Changes in physical symptoms during the menopause transition

This article analyzes physical symptoms experienced by mid-age Australian women in different stages of the menopause transition. A total of 8,623 women, aged 45 to 50 years in 1996, who participated the mid-age cohort of the Australian Longitudinal Study on Women's Health, completed Survey I in 1996 and Survey 2 in 1998. Women were assigned to I of 6 menopause groups according to their menopausal status at Surveys 1 and 2, and compared on symptoms experienced at Surveys I and 2, adjusted for lifestyle, behavioral and demographic factors. At Survey 1, the most commonly reported symptoms were headaches, back pain, stiff joints, tiredness, and difficulty sleeping. Perimenopausal women were more likely than premenopausal or postmenopausal women to report these symptoms. Hot flushes and night sweats were more common among postmenopausal women. Compared with those who remained premenopausal, women who were in the early stages of menopause or perimenopausal were more likely to report tiredness, stiff joints, difficulty sleeping, and hot flushes at Survey 2. Women who remained perimenopausal were also more likely to report back pain and leaking urine. Compared with premenopausal women, odds ratios for night sweats increased for women in consecutive stages of the menopause transition and remained high in the postmenopausal women.

Childhood emotional abuse and neglect as predictors of psychological and physical symptoms in women presenting to a primary care practice

Objective: There were two aims to this study: first to examine whether emotional abuse and neglect are significant predictors of psychological and somatic symptoms, and lifetime trauma exposure in women presenting to a primary care practice, and second to examine the strength of these relationships after controlling for the effects of other types of childhood abuse and trauma. Method: Two-hundred and five women completed the Childhood Trauma Questionnaire (Bernstein et al., 1994), Trauma History Questionnaire (Green, 1996), the Symptom Checklist-revised (Derogatis, 1997), and the Revised Civilian Mississippi Scale for posttraumatic stress disorder (Norris & Perilla, 1996) when presenting to their primary care physician for a visit. Hierarchical multiple regression analyses were conducted to examine unique contributions of emotional abuse and neglect variables on symptom measures while controlling for childhood sexual and physical abuse and lifetime trauma exposure. Results: A history of emotional abuse and neglect was associated with increased anxiety, depression, posttraumatic stress and physical symptoms, as well as lifetime trauma exposure. Physical and sexual abuse and lifetime trauma were also significant predictors of physical and psychological symptoms. Hierarchical multiple regressions demonstrated that emotional abuse and neglect predicted symptomatology in these women even when controlling for other types of abuse and lifetime trauma exposure. Conclusions: Long-standing behavioral consequences may arise as a result of childhood emotional abuse and neglect, specifically, poorer emotional and physical functioning, and vulnerability to further trauma exposure. (C) 2003 Elsevier Ltd. All rights reserved.

Sleep bruxism increases the risk for painful temporomandibular disorder, depression and non-specific physical symptoms

To explore the relationship between sleep bruxism (SB), painful temporomandibular disorders (TMD) and psychologic status in a cross-sectional study. The sample consisted of 272 individuals. The Research Diagnostic Criteria for TMD (RDC/TMD) was used to diagnose TMD; SB was diagnosed by clinical criteria proposed by The American Academy of Sleep Medicine. The sample was divided into four groups: (1) patients without painful TMD and without SB, (2) patients without painful TMD and with SB, (3) patients with painful TMD and without SB and (4) patients with painful TMD and with SB. Data were analysed by Odds Ratio test with a 95% confidence interval. Patients with SB had an increased risk for the occurrence of myofascial pain (OR = 5.93, 95% CI: 3.1911.02) and arthralgia (2.34, 1.583.46). Group 3 had an increased risk for moderate/severe depression and non-specific physical symptoms (10.1, 3.6727.79; 14.7, 5.3939.92, respectively), and this risk increased in the presence of SB (25.0, 9.6564.77; 35.8, 13.9491.90, respectively). SB seems to be a risk factor for painful TMD, and this in turn is a risk factor for the occurrence of higher depression and non-specific physical symptoms levels, but a causeeffect relationship could not be established.

Negative mood, self-focused attention, and the experience of physical symptoms: the joint impact hypothesis

A joint impact hypothesis on symptom experience is introduced that specifies the role of negative mood and self-focus, which have been considered independently in previous research. Accordingly, negative affect only promotes symptom experience when people simultaneously focus their attention on the self. One correlational study and 4 experiments supported this prediction: Only negative mood combined with self-focus facilitated the experience (see the self-reports in Studies 1, 2a, & 2b) and the accessibility (lexical decisions, Stroop task in Studies 3 & 4) of physical symptoms, whereas neither positive mood nor negative mood without self-focus did. Furthermore, the joint impact of negative mood and self-focused attention on momentary symptom experience remained significant after controlling for the influence of dispositional symptom reporting and neuroticism.

Grief, Physical Symptoms, and Decision-Making in Mothers of Newborns Who Die

The purpose of this study was to describe predictors of level of grief and physical symptoms in mothers during the year after a newborn death. This was undertaken to fmd better ways to help these mothers during this crisis. Following appropriate approvals, volunteer subjects were contacted through hospitals, the Internet, and a health department. Of the 75 who responded, 77% were White and married, 64% were Christian. 51 % had other living children, 72% had had no prior pregnancy losses, 87% had support with decision-making about newborn care, and their mean age was 30 yrs. Once subjects had agreed to take Par4 the survey and consent form were sent to them. Study outcome variables were: Total scores on the Perinatal Grief Scale, Short Version (level of grief; T oedter, Lasker, & Alhadeff. 1988) and Sickness Impact Profile 68 (level of physical symptoms; de Bruin, Buys, de Witte, & Diederiks, 1994). Predictor variables were total scores on the Personal Resources Questionnaire 85, Part U (perceived support; Brandt & Weinert, 1981); Relationship Satisfaction Questionnaire (relationship satisfaction; Olson & McCubbin, 1983); Emotion-Focused. Problem-Focused, and Mixed Coping Subscales (emotion-focused, problem-focused, and mixed coping; Lazarus & Folkman, 1988); interval since death, ethnicity, religion, socioeconomic status, gestational age, and presence of living children. Coefficient alphas for scales were all over .75. In two stepwise-hierarchical multiple regressions, perceived support and emotion- focused coping combined to predict 43% of the variance in level of grief, and level of grief alone predicted 50% of the variance in level of physical symptoms. In written comments, mothers said they valued their role in decision-making about newborn care even with death as the result. and felt supported in that process. Findings may be used to design intervention programs to help bereaved mothers following a newborn death. Specifically, programs can help increase perceived support for bereaved mothers, and teach new ways of coping. Both strategies may result in lower levels of grief and physical symptoms in this group of bereaved mothers.

Effect of investigation intensity and treatment differences on prostate cancer survivor's physical symptoms, psychological well-being and health-related quality of life: a two country cross-sectional study.

Aim: To investigate effects on men's health and well-being of higher prostate cancer (PCa) investigation and treatment levels in similar populations. Participants: PCa survivors in Ireland where the Republic of Ireland (RoI) has a 50% higher PCa incidence than Northern Ireland (NI). Method: A cross-sectional postal questionnaire was sent to PCa survivors 2–18 years post-treatment, seeking information about current physical effects of treatment, health-related quality of life (HRQoL; EORTC QLQ-C30; EQ-5D-5L) and psychological well-being (21 question version of the Depression, Anxiety and Stress Scale, DASS-21). Outcomes in RoI and NI survivors were compared, stratifying into ‘late disease’ (stage III/IV and any Gleason grade (GG) at diagnosis) and ‘early disease’ (stage I/II and GG 2–7). Responses were weighted by age, jurisdiction and time since diagnosis. Between-country differences were investigated using multivariate logistic and linear regression. Results: 3348 men responded (RoI n=2567; NI n=781; reflecting population sizes, response rate 54%). RoI responders were younger; less often had comorbidities (45% vs 38%); were more likely to present asymptomatically (66%; 41%) or with early disease (56%; 35%); and less often currently used androgen deprivation therapy (ADT; 2%; 28%). Current prevalence of incontinence (16%) and impotence (56% early disease, 67% late disease) did not differ between RoI and NI. In early disease, only current bowel problems (RoI 12%; NI 21%) differed significantly in multivariate analysis. In late disease, NI men reported significantly higher levels of gynaecomastia (23% vs 9%) and hot flashes(41% vs 19%), but when ADT users were analysed separately, differences disappeared. For HRQoL, in multivariate analysis, only pain (early disease: RoI 11.1, NI 19.4) and financial difficulties (late disease: RoI 10.4, NI 7.9) differed significantly between countries. There were no significant between-country differences in DASS-21 or index ED-5D-5L score. Conclusions: Treatment side effects were commonly reported and increased PCa detection in RoI has left more men with these side effects. We recommended that men be offered a PSA test only after informed discussion.

Dimensionality of the premenstrual syndrome: confirmatory factor analysis of premenstrual dysphoric symptoms among college students

Premenstrual syndrome and premenstrual dysphoric disorder (PMDD) seem to form a severity continuum with no clear-cut boundary. However, since the American Psychiatric Association proposed the research criteria for PMDD in 1994, there has been no agreement about the symptomatic constellation that constitutes this syndrome. The objective of the present study was to establish the core latent structure of PMDD symptoms in a non-clinical sample. Data concerning PMDD symptoms were obtained from 632 regularly menstruating college students (mean age 24.4 years, SD 5.9, range 17 to 49). For the first random half (N = 316), we performed principal component analysis (PCA) and for the remaining half (N = 316), we tested three theory-derived competing models of PMDD by confirmatory factor analysis. PCA allowed us to extract two correlated factors, i.e., dysphoric-somatic and behavioral-impairment factors. The two-dimensional latent model derived from PCA showed the best overall fit among three models tested by confirmatory factor analysis (c²53 = 64.39, P = 0.13; goodness-of-fit indices = 0.96; adjusted goodness-of-fit indices = 0.95; root mean square residual = 0.05; root mean square error of approximation = 0.03; 90%CI = 0.00 to 0.05; Akaike's information criterion = -41.61). The items "out of control" and "physical symptoms" loaded conspicuously on the first factor and "interpersonal impairment" loaded higher on the second factor. The construct validity for PMDD was accounted for by two highly correlated dimensions. These results support the argument for focusing on the core psychopathological dimension of PMDD in future studies.

[What are the physical complaints without pathological clinical signs in patients with diabetes mellitus?]

In previous research it was found that patients with diabetes mellitus suffer from multiple physical symptoms even early in their disease course. Such complaints may relate to blood glucose levels or can be understood as a sign of distress in respect to the diagnosis of a chronic disease. PURPOSE: This study was performed to evaluate in a cross-sectional analysis all the symptoms that patients may complain of and to relate these symptoms to a possible dysfunction of the autonomic nervous system. METHOD: We assessed the complaints of 66 patients with diabetes mellitus and compared these variables with those of patients with psychological disturbances (n = 794) or somatic disease (n = 162). The symptoms were recorded by means of several questionnaires such as the "Giessener Beschwerdebogen" (GBB), "the Freiburger Persönlichkeitsinventar" (FPI), the German version of the State Trait Anxiety Inventory (STAI) and the German version of the State Trait Anger Expression Inventory (STAXI). The autonomic nervous system was assessed using resting and mental stress conditions in a subset of patients with diabetes mellitus (n = 29) and psychological disturbances (n = 44). RESULTS: Patients suffering from diabetes mellitus and psychological disturbances showed a tendency to higher scores in GBB, STAI and STAXI. As far as psychological disturbances are concerned, the complaints experienced by patients with diabetes mellitus were found to be similar to those with somatic diseases. Both groups, however, rate clearly below those with psychological disturbances. The results of autonomic testing showed a significant disturbance in patients with diabetes mellitus with reduced sensitivity of the baroreceptor indicating autonomic neuropathy. CONCLUSION: Some of the physical complaints of patients with diabetes mellitus can be understood in connection with autonomic dysfunction. Moreover, an explicitly psychological view of these complaints may not be correct.

Long-term effects of heart transplantation: the gap between physical performance and emotional well-being

The purpose of our study was to assess physical and emotional factors in heart transplant patients. A prospective design was used to compare patients' physical symptoms, emotional complaints, and restrictions at admission to the waiting list, immediately after, and 1 and 5 years after heart transplantation. Thirty-three patients were included (30 male, 3 female) in the study. Their mean age at admission was 48 +/- 10.2 years. Of these, 23 suffered from cardiomyopathy, 8 from coronary heart disease, and 2 from valvular insufficiency. At admission, the patients suffered from symptoms of cardiac insufficiency, and were restricted in sports, gardening, hobbies, sexual life, job, food-intake, and mobility. More than three-fourths rated their physical and emotional status as moderate to poor. Emotionally, they suffered from irritability, restlessness, depression, psychic lability, lowered drive, lack of social contact, low self-esteem, and anxiety. At the end of rehabilitation (4-8 weeks after the operation), all physical and emotional complaints, as well as restrictions had significantly decreased (p < 0.0001 to p < 0.001), except for trembling, numbness of hands/feet, and food-intake. One year postoperatively, patients reported even fewer physical complaints (p < 0.01). Three-fourths rated their physical and emotional status good or excellent. Five years postoperatively--in contrast to physical status, restrictions, and physical complaints--the emotional complaints had increased significantly (p < 0.0001). Patients reported excellent physical performance up to 5 years postoperatively. On the other hand, the study revealed that their emotional well-being had significantly deteriorated from 1 to 5 years postoperatively. Attention should, therefore, not only be paid to the good physical health of the survivors, but also to the worsening of their emotional status.

Correlates of depressive symptoms in a representative sample of young Australian women

This paper presents a descriptive analysis of the prevalence of depressive symptoms among a national cohort of young Australian women, and the characteristics of those who experience them. It explores the associations between demographic and health-related variables and depressive symptoms in a representative sample of 9333 Australian women aged 22-27 years, from the Australian Longitudinal Study on Women's Health. Approximately 30% of these young women indicated that they were experiencing depressive symptoms, as indicated by the Center for Epidemiological Studies Depression Scale (CESD-10). After adjusting for age and rurality of residence, depressive symptoms were related to the following demographic variables: low income, low educational qualifications, a history of unemployment, not being in a relationship, and living arrangements other than living with a partner. Those health-related variables that were significantly associated with depressive symptoms included frequent visits to doctors and medical specialists, and a higher number of physical symptoms experienced and diagnoses made. More illicit drug use, higher use of cigarettes and alcohol, and lower exercise status were also significantly associated with depressive symptoms. This analysis supports the view that depression is one aspect of a multifactorial cluster of negative conditions across several domains of functioning, including physical ill-health, risky behaviours, and marginal social status. The complex interactions between these conditions, of which depression is only one, underscore the difficulties that arise in the treatment of depression and support the value of preventive interventions as an important public health strategy.

Psychosocial Functioning in Women with Symptoms of Persistent Genital Arousal

Persistent genital arousal disorder (PGAD) is characterized by physiological sexual arousal (vasocongestion, sensitivity of the genitals and nipples) that is described as distressing, and sometimes painful. Although awareness of PGAD is growing, there continues to be a lack of systematic research on this condition. The vast majority of published reports are case studies. Little is known about the symptom characteristics, biological factors, or psychosocial functioning associated with the experience of persistent genital arousal (PGA) symptoms. This study sought to characterize a sample of women with PGA (Study One); compare women with and without PGA symptoms on a series of biopsychosocial factors (Study Two); and undertake an exploratory comparison of women with PGA, painful PGA, and genital pain (Study Three)—all within a biopsychosocial framework. Symptom-free women, women with PGA symptoms, painful PGA, and genital pain, completed an online survey of biological factors (medical history, symptom profiles), psychological factors (depression, anxiety) and social factors (sexual function, relationship satisfaction). Study One found that women report diverse symptoms associated with PGA, with almost half reporting painful symptoms. In Study Two, women with symptoms of PGA reported significantly greater impairment in most domains of psychosocial functioning as compared to symptom-free women. In particular, catastrophizing of vulvar sensations was related to symptom ratings (i.e., greater severity, distress) and psychosocial outcomes (i.e., greater depression and anxiety). Finally, Study Three found that women with PGA symptoms reported some overlap in medical comorbidities and symptom expression as those with combined PGA and vulvodynia and those with vulvodynia symptoms alone; however, there were also a number of significant differences in their associated physical symptoms. These studies indicate that PGA symptoms have negative consequences for the psychosocial functioning of affected women. As such, future research and clinical care may benefit from a biopsychosocial approach to PGA symptoms. These studies highlight areas for more targeted research, including the role of catastrophizing in PGA symptom development and maintenance, and the potential conceptualization of both PGA and vulvodynia (and potentially other conditions) under a general umbrella of ‘genital paraesthesias’ (i.e., disorders characterized by abnormal sensations, such as tingling and burning).

Effects of coping strategies, social support and work-nonwork conflict on shift worker's health

Objectives This study examines the direct and mediated effects of shift workers' coping strategies and social support on structural work-nonwork conflict and subjective health. Methods The participants were 172 registered female nurses, aged 21 to 40 years. They all worked full-time, on rapidly rotating, 8-hour shifts in metropolitan general hospitals. All the respondents completed a self-administered questionnaire requesting demographic information and data on sources of social support, work-nonwork conflict, and coping strategies. Results A path model with good fit (chi(2)=28.88, df=23, P>.23, CFI=0.97) demonstrated complex effects of social support and coping on structural work-nonwork conflict and health. Conclusions Structural work-nonwork conflict mediated the effects of social support from supervisors and emotionally expressive coping on psychological symptoms. Control of shifts mediated the effect of social support from supervisors on structural work-nonwork conflict. Disengagement coping had direct and mediated effects on psychological and physical health. However, it also had mediated effects, with the effect on psychological health being mediated by support from co-workers and the effect on physical symptoms being mediated by family support. Go-worker support mediated the effect of social support from supervisors on psychological symptoms. Overall, these findings support previous research and clarify the process by which coping strategies and social support affect structural work-nonwork conflict and health in shift work.

Parental reactions to infant death: The effects of resources and coping strategies

The aim of this research was to examine, from a stress and coping perspective, the effects of resources (both personal and environmental) and coping strategies on parental reactions to infant death. One hundred and twenty-seven parents (60 fathers, 67 mothers) participated in the study. The predictors of parental distress (background factors, resources, coping methods) were initially assessed at 4-6 weeks post-loss. Parental distress (assessed using a composite measure of psychiatric disturbance, physical symptoms, and perinatal grief) was further assessed at 6 months post-loss and at 15 months postloss. After control for the stability in adjustment across time, there was consistent evidence that higher levels of education were associated with lower levels of parental distress over time. Among mothers, the number of friends in whom mothers had the confidence to confide emerged as a positive predictor of adjustment to infant death. A reliance on problem-focused coping was associated with greater maternal distress at 6 months post-loss, whereas coping by seeking support was associated with less distress at 15 months post-loss. There is no evidence that background factors and resources influenced parental distress through coping.

Effects of a program of intervention on parental distress following infant death

A longitudinal study of 144 patents (65 fathers, 79 mothers) was conducted to evaluate the effectiveness of a program of intervention in relieving the psychological distress of parents affected by infant death. Participants were assessed in terms of their psychiatric disturbance, depression, anxiety, physical symptoms, dyadic adjustment, and coping strategies. The experimental group (n = 84) was offered an intervention program comprising the use of specially designed resources and contact with a trained grief worker. A control group (n = 60) was given routine community care. Parental reactions were assessed at four to six weeks postloss (prior to the implementation of the intervention program), at six months postloss, and at 15 months postloss. A series of multivariate analyses of valiance revealed that the intervention was effective in reducing the distress of parents, particularly those assessed prior to the intervention as being at high-risk of developing mourning difficulties. Effects of the intervention were noted in terms of parents' overall psychiatric disturbance, marital quality, and paternal coping strategies.

Short communication: Extended shifts in ambulance work: influences on health

Shiftwork is a major source of stress for many worker's. This study highlights the role that organizational and psychosocial variables play in alleviating the negative health effects of 10 and 14-h shifts. It examines the direct and mediated effects of coping strategies, social support and control of shifts on work/non-work conflict and subjective health. Participants are 60 ambulance workers, aged 22 to SS years. A structural equation model with good fit demonstrates complex effects of social support from various sources (supervisors, co-workers and family), coping and control on work/non-work conflict and subjective health., Conceptually, the research contributes to the development of a theoretical framework that can assist in explaining how key psychosocial and organizational variables influence the psychological and physical symptoms experienced by shiftworkers. Copyright (C) 2002 John Wiley Sons, Ltd.