Stress, psychological distress, psychosocial factors, menopause symptoms and physical health in women

ArticleinMaturitas 62(2):160-5 · February 2009with 567 Reads
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Abstract
Relatively few studies have evaluated relationships between stress, psychological distress, psychosocial factors and menopause symptoms, and none have evaluated emotional intelligence (EI) in relation to menopause. In this study, direct and indirect relationships were evaluated between stress, psychological distress, psychosocial factors (e.g. social support, coping, EI), menopause symptom severity and physical health in middle-aged women. One hundred and sixteen women aged 45-55 years were recruited through women's health centres and community organizations. They completed a short questionnaire asking about stress, psychological distress (i.e. anxiety, depression), EI, attitude to menopause, menopause symptoms and physical health. Low emotional intelligence was found to be related to worse menopause symptoms and physical health, and these associations were partly mediated by high stress, anxiety and depression, a negative attitude to menopause and low proactive coping. Women with high EI appear to hold more positive attitudes to menopause and experience less severe stress, psychological distress and menopause symptoms and better physical health. These results suggest that women who expect menopause to be a negative experience or are highly stressed or distressed may be more likely to experience a more negative menopause.

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    Objective: Analyze the variables that favor women’s adaptation to menopause, such as self-concept, self esteem and perceived family support as the factors that predict satisfaction with life during perimenopause and postmenopause, and to identify differences among groups. Materials and methods: The sample was non-probabilistic and included a total of 404 women, separated into two groups: GroupI (perimenopause) and Group II (postmenopause). The following scales were applied: (1) Satisfaction with Life (SELS), (2) the Valdez Self-Concept Scale, (3) Self-Esteem Scale - IGA, (4) perceived social support (SSP-Fa) and socio-demographic data. Results: It was found that self-esteem, perceived family support and the expressive-affective dimension of self-concept predict life satisfaction in 40.3% (R2 = 0,403 p < 0,005), with no difference between the two groups. Conclusions: The aforementioned variables are positively present in these groups of women and should be considered as mental health strengths for comprehensive nursing care during this stage of life.
  • Article
    This volume provides a comprehensive, up-to-date theoretical and empirical background to the psychology of reproductive health. Provides a life span perspective of the psychology of reproductive health and its disorders, from menarche to menopause and reproductive health in older age. Focuses on issues of the individual's reproductive health experience, including reproduction, pregnancy, maternity, and birth, as well as conditions such as PMDD, dysmenorrhea, and events including pregnancy failure, and abortion. Acknowledges the wider social context with discussions of poverty, inequality, educational and economic status, age, and urban versus rural access. Addresses life style related factors, human rights to choice, information and access, fertility control and reproductive health regulation and health care services. Illustrates topics with empirical data supported with tables and figures.
  • Article
    Objectives: This cross-sectional study aimed to explore the relationship between menopause status and attitude toward menopause, and also its relationship with quality of life (QoL) of Chinese midlife women in Hong Kong. Methods: Hong Kong Chinese women aged 40 to 59 years were recruited through computer-generated random telephone dialing. Information was obtained through telephone interviews based on a structured questionnaire. Women were classified into 3 groups: premenopausal, perimenopausal, and postmenopausal. Menopause Belief Scale and Utian Quality of Life Scale (QoL) were used to measure respondents' attitude toward menopause and their QoL. Information on social, health, and lifestyle factors was also collected. Results: The mean age of the participants was 49.4 ± 5.2 years. Respondents generally had a positive attitude toward menopause. Compared with premenopausal women, postmenopausal women were noted to have significantly higher attitude score toward menopause. No significant differences in QoL score were noted among women of the 3 menopause statuses. Stepwise regression analysis showed that women with more positive attitude toward menopause tended to have higher QoL score. Furthermore, better self-reported health status, doing physical activities, higher education level, being married, and non-smoking status were associated with better QoL. Conclusions: Postmenopausal women tended to have more positive attitude toward menopause. Although menopause status did not seem to be associated with QoL, attitude toward menopause, self-reported health status, as well as social and lifestyle factors were associated with QoL in Chinese midlife women.
  • Article
    In the past 20 years a large number of studies have been made in order to investigate what is associated with the severity of perimenopausal symptoms and large interindividual differences in their manifestation. Apart from studies of the biological determinants of perimenopausal symptoms, they have also examined the contribution of various psychosocial factors in their occurrence and severity. Although menopausal symptoms are primarily considered to be a result of the sometimes intense hormonal fluctuations that are experienced during perimenopause, this does not necessarily exclude the role of psychosocial factors such as demographic characteristics, cultural or ethnic background, attitudes toward menopause, specific lifestyles and habits, specific previous life experiences and personality traits. A review of recent research findings and contributions of these psychosocial factors in the development of perimenopausal symptoms engaged will be presented in this work. Studies have clearly shown that certain psychosocial factors contribute to the occurrence and severity of symptoms or increased risk for perimenopausal symptoms, including the risk for major disturbances, such as clinical depression.
  • Article
    Full-text available
    Menopausal transition is highly symptomatic in at least 20% of women. A higher prevalence of psychiatric symptoms, including depression, anxiety, and sleep disturbance, has been shown in women with symptomatic menopausal transition. However, a clear correlation between symptomatic menopausal transition and psychiatric disorders has not been established. We explored the association between symptomatic menopausal transition and subsequent newly diagnosed psychiatric disorders, including schizophrenia as well as bipolar, depressive, anxiety, and sleep disorders. We investigated women who were diagnosed with symptomatic menopausal transition by an obstetrician-gynecologist according to the data in the Taiwan National Health Insurance Research Database. A comparison cohort comprised age-matched women without symptomatic menopausal transition. The incidence rate and the hazard ratios of subsequent newly diagnosed psychiatric disorders were evaluated in both cohorts, based on the diagnoses of psychiatrists. The symptomatic menopausal transition and control cohorts each consisted of 19,028 women. The incidences of bipolar disorders (hazard ratio [HR] = 1.69, 95% confidence interval [CI] = 1.01–2.80), depressive disorders (HR = 2.17, 95% CI = 1.93–2.45), anxiety disorders (HR = 2.11, 95% CI = 1.84–2.41), and sleep disorders (HR = 2.01, 95% CI = 1.73–2.34) were higher among the symptomatic menopausal transition women than in the comparison cohort. After stratifying for follow-up duration, the incidence of newly diagnosed bipolar disorders, depressive disorders, anxiety disorders, and sleep disorders following a diagnosis of symptomatic menopausal transition remained significantly increased in the longer follow-up groups (1–5 and ≥ 5 years). Symptomatic menopausal transition might increase the risk of subsequent newly onset bipolar disorders, depressive disorders, anxiety disorders, and sleep disorders. A prospective study is necessary to confirm these findings.
  • Article
    Full-text available
    Objective: Middle age period brings about particular difficulties for some women, because of the physiological and psychological changes. The physiological changes occuring in this period is called andropause for males and menopause for females. While it starts about 40-50 years of age in general, it might be at an earlier stage of life for some women which is called premature menopause, indicating the climacterium. The main aim of this study is to compare two groups of women with premature menopause and normal menopause in terms of stress reactions, ways of coping, marital adjustment, and sex roles. Method: Data were collected from a total of 224 women, 82 of which had premature menopause (under age 40), and 142 had normal menopause (above age 40). The participants were given Demographic Information Form (DIF), Stress Reactions Scale (SRS), Ways of Coping Inventory (WCI), Marital Adjustment Scale (MAS), and Bem Sex Roles Inventory (BSRI) to obtain data. Results: The t-test analysis has revealed that the premature menopause group had higher scores in stress reactions, lower scores in self confident and optimistic ways of coping with stress, and lower scores in marital adjustment, compared to the normal menopause group. The predictive variables for both groups were found to be "degree of agreement in marriage", "helpless style", and "searching for social support" by regression analysis. The "masculine sex role" was the predictor of only the premature menopause group. Discussion: When we review the related literature, we see that most of the studies are about women who entered menopause around 40 years of age and the problems they face in the process. There is very little research on women who enter menopause earlier (premature menopause). For this reason, it is felt that the current study will add to our knowledge on the premature manapause phenomenon, which challenges women physically and psychologically. We feel it is important to raise awareness in women on the issue in order to prevent and alleviate stress-related problems. We also feel the results of the study might be important in the areas of psychotheraphy and psychological counselling. For example during psychological counselling or psychotheraphy for premature menopause, it might be important to measure the sex roles, marital satisfaction levels and the levels of satisfaction of these women with their close interpersonal relationships, and try to design interventions accordingly. Additionally it might be helpful to teach new coping strategies to manage their stress levels.
  • Article
    Objective: This cross-cultural study aimed to compare climacteric symptoms, self-esteem, and perceived social support between Mosuo and Han Chinese women, and to explore the interaction between culture and climacteric symptoms. Mosuo is a Chinese minority group with a matriarchal structure, and Han Chinese is the majority ethnic group in China with a patriarchal structure. Methods: Through convenience sampling, 54 Mosuo women and 52 Han Chinese women between 40 and 60 years of age completed the sociodemographic questionnaire, the Menopause Rating Scale, the Self-Esteem Scale, and the Perceived Social Support Scale. Results: Compared with Han Chinese women, Mosuo women scored lower on the psychological (P < 0.001) and the somato-vegetative (P = 0.047) subscales of the Menopause Rating Scale, but higher on the Self-Esteem Scale (P = 0.006) and the "support from family" subscale of the Perceived Social Support Scale (P = 0.004). Multiple linear regressions indicated that minority ethnicity (β = 0.207, P = 0.016) was one of the predictive variables of psychological symptoms severity. Referring to the severity of all symptoms, predictive variables were: perceived support from family (β = -0.210, P = 0.017); self-esteem (β = 0.320, P < 0.001); previous history of premenstrual syndrome (β = 0.293, P < 0.001); number of family members (β = -0.229, P = 0.003); and family income (β = -0.173, P = 0.028). Conclusions: Differences in climacteric symptoms were found between two groups. Cultural variables such as familial structure, women's self-esteem, and perceived social support were correlated with symptomatology.
  • Article
    Full-text available
    Introduction Menopause is a natural event in a woman’s life which affects her general health and quality of life. However, currently there is no Persian instrument for measuring health status during this period. Therefore, the present study was performed to assess the validity and reliability of the Persian version of the Menopausal Health Questionnaire in Iran. Methods The questionnaire was translated to Persian with the approach of Jones et al and its validity was assessed by a panel of experts. The Persian version was tested among 300 patients who had referred to the gynecological clinic at the Ali ibn Abi Talib Hospital in Zahedan. Convenience method was used for sampling. Exploratory factor analysis was used to assess construct validity of collected data. Test-retest method was used to determine reliability in two-week intervals and Cronbach’s alpha coefficient was used to check the internal consistency. Results According to research findings, the exploratory factor analysis showed an acceptable fitness. Varimax rotation indicated 6 factors with Eagan values more than 1, which explained 49.27% of the variance. Cronbach’s alpha coefficient for the entire tool was 0.84 and it was from 0.50 to 0.82 for the subcategories. All factors had a significant case-total correlation. Results of test-retest showed the stability of the questionnaire and its subcategories, and the intraclass correlation coefficient (ICC) was assessed to be 0.93. Conclusions The 14-item Menopausal Health Questionnaire is a valid and reliable instrument to assess postmenopausal women’s health.
  • Chapter
    The Menopause and HealthDefinitionCauses of Menopausal Distress / DiscomfortEpidemiologyScreening / AssessmentTheories / ModelsProcesses and Factors Affecting the ProblemTreatment / ManagementGuidelinesSummaryReferences
  • Chapter
    Physical activity (PA) is a promoter of health in general. Its benefits include maintaining proper weight, providing stress relief, increasing muscle strength, improving balance and coordination, increasing bone strength, and increasing mental focus. In addition, PA improves the evolution of diseases such as hypertension, diabetes, osteoporosis, and dementia. We can infer that PA is more than a lifestyle; it constitutes a form of therapy in itself. The aim of this chapter is to analyse the perimenopausal and postmenopausal impact of healthy PA, to determine the PA-associated improvements in the symptoms and processes that emerge during this period, and to identify the optimal PA recommendations for those purposes.
  • Article
    Full-text available
    Although emotional intelligence (EI) and social support are important predictors of well-being in adolescents and adults, there has been little research on their combined effects on well-being in older people. From a developmental perspective, it would be premature to assume similar models for EI, social support and well-being for older adults as were established for adolescents and adults. This study investigated sources of perceived social support as potential mediators of the relationship between EI and well-being indicators (life satisfaction and happiness) in older people. A Spanish sample of 383 older people aged 55 years and older completed a self-report survey regarding perceived emotional intelligence, perceived social support, life satisfaction, and subjective happiness. We found EI scores to be moderately and significantly related to different sources of perceived social support, life satisfaction and subjective happiness measures. Using path analyses, results showed that perceived social support from both family members and friends partially mediated the relationships between EI scores and life satisfaction and happiness (only for social support from friends). That is, emotionally intelligent older people reported higher level of perceived support from friends and family which resulted in higher well-being indicators. These findings suggest that EI may play a role in the well-being of older people with the benefit depending on the sources of perceived social support.
  • Article
    Full-text available
    Clinically speaking menopause is a date; for those women who still have a uterus, menopause is defined as the day after a woman's final period finishes. This date is fixed retrospectively, once twelve months have gone by with no menstrual flow at all, at this point a woman is considered to be a year into post menopause and infertile. Aim of the present research paper is to explore the difference between stress and wellbeing of menopausal and post-menopausal working and non-working women. For this purpose the sample of 120 women (30 menopausal working, 30 menopausal non-working, 30 post-menopausal working and 30 post-menopausal non-working) were select- ed through purposive method of sampling. "Perceived stress scale-10" and "PGI General Well Being Questionnaire" was administered in order to measure the stress and well-being of the sample. The results overall indicate compara- tively better well-being and low stress levels in working menopausal as well as post-menopausal women. Middle age is one of the turning points in one's life as it brings along many changes. It roughly starts in the early 40s, when for most of the people; it is the best period in their life when their achievements are at the highest point. In this regard, Mitchell (1971) stated that midway be- tween the challenges of adulthood and despair of old age, comes the change menopause in women and during which lives take a compulsory change of direction. Menopause is derived from Latin words meno (month) and pausia (halt), and essentially marks the end of a woman's period of natural fertility. Bavadam (1999) stated that it is not merely the end of menstruation but also is an inevita- ble part of aging. The exact age of menopause varies from population to population but generally the spread is from late 30s to 50s. Studies done in various regions of India by Indira (1979) and Kaw et.al. (1994) report the age of meno- pause ranging from 40 to 50 years. The meaning of the word menopause in more recent times has been expanded to indicate the permanent but naturally occurring discon- tinuation of female fertility.
  • Article
    A semantic differential instrument that measures adult women's attitudes toward menopause was constructed and validated. A volunteer sample of 504 women, 18 years or older, completed the pilot instrument of 45 bipolar adjective scales. A principal components factor analysis revealed 20 scales that loaded on one dominant factor; this factor accounted for 60% of the variance for the 20 scales. Cronbach alpha reliability was .96. The revised 20-scale instrument was called the Menopause Attitude Scale (MAS). A second sample of 419 women completed the MAS and one additional instrument for assessment of convergent and discriminant validity. Convergent validity was demonstrated by a correlation of r = .63 for the MAS with the Attitudes Toward Menopause Scale. Discriminant validity was demonstrated by a correlation of r = .42 for the MAS with the Attitudes Toward Old People Scale and a correlation of r = -.04 for the MAS with the Attitudes Toward Women Scale. Factor analysis of MAS scores revealed that one factor accounted for 61.5% of the variance for the 20 scales. The test-retest reliability for 39 subjects was .87. Multiple regression analysis identified age and menopausal status as significant explanatory variables for MAS scores.
  • Menopause and mood: are they connected?
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    Choi M. Menopause and mood: are they connected? Female Patient 2001;26:62–3.
  • The Proactive Coping Inventory: a multidimensional research instrument
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    Greenglass E, Schwartzer R, Taubert S. The Proactive Coping Inventory: a multidimensional research instrument. Online publication available at http://www.psych.yorku.ca/greenglass/; 1999.
  • What is emotional intelligence? In: Salovey P, Sluyter D, editors. Emotional development and emotional intelligence: implications for educators
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    Mayer J, Salovey P. What is emotional intelligence? In: Salovey P, Sluyter D, editors. Emotional development and emotional intelligence: implications for educators. New York: Basic Books; 1997.
  • The Menopause. The Lancet
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    Greendale, G, Lee, N, Arriola, E. The Menopause. The Lancet 1999: 353: 571-580.
  • Article
    Full-text available
    In this article, we attempt to distinguish between the properties of moderator and mediator variables at a number of levels. First, we seek to make theorists and researchers aware of the importance of not using the terms moderator and mediator interchangeably by carefully elaborating, both conceptually and strategically, the many ways in which moderators and mediators differ. We then go beyond this largely pedagogical function and delineate the conceptual and strategic implications of making use of such distinctions with regard to a wide range of phenomena, including control and stress, attitudes, and personality traits. We also provide a specific compendium of analytic procedures appropriate for making the most effective use of the moderator and mediator distinction, both separately and in terms of a broader causal system that includes both moderators and mediators. (46 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
  • Article
    The increase in the number of older people and the functional disability associated with increasing age have caused concern regarding the consequences of large numbers of elderly people who are limited in their functional ability. One of the psychological factors that should be related to functional disability in the elderly is the way they cope with stress. The present study examines the use of proactive coping in the elderly in relation to their depression and their functional ability. Results of structural equation modeling showed that proactive coping was negatively associated with functional disability and with depression. Social support was positively associated with proactive coping and negatively with depression. Depression was positively associated with functional disability. A significant implication of the results is the importance of studying the combined relationship of social support and coping to elderly functioning.
  • Article
    Two studies leading to the development of a short form of the Social Support Questionnaire (SSQ) are reported. In Study 1 three items selected for high correlations with the total score (SSQ3) were administered to 182 university students together with several personality measures. SSQ3 had acceptable test-retest reliability and correlations with personality variables similar to those of the SSQ. Internal reliability was marginal although acceptable for an instrument with so few items. Study 2 employed three sets of data in developing a six-item instrument (SSQ6). The SSQ6 had high internal reliability and correlated highly with the SSQ and similarly to it with personality variables. The research findings accompanying the development of the short form social support measure suggest that perceived social support in adults may be a reflection of early attachment experience.
  • Article
    Both theory and previous research suggest a link between emotional intelligence and emotional well-being. Emotional intelligence includes the ability to understand and regulate emotions; emotional well-being includes positive mood and high self-esteem. Two studies investigated the relationship between emotional intelligence and mood, and between emotional intelligence and self-esteem. The results of these studies indicated that higher emotional intelligence was associated with characteristically positive mood and higher self-esteem. The results of a third study indicated that higher emotional intelligence was associated with a higher positive mood state and greater state self-esteem. The third study also investigated the role of emotional intelligence in mood and self-esteem regulation and found that individuals with higher emotional intelligence showed less of a decrease in positive mood and self-esteem after a negative state induction using the Velten method, and showed more of an increase in positive mood, but not in self-esteem, after a positive state induction. The findings were discussed in the light of previous work on emotional intelligence, and recommendations were made for further study.
  • Article
    This series of studies describes the development of a measure of emotional intelligence based on the model of emotional intelligence developed by Salovey and Mayer [Salovey, P. & Mayer, J. D. (1990). Emotional intelligence. Imagination, Cognition and Personality, 9, 185–211.]. A pool of 62 items represented the different dimensions of the model. A factor analysis of the responses of 346 participants suggested the creation of a 33-item scale. Additional studies showed the 33-item measure to have good internal consistency and testretest reliability. Validation studies showed that scores on the 33-item measure 1.(a) correlated with eight of nine theoretically related constructs, including alexithymia, attention to feelings, clarity of feelings, mood repair, optimism and impulse control;2.(b) predicted first-year college grades;3.(c) were significantly higher for therapists than for therapy clients or for prisoners;4.(d) were significantly higher for females than males, consistent with prior findings in studies of emotional skills;5.(e) were not related to cognitive ability and6.(f) were associated with the openness to experience trait of the big five personality dimensions.
  • Article
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    The factor structure, reliability, and validity of the Depression Anxiety Stress Scales (DASS; S. H. Lovibond & P. F. Lovibond, 1995) and the 21-item short form of these measures (DASS–21 ) were examined in nonclinical volunteers ( n = 49) and patients with Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994) diagnoses of panic disorder ( n =  67), obsessive-compulsive disorder ( n = 54), social phobia ( n = 74), specific phobia ( n = 17), and major depressive disorder ( n = 46). This study replicates previous findings indicating that the DASS distinguishes well between features of depression, physical arousal, and psychological tension and agitation and extends these observations to the DASS–21. In addition, the internal consistency and concurrent validity of the DASS and DASS–21 were in the acceptable to excellent ranges. Mean scores for the various groups were similar to those in previous research, and in the expected direction. The implications of these findings are discussed. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
  • Article
    Full-text available
    Depression in a middle aged woman should not automatically be blamed on the menopause The linking of the menopause with depression is pervasive in lay and medical discourse, despite limited supporting evidence. Historically, myths relating to menstrual taboos, as well as attitudes towards fertility and aging, have produced an image of the menopause as a time of physical and emotional decline. In the 19th century the menopause was thought to cause insanity, and it was only as recently as 1980 that the diagnosis of involutional melancholia was removed from the third edition of the Diagnostic and Statistical Manual of Mental Disorders.1 With the development of hormone replacement therapy, treatment of menopausal women shifted from the domains of psychiatry and psychoanalysis to gynaecology and endocrinology. Initially prescribed for the treatment of vasomotor symptoms, hormone replacement therapy is now recommended for preventing osteoporosis and cardiovascular disease and improving quality of life.2 In the past few years interest has increased in the possible psychoactive properties of hormone replacement therapy. It has been proposed that oestrogen might cure “menopausal depression” and that it might offer an additional bonus of increased wellbeing or quality of life for non-depressed, healthy women. Defining the menopause as an oestrogen deficiency disease implies that the cause of depression lies in a woman's hormones. This has important implications for the way middle aged and older women's views and behaviours are perceived in …
  • Article
    Although some research has linked emotional intelligence (EI) and psychological health, little research has examined EI's ability to predict health outcomes after controlling for related constructs, or EI's ability to moderate the stressor–strain relationship. The present study explored the relationships among EI (as assessed by a trait-based measure, the EQ-i), Big Five personality factors, Type A Behaviour Pattern (TABP), daily hassles, and psychological health/strain factors (in terms of perceived well-being, strain, and three components of burnout). The EQ-i was highly correlated with most aspects of personality and TABP. After controlling for the impact of hassles, personality, and TABP, the five EQ-i subscales accounted for incremental variance in two of the five psychological health outcomes. However, the EQ-i scales failed to moderate the hassles–strain relationship. Copyright © 2005 John Wiley & Sons, Ltd.
  • Article
    Full-text available
    We sought to determine the relationship between emotional competence and willingness to seek help for emotional problems and suicidal ideation. A survey of 300 university undergraduates assessed emotional competence (skill at emotion perception, managing self-relevant emotions, and managing others' emotions), hopelessness, willingness to seek help from health professionals (e.g. counsellor) and nonprofessionals (friends, family), and perceived usefulness of past help-seeking experience. Those who reported feeling less skilled at managing emotions were less willing to seek help from family and friends for both emotional problems and suicidal ideation and less willing to seek help from health professionals for suicidal ideation. These relationships held even after controlling for hopelessness, sex, and past help-seeking experience. Mediational analysis suggested that people low in managing others' emotions were less willing to seek help from professionals because they had had poorer experiences with mental health professionals in the past. There was no significant relationship between emotion perception skill and willingness to seek help. People most likely to be in need of help (those poor at managing emotions) were the least willing to seek it, and if they did seek it, were the least likely to benefit from it.
  • Article
    Associations amongst personality, coping, health locus of control, emotional intelligence (EI) and health behaviours were examined in a group of 364 Canadian students. Consistent associations with health behaviours were found for Conscientiousness, with the correlation pattern for other measures being more variable. EI, coping and health locus of control scales were intercorrelated, and a scale-level factor analysis suggested the extraction of a superordinate Coping/EI factor. This was found to mediate the relationship between personality and both taking regular exercise and healthy diet strategy. These findings suggest that associations between coping and EI, and the ways in which EI can act as a coping resource, should be investigated further.
  • Article
    Most empirical tests of mediation utilize cross-sectional data despite the fact that mediation consists of causal processes that unfold over time. The authors considered the possibility that longitudinal mediation might occur under either of two different models of change: (a) an autoregressive model or (b) a random effects model. For both models, the authors demonstrated that cross-sectional approaches to mediation typically generate substantially biased estimates of longitudinal parameters even under the ideal conditions when mediation is complete. In longitudinal models where variable M completely mediates the effect of X on Y, cross-sectional estimates of the direct effect of X on Y, the indirect effect of X on Y through M, and the proportion of the total effect mediated by M are often highly misleading.
  • Article
    Menopause is a reproductive milestone in a woman's life around which many different myths have developed. We reviewed three sets of myths that middle-aged premenopausal women hold and evaluated those myths according to scientific data from our own work and that of others. First, middle-aged women expect to experience depression, irritability, and vasomotor symptoms during the menopause. It appears that the vast majority of postmenopausal women do not experience depression, but do experience vasomotor symptoms that are uncomfortable and may have secondary effects on psychological well being, especially during the perimenopause. Second, middle-aged women believe that holding negative expectations about the menopause affects the quality of the menopausal experience. Indeed, that appears to be the case, perhaps because myths can function as self-fulfilling prophecy. The third myth is that there are no important changes that occur during the menopause. That is incorrect. Estrogen deficiency during the menopause sets the stage for substantial changes in risk for CHD, which becomes clinically apparent later in life. We discussed how estrogen deficiency may influence both lipids and lipoprotein levels and the magnitude of neuroendocrine and cardiovascular respond to mental stress. That latter pathway is of particular interest because middle-aged women may be exposed more often to interpersonal stress and may respond more emotionally to it, relative to men, suggesting a potential interactive effect of the decline in reproductive hormones and co-occurring social and psychological changes during the menopausal period. This discussion of the myths and realities of the menopause has deliberately not been exhaustive.(ABSTRACT TRUNCATED AT 250 WORDS)
  • Manual for the Depression Anxiety Stress Scales Sydney: Psychology Foundation
    • Lovibond
    • Sh
    • Lovibond
    • Pf
    Lovibond SH, Lovibond PF. Manual for the Depression Anxiety Stress Scales. 2nd ed. Sydney: Psychology Foundation; 1995.
  • Article
    It has been hypothesized that irrational belief is a prime cause of maladjustment. Existing measures of irrational belief appear to lack construct validity in that they contain many items that ask about anxiety reactions. In this article we describe the development of a 20-item measure of irrational belief that asks only about irrational belief. Two studies of the scale produced evidence that it has good internal consistency and good test-retest reliability. Three additional studies of the scale found evidence of validity.
  • Article
    Full-text available
    In this article, we attempt to distinguish between the properties of moderator and mediator variables at a number of levels. First, we seek to make theorists and researchers aware of the importance of not using the terms moderator and mediator interchangeably by carefully elaborating, both conceptually and strategically, the many ways in which moderators and mediators differ. We then go beyond this largely pedagogical function and delineate the conceptual and strategic implications of making use of such distinctions with regard to a wide range of phenomena, including control and stress, attitudes, and personality traits. We also provide a specific compendium of analytic procedures appropriate for making the most effective use of the moderator and mediator distinction, both separately and in terms of a broader causal system that includes both moderators and mediators.
  • Article
    Full-text available
    This paper presents findings from the Massachusetts Women's Health Study (MWHS), one of the largest population-based studies of mid-aged women. A longitudinal study that followed a population-based cohort of women as they proceeded through menopause, the MWHS's goal was to describe their responses and to identify health-related, life-style, and other social factors that affect this transition. Findings indicate that natural menopause appears to have no major impact on health or health behavior. The majority of women do not seek additional help concerning menopause, and their attitudes toward it are, overwhelmingly, positive or neutral. Physicians treating mid-aged women must be careful not to confuse "menopausal" symptoms with indicators of underlying disease or conditions unrelated to menopause.
  • Article
    Recent studies suggest that health care utilisation by women during menopause transition in general is highly idiosyncratic, despite the widespread advocation of prophylactic hormone therapy and increased health vigilance. The Melbourne Women's Midlife Health Study, a community-based cross-sectional study of 2001 urban Australian-born women aged 45-55 years, evaluated women's physical and emotional experiences, past and present health status, attitudes and beliefs about menopause, health behaviours and current menopausal status in a 30-min telephone interview. This paper reports on those factors related to help-seeking and health care utilisation. Findings show that treatment utilisers, in contrast to non-utilisers, reported a wider range of general symptoms, but reports on vasomotor symptoms did not contribute to the regression analysis. Treatment utilisers were further identified as problem-related or prevention-related utilisers. In three-way analyses, the past and present social and physical health of the problem-related treatment user was reportedly worse than either the prevention-related utiliser or non-utiliser. These findings suggest that medical and societal views about the health of middle-aged women during menopausal transition are likely to be based on the experiences of a particular segment of the population only. It is proposed that biased views of menopause as a time of considerable distress and ill-health are being perpetuated and over-generalised. This perspective appears to have little relevance for the majority of middle-aged women.
  • Article
    Hormonal changes as well as sociocultural and personal factors account for climacteric symptoms. The aim of this study is to investigate in a clinical population the correlation between the severity of hot flashes and vaginal dryness and the 'coping-ineffectiveness of coping' construct. Out of 120 women consecutively referring to the University Menopause Clinic, 85 subjects were evaluated for their climacteric complaints including anxiety and depression and for their coping style assessed with the Italian version of the Utrechtse Coping Lijst. Daily hot flashes and severe vaginal dryness were reported by almost half of the studied population, regression analyses were performed in order to investigate how much of the variance in such symptoms was explained by the psychosocial variables and by the coping mechanisms. A more recent menopause, a lower educational level and an active coping predict a higher severity of hot flashes; a longer time since last menstrual period and a coping of avoidance predict a higher severity of vaginal dryness. The present study suggests that the severity of hot flashes and vaginal dryness among a clinical sample of postmenopausal women is not only determined by biological and social variables, but personal resources also explain part of the variance of such climacteric complaints.
  • Article
    Menopause is diagnosed after 12 months of amenorrhoea resulting from the permanent cessation of ovarian function. The mean age at menopause is 51 years. The perimenopause, a time of changing ovarian function, precedes the final menses by several years. The physiology and clinical manifestations of this transition to menopause are not well understood; however, some symptoms, such as hot flashes, certainly begin in the perimenopause. Causal associations between menopause and several symptoms and diseases are proposed. The evidence for these associations varies and is reviewed. Hormone replacement therapy can be directed at symptom relief or at prevention or treatment of chronic diseases. Doses and routes of hormone replacement therapy vary by indication. Complications of hormone replacement therapy depend on the regimen used. Knowing the expected vaginal bleeding pattern for each hormone replacement therapy regimen is important, since unexpected bleeding may signal endometrial hyperplasia. Postmenopausal hormone therapy is a complex intervention that produces positive and negative specific health effects. Overall, based on observational studies, postmenopausal women who use hormones have a 30-50% lower all-cause mortality rate than those who do not use hormones. It is important to recognise that the value that individual women place on various health outcomes associated with hormone replacement therapy may differ. Thus, the decision to use hormone replacement therapy should be made jointly by each woman and her health-care provider, after careful consideration of possible benefits, risks, and her personal preferences.
  • Article
    To explore a possible association between climacteric symptoms and ways of coping with stress, a comparative study was conducted among 19 menopausal women who sought treatment for climacteric symptoms (the study group) and 44 healthy menopausal women (the control group). Life stress was assessed using a life event method in which factor analysis extracted four ways that women cope with stress: avoidance-oriented coping, consultation-oriented coping, aggression-expression coping, and problem-solving coping. The study group had a higher symptom score and was more prone to avoidance-oriented coping than the control group despite experiencing the same number of undesirable life events. The severity of climacteric symptoms correlated positively with the number of undesirable life events and the degree of avoidance-oriented coping and correlated negatively with the degree of aggression- expression coping for the study group. These results suggest that vulnerability to stress contributes to worsening climacteric symptoms caused by stress.
  • Article
    In 7 studies, the authors examined the link between emotional intelligence and interpersonal relations. In Studies 1 and 2, the participants with higher scores for emotional intelligence had higher scores for empathic perspective taking and self-monitoring in social situations. In Study 3, the participants with higher scores for emotional intelligence had higher scores for social skills. In Study 4, the participants with higher scores for emotional intelligence displayed more cooperative responses toward partners. In Study 5, the participants with higher scores for emotional intelligence had higher scores for close and affectionate relationships. In Study 6, the participants' scores for marital satisfaction were higher when they rated their marital partners higher for emotional intelligence. In Study 7, the participants anticipated greater satisfaction in relationships with partners described as having emotional intelligence.
  • Article
    The objective of the study was to examine the direct and indirect influences of dispositional factors, namely optimism, health-related hardiness (HRH) and sense of coherence (SOC), on the symptom experiences of peri- and postmenopausal women. Indirect effects of dispositional factors were examined via attitudes to the menopause and coping (emotion-versus problem-focused). A survey methodology was employed to assess the research objective for 176 peri- and postmenopausal women recruited from menopause clinics and family planning centers in Queensland, Australia. Emotional stability of the subjects was statistically controlled to eliminate any possible confounding effect on symptom reporting. The results indicated that optimism and SOC affect menopausal health directly, as evidenced by fewer symptoms reported by women scoring highly on these dispositions. Any indirect effect of HRH, optimism and SOC appears to be exerted via problem-focused coping rather than emotion-focused coping or through attitudes. It was concluded that dispositional factors are important to the experience of the menopause and how women adapt to their midlife transition. Psychologists and professionals working in menopause clinics may need to promote feelings of optimism and a sense of coherence in menopausal women, to facilitate better adaptation to this important transitional phase in women's lives.
  • Article
    Full-text available
    We focused on the computer-mediated communication (CMC) of social support in an electronic health discussion group dealing with menopause and midlife transition to show how vital support is to women who are trying to make sense of the change in their lives. We analyzed 2,000 messages, examining the type and frequency of support messages, how support was demonstrated, and how support was recognized by participants. We then provided evidence to show that a community of support had developed.
  • Article
    Full-text available
    This study examined the relationship between perceived emotional intelligence and health-related quality of life in middle-aged women. 99 middle-aged Spanish women, who studied in two adult schools, volunteered to participate. 49 were premenopausal and 45 were postmenopausal. These women completed the Trait Meta-Mood Scale and Health Survey SF-36. Scores were analyzed according to social, physical, and mental health, menopausal status, and scores on perceived emotional intelligence. Then, the data regarding the mental and physical health of the premenopausal and postmenopausal women were compared after controlling for age. No associations between menopausal status and health-related quality of life were found. Perceived skill at mood repair was significantly associated with scores on health-related quality of life in these middle-aged women. These findings provide empirical evidence that aspects of perceived emotional intelligence may account for the health-related quality of life in midlife including social, physical, and psychological symptoms.
  • Article
    The Ohio Midlife Women's Study was longitudinal with measurements occurring at three, 9-month intervals. Our purpose in doing this research was to examine predictors, moderators, and outcome variables associated with the transition to midlife in Caucasian and African American women. Predictor variables included loss and gain of resources. Moderators included menopause symptoms, menopausal status, attitude toward menopause, coping, and demographic characteristics. Outcome variables included anxiety, depression, and health promoting activities. To obtain the proposed final sample of 160 midlife women, an initial sample of 103 African American and 105 Caucasian "healthy" women were recruited in the community. Consistent predictors of anxiety were loss of resources, coping effectiveness, and education. Consistent predictors of depression were loss of resources and education. Health promoting activities were consistently predicted by attitude toward menopause and coping effectiveness. Stress is a better predictor of negative health outcomes than menopausal status.
  • Article
    Full-text available
    The majority of women diagnosed with early-stage breast cancer have an excellent long-term prognosis, but many will undergo temporary or permanent chemotherapy-induced amenorrhea. While breast cancer is more common in older women, about 1 in 200 women under the age of 40 is at risk to develop breast cancer. Many of these women benefit from chemotherapy but are afraid to risk the opportunity to bear children. The authors review the current studies on the impact of adjuvant chemotherapy on amenorrhea and fertility in women with breast cancer. The likelihood of amenorrhea is based on the specific adjuvant chemotherapy regimen administered and the age of the patient. Future childbirth is a viable option for women treated for breast cancer at an early stage. While the use of tamoxifen as a hormonal therapy in premenopausal breast cancer is now the standard of care, no conclusive data confirm the benefit of GnRH agonists in adjuvant therapy after treatment with chemotherapy followed by tamoxifen. As more women over the age of 35 consider pregnancy, fertility issues are becoming important areas of investigation for the adjuvant treatment of breast cancer. Whether chemotherapy-induced amenorrhea has a prognostic effect remains unclear, and further studies are warranted.
  • Article
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    Background Symptom scales for aging women have clinically been used for years and the interest in measuring health-related quality of life (HRQoL) has increased in recent years. The Menopause Rating Scale (MRS) is a formally validated scale according to the requirements for quality of life instruments. The aim of this paper is to review the current state of the instrument particularly concerning versions of the scale in different languages. MRS versions available The translations were performed following international methodological recommendations for the linguistic & cultural adaptation of HRQoL instruments. The first translation was done from the German original scale into English (UK & USA). The English version was used as the source language for the translations into French, Spanish, Swedish, Mexican/Argentine, Brazilian, Turkish, and Indonesian languages (attached as additional PDF files). Conclusion The MRS scale is obviously a valuable tool for assessing health related quality of life of women in the menopausal transition and is used worldwide. The currently available 9 language versions have been translated following international standards for the linguistic and cultural translation of quality of life scales. Assistance is offered to help interested parties in the translation process.
  • Article
    The midlife period in the lifespan is characterized by a complex interplay of multiple roles. The goal of this chapter is to summarize research findings on the central themes and salient issues of midlife such as balancing work and family responsibilities in the midst of the physical and psychological changes associated with aging. The field of midlife development is emerging in the context of large demographic shifts in the population. A section on the phenomenology of midlife development presents images and expectations including the seemingly disparate views of midlife as a time of peak functioning and a period of crisis. Conceptual frameworks useful for studying the multiple patterns of change in midlife are presented. Findings demonstrating patterns of gains and losses are reviewed for multiple domains: cognitive functioning, personality and the self, emotions, social relationships, work, and physical health. The need for future research to illuminate and integrate the diverse aspects of midlife is highlighted.
  • Article
    Full-text available
    This paper compiles data from different sources to get a first comprehensive picture of psychometric and other methodological characteristics of the Menopause Rating Scale (MRS) scale. The scale was designed and standardized as a self-administered scale to (a) to assess symptoms/complaints of aging women under different conditions, (b) to evaluate the severity of symptoms over time, and (c) to measure changes pre- and postmenopause replacement therapy. The scale became widespread used (available in 10 languages). A large multinational survey (9 countries in 4 continents) from 2001/ 2002 is the basis for in depth analyses on reliability and validity of the MRS. Additional small convenience samples were used to get first impressions about test-retest reliability. The data were centrally analyzed. Data from a postmarketing HRT study were used to estimate discriminative validity. Reliability measures (consistency and test-retest stability) were found to be good across countries, although the sample size for test-retest reliability was small.Validity: The internal structure of the MRS across countries was astonishingly similar to conclude that the scale really measures the same phenomenon in symptomatic women. The sub-scores and total score correlations were high (0.7-0.9) but lower among the sub-scales (0.5-0.7). This however suggests that the subscales are not fully independent. Norm values from different populations were presented showing that a direct comparison between Europe and North America is possible, but caution recommended with comparisons of data from Latin America and Indonesia. But this will not affect intra-individual comparisons within clinical trials. The comparison with the Kupperman Index showed sufficiently good correlations, illustrating an adept criterion-oriented validity. The same is true for the comparison with the generic quality-of-life scale SF-36 where also a sufficiently close association has been shown. The currently available methodological evidence points towards a high quality of the MRS scale to measure and to compare HRQoL of aging women in different regions and over time, it suggests a high reliability and high validity as far as the process of construct validation could be completed yet.
  • Article
    Full-text available
    Psychosocial influences have been found to impact on the symptoms a woman may experience as she moves through the menopause transition. Consequently any assessment of the menopausal woman should include an exploration and understanding of how the many psychosocial factors influence the experience of menopause and midlife. This article describes the many psychosocial factors that influence the experience of menopause including midlife issues, role and purpose in life, interpersonal relationships, libido, personality, psychological history and present psychological functioning, body image and sociocultural issues. Case studies are included to illustrate the importance of including psychosocial factors in the assessment and treatment of the menopausal woman. Any assessment of the menopause experience should include psychosocial influences and the context of women's lives. In a consultation where both the physical and psychosocial issues are explored, we come closer to addressing the true needs of each patient.
  • Researchers often conduct mediation analysis in order to indirectly assess the effect of a proposed cause on some outcome through a proposed mediator. The utility of mediation analysis stems from its ability to go beyond the merely descriptive to a more functional understanding of the relationships among variables. A necessary component of mediation is a statistically and practically significant indirect effect. Although mediation hypotheses are frequently explored in psychological research, formal significance tests of indirect effects are rarely conducted. After a brief overview of mediation, we argue the importance of directly testing the significance of indirect effects and provide SPSS and SAS macros that facilitate estimation of the indirect effect with a normal theory approach and a bootstrap approach to obtaining confidence intervals, as well as the traditional approach advocated by Baron and Kenny (1986). We hope that this discussion and the macros will enhance the frequency of formal mediation tests in the psychology literature. Electronic copies of these macros may be downloaded from the Psychonomic Society's Web archive at www.psychonomic.org/archive/.
  • Article
    Full-text available
    To examine the impact of participation in a psycho-educational program on women's attitudes toward menopause, the perceived severity of their symptoms, and the association between the two. Quasi-experimental. Data were gathered at baseline and 3 months after termination of the program. Two health maintenance organization clinics. Eighty-two healthy 40- to 60-year-old women who chose to participate in the study. Thirty-six women participated in the program, and 46 women comprised the control group. Program participants met for 10 weekly sessions to receive information from a professional team on subjects related to menopause and to share and discuss their experiences. Attitudes toward menopause and severity of menopause symptoms. The more negative the attitudes, the higher was the severity of symptoms. Participants reported significant improvements in attitudes and reductions in symptom severity compared to their own baseline scores and compared with the control group. Participation in a program that combines delivery of information and processing of experiences on the cognitive, emotional, and social levels may improve women's attitudes toward menopause and ease the perceived severity of their symptoms, thereby increasing quality of life.
  • Article
    Full-text available
    Menopause is a physiological event occurring in women at about the age of 50. It signals the end of the reproductive years and is associated with signs of estrogen deficiency having a considerable impact on women's health-related quality of life (HRQoL). The most common form of treatment is hormone replacement therapy (HRT). Studies have shown negative events can arise from long-term use of HRT. The aim of this review is to determine if there are any HRQoL instruments that address the impact of menopausal symptoms including positive and negative effects of HRT. The following eight instruments were identified: Greene Climacteric Scale, Women's Health Questionnaire (WHQ), Qualifemme, Menopause-Specific QOL Questionnaire (MENQOL), Menopausal Symptoms List (MSL), Menopause Rating Scale (MRS), Menopausal Quality of Life Scale (MQOL), and the Utian Quality of Life Scale (UQOL). All instruments reviewed proved to be reasonably structured and have their place in applied research. None were found that addressed all aspects of the impact of HRT on HRQoL. In order to capture the possible short-term side effects of HRT on HRQoL, it is necessary to modify one or more of the existing instruments or develop a new instrument applicable in many different countries and languages.
  • Article
    Transition to menopause has long been considered a period of increased risk for depressive symptoms. However, it is unclear whether this period is one of increased risk for major depressive disorder, particularly for women who have not had a previous episode of depression. To examine the association between the menopausal transition and onset of first lifetime episode of depression among women with no history of mood disturbance. Longitudinal, prospective cohort study. A population-based cross-sectional sample. Premenopausal women, 36 to 45 years of age, with no lifetime diagnosis of major depression (N = 460), residing in 7 Boston, Mass, metropolitan area communities. Main Outcome Measure Incidence of new onset of depression based on structured clinical interviews, Center for Epidemiologic Studies Depression Scale scores, and an operational construct for depression. Premenopausal women with no lifetime history of major depression who entered the perimenopause were twice as likely to develop significant depressive symptoms as women who remained premenopausal, after adjustment for age at study enrollment and history of negative life events. The increased risk for depression was somewhat greater in women with self-reported vasomotor symptoms. The current study suggests that within a similarly aged population of women with no lifetime history of depression, those who enter the menopausal transition earlier have a significant risk for first onset of depression. Further studies are needed to determine more definitively whether other factors, such as the presence of vasomotor symptoms, use of hormone therapy, and the occurrence of adverse life events, independently modify this risk. Physical symptoms associated with the menopausal transition and mood changes seen during this period may affect many women as they age and may lead to a significant burden of illness.
  • Article
    The aim of this study was to examine the direct and indirect relationships between emotional intelligence and subjective fatigue. One hundred sixty seven university students completed questionnaires assessing subjective fatigue, emotional intelligence, and a range of other psychosocial factors. A series of regression analyses were used to examine the direct and indirect relationships between subjective fatigue and psychosocial factors. Higher emotional intelligence was associated with less fatigue. The psychosocial variables depression, anxiety, optimism, internal health locus of control, amount of social support, and satisfaction with social support each partially mediated between emotional intelligence and fatigue. Additionally, sleep quality partially mediated between emotional intelligence and fatigue. These findings regarding the association between subjective fatigue, emotional intelligence, and other psychosocial factors may facilitate an understanding of the aetiology of fatigue and contribute to future research examining interventions aimed at helping individuals cope with fatigue.
  • Article
    Stress plays an essential role in the development, continuation and exacerbation of mood problems throughout a woman's life. It exacerbates somatic symptoms of menopause, increasing the risk of recurrence of mood disorders, as well as of a mood disorder de novo throughout the lifespan and specifically in the menopausal transition. Chronic stress affects the hypothalamic-pituitary axis, hypothalamic-pituitary-ovarian axis, the proinflammatory cytokines and cardiovascular risk. The current evidence for the potential interactions between acute stress, chronic stress, childhood stress and victimization, and individual susceptibility to the development of depression and/or anxiety in response to stressful life events, are reviewed in the context of the increasing data on the association of these and a symptomatic menopausal transition. Strategies for the optimal approach for clinicians to evaluate and treat the symptomatic perimenopausal patient with stressful life events and comorbid mood disorders are presented.