{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T19:51:48Z","timestamp":1782157908334,"version":"3.54.5"},"reference-count":34,"publisher":"BMJ","issue":"9","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2013,7,8]]},"published-print":{"date-parts":[[2013,8]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To study the relation among psychosocial stressors, long-standing distress and incidence of dementia, in a sample of women followed from midlife to late life.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Prospective longitudinal population study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>The analyses originate from the prospective population study of women in Gothenburg, Sweden, a representative sample of women examined in 1968 (participation rate 90%) and re-examined in 1974, 1980, 1992, 2000 and 2005.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>800 women born in 1914, 1918, 1922 and 1930 who were systematically selected for a psychiatric examination at baseline, in 1968.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Primary and secondary outcome measures<\/jats:title>\n                    <jats:p>18 psychosocial stressors (eg, divorce, widowhood, work problems and illness in relative) were obtained at baseline. Symptoms of distress were measured according to a standardised question at each study wave. Dementia was diagnosed according to Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R) criteria based on information from neuropsychiatric examinations, informant interviews, hospital records, and registry data, and measured through the whole study period.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>During the 37\u2005years of follow-up, 153 women developed dementia (104 of those had Alzheimer's disease (AD)). Number of psychosocial stressors in 1968 was associated (HR, 95% CI) with higher incidence of dementia (1.15, 1.04 to 1.27) and AD (1.20, 1.07 to 1.35) between 1968 and 2005, in multivariate Cox regressions. Number of psychosocial stressors in 1968 was also associated (OR, 95% CI) with distress in 1968 (1.48, 1.32 to 1.67), 1974 (1.31, 1.17 to 1.46), 1980 (1.27, 1.11 to 1.45), 2000 (1.39, 1.14 to 1.70) and 2005 (1.35, 1.02 to 1.79), in multivariate logistic regressions. Number of psychosocial stressors (HR 1.17, 95% CI 1.03 to 1.33) and long-standing distress (1968\u20131974\u20131980) (HR 1.58, 95% CI 1.03 to 2.45) were independently associated with AD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Our study shows that common psychosocial stressors may have severe and long-standing physiological and psychological consequences. However, more studies are needed to confirm these results and investigate whether more interventions such as stress management and behavioural therapy should be initiated in individuals who have experienced psychosocial stressors.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2013-003142","type":"journal-article","created":{"date-parts":[[2013,10,1]],"date-time":"2013-10-01T02:04:36Z","timestamp":1380593076000},"page":"e003142","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":92,"title":["Common psychosocial stressors in middle-aged women related to longstanding distress and increased risk of Alzheimer's disease: a 38-year longitudinal population study"],"prefix":"10.1136","volume":"3","author":[{"given":"Lena","family":"Johansson","sequence":"first","affiliation":[{"name":"Neuropsychiatric Epidemiology Unit, Institute of Neuroscience and Physiology, Sahlgrenska Academy at Gothenburg University, M\u00f6lndal, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinxin","family":"Guo","sequence":"additional","affiliation":[{"name":"Neuropsychiatric Epidemiology Unit, Institute of Neuroscience and Physiology, Sahlgrenska Academy at Gothenburg University, M\u00f6lndal, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tore","family":"H\u00e4llstr\u00f6m","sequence":"additional","affiliation":[{"name":"Neuropsychiatric Epidemiology Unit, Institute of Neuroscience and Physiology, Sahlgrenska Academy at Gothenburg University, M\u00f6lndal, Sweden"},{"name":"Department of Clinical Neuroscience, Section for Psychiatry\/Huddinge, Karolinska Institutet, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria C","family":"Norton","sequence":"additional","affiliation":[{"name":"Department of Family Consumer and Human Development and Departments of Psychology, Utah State University, Logan, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Margda","family":"Waern","sequence":"additional","affiliation":[{"name":"Neuropsychiatric Epidemiology Unit, Institute of Neuroscience and Physiology, Sahlgrenska Academy at Gothenburg University, M\u00f6lndal, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Svante","family":"\u00d6stling","sequence":"additional","affiliation":[{"name":"Neuropsychiatric Epidemiology Unit, Institute of Neuroscience and Physiology, Sahlgrenska Academy at Gothenburg University, M\u00f6lndal, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Calle","family":"Bengtsson","sequence":"additional","affiliation":[{"name":"Sahlgrenska School of Public Health and Community Medicine, Section for Public Health Epidemiology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ingmar","family":"Skoog","sequence":"additional","affiliation":[{"name":"Neuropsychiatric Epidemiology Unit, Institute of Neuroscience and Physiology, Sahlgrenska Academy at Gothenburg University, M\u00f6lndal, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2013,9,30]]},"reference":[{"key":"2025120619125995000_3.9.e003142.1","doi-asserted-by":"crossref","first-page":"973","DOI":"10.1176\/ajp.152.7.973","article-title":"MRI-based measurement of hippocampal volume in patients with combat-related posttraumatic stress disorder","volume":"152","author":"Bremner","year":"1995","journal-title":"Am J Psychiatry"},{"key":"2025120619125995000_3.9.e003142.2","doi-asserted-by":"crossref","unstructured":"Sezgin U Punamaki RL . Earthquake trauma and causal explanation associating with PTSD and other psychiatric disorders among South East Anatolian women. J Affect Disord 2012.","DOI":"10.1016\/j.jad.2012.03.005"},{"key":"2025120619125995000_3.9.e003142.3","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ajp.157.8.1252"},{"key":"2025120619125995000_3.9.e003142.4","doi-asserted-by":"publisher","DOI":"10.1093\/ageing\/afp023"},{"key":"2025120619125995000_3.9.e003142.5","doi-asserted-by":"crossref","first-page":"814","DOI":"10.1097\/JGP.0b013e3182011b38","article-title":"Early parental death and remarriage of widowed parents as risk factors for Alzheimer disease: the Cache County study","volume":"19","author":"Norton","year":"2011","journal-title":"Am J Geriatr Psychiatry"},{"key":"2025120619125995000_3.9.e003142.6","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1099-1166(199601)11:1<15::AID-GPS262>3.0.CO;2-5"},{"key":"2025120619125995000_3.9.e003142.7","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1016\/j.psychres.2009.06.001","article-title":"Severely stressful events and dementia: a study of an elderly Greek demented population","volume":"176","author":"Tsolaki","year":"2010","journal-title":"Psychiatry Res"},{"key":"2025120619125995000_3.9.e003142.8","doi-asserted-by":"publisher","DOI":"10.1016\/j.psyneuen.2005.02.007"},{"key":"2025120619125995000_3.9.e003142.9","doi-asserted-by":"publisher","DOI":"10.1007\/BF02895778"},{"key":"2025120619125995000_3.9.e003142.10","doi-asserted-by":"publisher","DOI":"10.1159\/000104854"},{"key":"2025120619125995000_3.9.e003142.11","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/awq116"},{"key":"2025120619125995000_3.9.e003142.12","doi-asserted-by":"publisher","DOI":"10.1097\/PSY.0b013e318246eb10"},{"key":"2025120619125995000_3.9.e003142.13","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1111\/j.0954-6820.1973.tb10583.x","article-title":"The study of women in Gothenburg 1968\u20131969\u2014a population study. General design, purpose and sampling results","volume":"193","author":"Bengtsson","year":"1973","journal-title":"Acta Med Scand"},{"key":"2025120619125995000_3.9.e003142.14","doi-asserted-by":"publisher","DOI":"10.1080\/02813430310003309-1693"},{"key":"2025120619125995000_3.9.e003142.15","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199301213280301"},{"key":"2025120619125995000_3.9.e003142.16","doi-asserted-by":"publisher","DOI":"10.1016\/j.neurobiolaging.2006.01.008"},{"key":"2025120619125995000_3.9.e003142.17","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1111\/j.1532-5415.1985.tb02850.x","article-title":"Excerpts from the NINCDS-ADRDA work group report","volume":"33","author":"Criteria for the clinical diagnosis of Alzheimer's disease","year":"1985","journal-title":"J Am Geriatr Soc"},{"key":"2025120619125995000_3.9.e003142.18","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.43.2.250"},{"key":"2025120619125995000_3.9.e003142.19","unstructured":"Carlsson G . Socialgruppering. Social mobility and class structure. 1958."},{"key":"2025120619125995000_3.9.e003142.20","first-page":"645","article-title":"The diagnosis of ischaemic heart pain and intermittent claudication in field surveys","volume":"27","author":"Rose","year":"1962","journal-title":"Bull World Health Organ"},{"key":"2025120619125995000_3.9.e003142.21","doi-asserted-by":"crossref","first-page":"129","DOI":"10.31887\/DCNS.2012.14.2\/tbuckley","article-title":"Physiological correlates of bereavement and the impact of bereavement interventions","volume":"14","author":"Buckley","year":"2012","journal-title":"Dialogues Clin Neurosci"},{"key":"2025120619125995000_3.9.e003142.22","doi-asserted-by":"publisher","DOI":"10.1126\/science.274.5288.749"},{"key":"2025120619125995000_3.9.e003142.23","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ajp.163.12.2164"},{"key":"2025120619125995000_3.9.e003142.24","doi-asserted-by":"publisher","DOI":"10.1016\/j.neuroscience.2004.05.040"},{"key":"2025120619125995000_3.9.e003142.25","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.0700148104"},{"key":"2025120619125995000_3.9.e003142.26","doi-asserted-by":"publisher","DOI":"10.1523\/JNEUROSCI.2797-06.2006"},{"key":"2025120619125995000_3.9.e003142.27","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1007\/s11906-001-0047-1","article-title":"Mental stress as a causal factor in the development of hypertension and cardiovascular disease","volume":"3","author":"Pickering","year":"2001","journal-title":"Curr Hypertens Rep"},{"issue":"(Suppl 1)","key":"2025120619125995000_3.9.e003142.28","first-page":"131s","article-title":"Cardiovascular responses to acute mental \u201cstress\u201d in spontaneously hypertensive rats","volume":"45","author":"Folkow","year":"1973","journal-title":"Clin Sci Mol Med Suppl"},{"key":"2025120619125995000_3.9.e003142.29","doi-asserted-by":"publisher","DOI":"10.1038\/jhh.2008.74"},{"key":"2025120619125995000_3.9.e003142.30","doi-asserted-by":"publisher","DOI":"10.1097\/00002093-199912003-00016"},{"key":"2025120619125995000_3.9.e003142.31","doi-asserted-by":"publisher","DOI":"10.1016\/S0193-953X(01)00008-9"},{"key":"2025120619125995000_3.9.e003142.32","doi-asserted-by":"crossref","first-page":"e35967","DOI":"10.1371\/journal.pone.0035967","article-title":"Social adversity in adolescence increases the physiological vulnerability to job strain in adulthood: a prospective population-based study","volume":"7","author":"Westerlund","year":"2012","journal-title":"PLoS ONE"},{"issue":"(11 Suppl 5)","key":"2025120619125995000_3.9.e003142.33","first-page":"S10","article-title":"Incidence of dementia and major subtypes in Europe: a collaborative study of population-based cohorts. Neurologic diseases in the elderly research group","volume":"54","author":"Fratiglioni","year":"2000","journal-title":"Neurology"},{"key":"2025120619125995000_3.9.e003142.34","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1997.03540340047031"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2013-003142","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,7]],"date-time":"2025-12-07T03:13:14Z","timestamp":1765077194000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2013-003142"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2013,8]]},"references-count":34,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2013,9,30]]},"published-print":{"date-parts":[[2013,8]]}},"alternative-id":["10.1136\/bmjopen-2013-003142"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2013-003142","relation":{"has-review":[{"id-type":"doi","id":"10.3410\/f.718129107.793506004","asserted-by":"object"}]},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2013,8]]}}}