men and people not part of a minority group, which results in increased stress. They note that more homosexual and bisexual women (65%) are met with discriminatory behaviour than homosexual and bisexual men (48%) in Sweden.
Another factor that increases stress for women according to the previous report is the levels of domestic violence. Domestic violence often leads to other side effects, like sleeping problems, depression or PTSD, which again increases stress.
What solutions are there?
According to Lidwall there needs to be a good psychosocial work environment and a balance between challenges at work and resources.
“Of course, increased gender equality in general would also help. For example, men should take more parental leave and stay at home more with their children when they are sick.” he recommended.
Hensing emphasises that healthcare professionals should also be more trained when it comes to gender-awareness.
“I think that gender-awareness is to be able to manage your own gender notions and stereotypes, because if you are not aware of your own gender stereotypes you might treat women and men according to these stereotypes.” she stated.
Ahl agrees with Hensing regarding gender-awareness and adds that there is a need for standardised working methods to step away from the gender gap within health care. That, and adding a specialised team for this kind of diagnosis, has proven to show “positive results”, she said.
However, she recognises that standardised methods are not completely reliable.
“Of course, if the patients present their symptoms differently independent of gender, we will choose a track based on the first description we get.” she said.
Even so, Ahl said that, of course, they tend to find the actual problem the patient has, but it can take longer. If a man for example seeks help for chest pain and the examination does not show anything, they start to consider other aspects of the patient's life, for example their mental status.
How is work-related stress in other countries of the world compared to Sweden?
According to Gallup’s State of the Global Workplace 2022 Report, Sweden reported a stress level of 36% in both genders, which sits on the average compared to other European countries. In Europe, 39% of respondents said that they experienced stress, 40% of those being women and 39% being men. In other Nordic Countries, Norway shows 43% of women being under work-stress, Denmark with 24% and Finland with 46%, all percentages higher than men.
"We are approximately on the average. We have had high growth in Sweden. Men and women work to a great extent and this is the price we pay for that. We are similar to other countries that are economically developed.” Lidwall said.
According to Hensing it is difficult to compare different countries with different social insurance systems.
“In many ways, the Swedish country is more gender equal than other countries. (…) But then again, we have that kind of gender selection into the different labour markets, and I think this is very similar in many countries. Perhaps that is an example of why we are not so gender equal. Why do men not choose to work in healthcare? Why don't Swedish men want to be nurses? If you look globally, the nurse occupation is dominated by women all over the world.” she said.
How is stress at work perceived in a non-Western context?
According to the State of the Global Workplace 2022 Report, in the Middle East and North Africa 47% of women experience more stress, compared to 44% of men. For instance, in Iran, reliable data is hard to find, with only specific studies covering small regions, and sometimes no data at all. A focused research of working women in the city of Ahwaz showed how lack of rest (96.9%), dissatisfaction of work time (91.9%), and psychological pressures (88.7%) were the biggest causes of stress for Iranian women at work, but information on national figures is limited.
In Asia, Japan stands out as a male-dominated society and the role of women within society, as well as discrimination, are still important issues. The country ranked 116 out of 149 countries in the World Economic Forum’s (WEF) global gender gap index for 2022, which is six positions lower than in 2018. Data about women’s sick leave due to stress is also limited.
To this, Lidwall added, "Japan has problems with suicide, and this is an extreme expression of the problem of stress."
When asked about cultural differences in Sweden’s healthcare system, Ahl explained how doctors from different parts of the world don't have the same criteria for the F43 in their countries, which sometimes creates confusion when diagnosing.
“It is a strange phenomenon for them that seemingly healthy patients go on sick leave.” she said.
She also works with patients from other countries, and her experience is that some question a sick leave not only because of stress, but also due to cultural barriers and linguistic isolation.
“Sometimes people don't have the language or other factors that result in a difficulty to approach the labour market and therefore question a sick leave from us.”