۱- Introduction

۲- Methods

۳- Results

۴- Discussion

References

Abstract

Background
Reported traditional gender role attitudes (GRAs) have been related to worse mental health in western countries. This study examined the link of GRAs with symptoms of depression and generalised anxiety disorder (GAD) in two Russian cities.
Methods
We used interview data from the cross-sectional Know Your Heart Study conducted among 5099 adults aged 35-69 in the Russian cities of Arkhangelsk and Novosibirsk between 2015 and 2017. Attitudes about gender inequality and division of labour between women and men at home or in the public sphere were measured by single items. Binary variables indicating presence of symptoms of depression and GAD were defined by a cut-off of ≥ ۵ of the PHQ-9 and GAD-7 scores respectively. Multivariable logistic regression was used to determine crude and adjusted associations.
Results
There was evidence that all types of GRAs were associated with symptoms of depression and GAD consistent with a U-shape after controlling for confounding with stronger evidence for all relationships for depression than for GAD. Odds of depressive symptoms were elevated among participants strongly agreeing to gender inequality and gender division of labour. There was good evidence for effect measure modification by age. Limitations The possibilities of measurement error of the exposure and outcomes, residual confounding and reverse causality are important limitations of this study.
Conclusions
Agreeing to gender inequality and gender division of labour was associated with reporting symptoms of common mental disorders in Russia. This study adds evidence for a link of GRAs with mental health from a non-western context.

Introduction

Globally, the burden of years lived with disability (YLD) of depression and anxiety disorders has been increasing since 2005, with depression ranking 3rd and anxiety disorders 9th of most common causes of YLD in 2015 (Vos et al., 2016). In Russia, a cross-sectional study from 2000 using the Centre for Epidemiologic Studies Depression Scale (CES-D) showed a point prevalence of depressive symptoms of 44% among women and 23% among men aged 45-64 living in Novosibirsk, which was comparable to levels found internationally in 2000 (Bobak et al., 2006). In a cross-sectional study conducted in Arkhangelsk among adults aged 18-90 in 2000, point prevalence of symptoms of depression was estimated at 34% among women and 11% among men, while symptoms of anxiety were estimated at 53% among women and 21% among men (Averina et al., 2005). Self-harm was the third most common cause of years of life lost in Russia in 2016 (Starodubov et al., 2018). Depressive and anxiety disorders can be classified as common mental disorders (CMDs), sharing some risk factors and treatment approaches (National Collaborating Centre for Mental Health (UK), 2011). Gender is a “social construct regarding culture-bound conventions, roles, and behaviours for, as well as relations between and among, women and men and boys and girls.” (Krieger, 2003). Gender roles are behavioural norms applied to women and men for example in the spheres of the family, the labour force or education (Cuff and Payne, 1979; Tannenbaum et al., 2016). These norms ascribe for example childcare and domestic work to women, while family leadership and breadwinning are ascribed to men (Parsons and Bales, 1955; Risman and Davis, 2013). Norms about gender roles are assumed to be socially produced for example through socialisation and education of girls and boys during early childhood (Heise et al., 2019).