Sleep in Women: A Review

Sleep complaints are common in women, and women are more likely to suffer from insomnia than men. Multiple factors across a woman's lifespan, including hormonal changes, age‐related physiological changes, psychosocial factors, the presence of sleep disorders, and physical and mental health conditions, can contribute to complaints of poor sleep in women. This article reviews the literature on the characteristics of, and contributing factors to, subjectively and objectively measured sleep during the menstrual cycle, pregnancy, and post‐partum period, as well as the menopausal transition and postmenopause. Evidence from both subjective and objective measurements supports the presence of chronic sleep fragmentation associated with pregnancy, acute sleep deprivation during labour and the immediate post‐partum periods, as well as disrupted sleep during the first few months after childbirth. While there is evidence for menstrual cycle and menopause related sleep disturbance based on women's self report, findings from objectively measured sleep have been mixed. Observational and intervention studies on the relationship between sleep and women's psychological well‐being suggest that underlying causes of sleep disturbance across a woman's lifespan are often multi‐factorial. Comprehensive assessments and targeted interventions are needed in managing sleep problems in women. Cognitive behavioural interventions have been shown to reduce sleep complaints during the perinatal and menopausal periods, and improvements in sleep are likely to lead to improvements in women's overall well‐being.     

Counseling Women in Midlife: An Integrative Approach to Menopause

Menopause is a normative life transition that is experienced by virtually all women, yet remains poorly understood. The dominance of the biomedical model results in a unidimensional definition of menopause as a biological event, ignoring the influence of cultural and psychosocial factors. Counselors who use an integrative approach can not only provide accurate biomedical information but also conceptualize menopause as a normative midlife transition. The purpose of this article is to provide a foundation in biomedical issues and to consider how these independently, and in interaction with cultural and psychosocial factors, influence the experience of menopause.     

Perimenopausal mental disorders: epidemiology and phenomenology

Perimenopause, the interval of irregular menstrual activity which directly precedes menopause, is characterized by widely fluctuating hormone levels amidst a large-scale decline in circulating estrogen. This phase in a woman's life is typically accompanied by physical discomforts including vasomotor symptoms, such as headaches, insomnia, and hot flushes, as well as genital atrophy. Not surprisingly, studies suggest a significant increase in mood lability for women during this time. While some evidence points toward an exacerbation of bipolar mood symptoms and an increase in schizophrenic psychosis during perimenopause, the majority of research conducted on perimenopausal mental disorders has focused on unipolar depression. Studies vary widely in methodology, definitions of menopausal status, and degrees of depression among subjects; however, the majority of findings indicate an increased susceptibility to depression during the perimenopausal transition. This greater susceptibility may be due to neuroendocrine effects of declining estrogen levels, the subjective experience of somatic symptoms resulting from this hormonal decline, and/or the more frequent occurrence of "exit" or "loss" events for women during this stage of life. At this time, more research is needed to address questions of prevalence, risk, and etiology for depression and other major mental disorders as related to the physiological and psychosocial changes associated with perimenopause.     

Depression During The Menopausal Transition

The perception that menopause leads to mood disturbances such as depression has a long history. How did these beliefs come about, and are they supported by the scientific literature? This article reviews the theories of menopause and depression, the scientific literature, and the implications of these findings for prevention and treatment. Epidemiologic studies of menopausal status and depression do not provide consistent evidence of an association between the menopausal transition and depression among the general population of women. Depression experienced by women transitioning through menopause may be attributed to factors unrelated to menopause. A subset of women, however, may be more vulnerable to the effects of hormonal changes. For some women, short-term estrogen replacement therapy to relieve vasomotor symptoms may be beneficial, although for others psychotherapy or antidepressants may be more appropriate. Additional research is needed to better understand the association between different stages of the menopausal transition and dysphoric mood or depression, and better identification of women potentially at risk for depression during the menopausal transition.     

Treatment of menopause-related mood disturbances

More than 1.7 million American women are expected to reach menopause each year. Recent Canadian statistics show that a 50-year-old woman can now expect to live until her mid-80s, which implies living at least one-third of her life after menopause. The menopausal transition is typically marked by intense hormonal fluctuations, accompanied by vasomotor symptoms (eg, hot flashes, night sweats), sleeps disturbance, and changes in sexual function, as well as increased risk for osteoporosis, cardiovascular disease, and cognitive decline. More importantly, recent studies have demonstrated a significant association between menopausal transition and a higher risk for developing depression. In the post-Women's Health Initiative Study era, physicians and patients are questioning the safety and efficacy of long-term hormone therapy use. This article reviews the current literature on the benefits and risks of using hormone therapy for the treatment of menopause-related mood disturbances and alternate strategies currently available for the management of menopause-related problems, including antidepressants, complementary and alternative medicine, and selective estrogen receptor modulators.     

Cognitive-behavioral intervention among women with slight menopausal symptoms: a pilot study

Menopause is associated with a considerable variety of physical, psychological and social symptoms that can be treated using cognitive-behavioral techniques. In the present study, 21 women took part in an eight-week group intervention consisting of weekly two-hour sessions to address their slight symptoms related to the climacteric stage of life. The intervention included: psycho education on menopause, relaxation techniques, nutrition and fitness exercises, Kegel exercises, and problem-solving techniques. A control group was included that did not receive treatment and consisted of 28 women. The results revealed a significant reduction in most symptoms (including depression and anxiety) after intervention as compared to the baseline period. No changes appeared in the control group. The relevance of this work lies in the potential element of prevention this therapeutic package could offer to relieve various symptoms, slight and incipient, during the perimenopausal stage.     

Spirituality and Severity of Menopausal Symptoms in a Sample of Religious Women

Menopause represents an important life change, particularly for religious women whose identity is significantly related to family. Two competing hypotheses are examined: one, because religious women have their identity focused on family and child rearing, spirituality will be related to increased menopausal symptoms because menopause represents a loss of identity and purpose; and two, because spirituality can provide strength and comfort during difficult times, it will, therefore, be related to decreased menopausal symptoms. To test these competing hypotheses, questionnaires were administered to 218 women (average age 55, 35% premenopausal, 26% peri-menopausal, 39% postmenopausal) who were members of the Church of Jesus Christ of Latter Day Saints. Regression analyses indicated that higher levels of spiritual strength were related to decreased levels of reported menopausal symptoms. Spiritual strength was also related to increased benefit finding during menopause, decreased concern with body appearance, and increased use of adaptive coping strategies. We conclude that finding strength in spirituality may help religious women cope better with the life changes associated with menopause.     

The Relationship Between Agentic and Communal Personality Traits and Psychosocial Adjustment to Breast Cancer

Agency, communion, unmitigated agency (UA), and unmitigated communion (UC) are related to psychosocial health outcomes in nonclinical and medical populations. This study examined the relationship between these personality traits and emotional and interpersonal well-being, as up to 50% of women experience difficulties in psychosocial adjustment after being diagnosed with breast cancer. Seventy-four women newly diagnosed with breast cancer completed baseline assessment measures within 2 weeks prior to their first chemotherapy treatment or at the beginning of their hormonal therapy. Findings indicate that (1) agency and UA are important correlates of emotional and interpersonal adjustment and should be considered when attempting to identify women at high risk for psychosocial distress, and (2) UC deserves increased attention in behavioral medicine research, given its strong relationship with emotional distress in a breast cancer population. Thus, evidence continues to accumulate regarding the important relationship of these personality traits to psychosocial outcomes in medical populations.     

Stress management interventions for HIV+ adults: a meta-analysis of randomized controlled trials, 1989 to 2006.

OBJECTIVE: Numerous studies document that stress accelerates disease processes in a variety of diseases including HIV. As a result, investigators have developed and evaluated interventions to reduce stress as a means to improve health among persons living with HIV. Therefore, the current meta-analysis examines the impact of stress-management interventions at improving psychological, immunological, hormonal, and other behavioral health outcomes among HIV+ adults. DESIGN: This meta-analytic review integrated the results of 35 randomized controlled trials examining the efficacy of 46 separate stress management interventions for HIV+ adults (N=3,077). MAIN OUTCOME MEASURES: Effect sizes were calculated for stress processes (coping and social support), psychological/psychosocial (anxiety, depression, distress, and quality of life), immunological (CD4+ counts and viral load), hormonal (cortisol, dehydroepiandrosterone sulfate [DHEA-S], cortisol/DHEA-S ratio, and testosterone) and other behavioral health outcomes (fatigue). RESULTS: Compared to controls, stress-management interventions reduce anxiety, depression, distress, and fatigue and improve quality of life (d+s=0.16 to 0.38). Stress-management interventions do not appear to improve CD4+ counts, viral load, or hormonal outcomes compared with controls. CONCLUSION: Overall, stress-management interventions for HIV+ adults significantly improve mental health and quality of life but do not alter immunological or hormonal processes. The absence of immunological or hormonal benefits may reflect the studies' limited assessment period (measured typically within 1-week postintervention), participants' advanced stage of HIV (HIV+ status known for an average of 5 years), and/or sample characteristics (predominately male and White participants). Future research might test these hypotheses and refine our understanding of stress processes and their amelioration.     

Psychosocial Adaptation and School Success of Italian,Portuguese and Albanian Students in Switzerland: Disentangling Migration Background,Acculturation and the School Context

The Swiss Mutual Intercultural Relations in Plural Societies (MIRIPS) study (n?=?1,488) examined the impact of migrant students’ acculturation strategies on their psychosocial adaptation and educational success. The study focused on the comparison of students with an Italian, Portuguese and Albanian migration background, because these three groups differ in their socioeconomic living conditions, educational resources and opportunities in Switzerland according to official statistics. With respect to acculturation strategies, the results partially confirm the integration hypothesis: immigrant students who are oriented towards the heritage culture and students who align with both the heritage culture and the majority culture (integration) and who are interested in their multicultural environment have a better psychosocial adaptation than students who align with no culture (marginalisation). In relation to educational success, a multicultural orientation and a combination of a minority and multicultural orientation turned out to be the strategies of the higher-performing students. Unexpectedly, the three groups of migrants examined in this study did not differ in their life satisfaction, an indicator for psychological adaptation or in their educational success in terms of educational aspirations and German reading skills. Rather than the migration background of the students, other demographic variables such as educational resources of the family as well as factors related to school quality (type of school, quality of social relationships, achievement expectancy of teachers, multicultural education at school) turned out to be crucial for psychosocial adaptation and educational success.     

Correlates of Patient Satisfaction Among Menopausal Women

Patient satisfaction can increase compliance and health outcomes in many populations. Menopausal-age women present unique physical and psychosocial concerns that separate them from other populations in their health care needs and preferences. We surveyed 48 women (ages 45–60) regarding their satisfaction with a recent annual exam office visit in a family practice clinic. Women reported the number of quality of life issues they discussed during this visit and which of these they considered most important, as well as menopausal symptoms and perceived health competence. Regression analyses identified variables most related to patient satisfaction. Of three components of visit satisfaction (Quality, Humaneness, and General Satisfaction), Quality was predicted by quality of life issues discussed. Physical, psychological, and functional domains were considered most important to the patients, whereas physical, psychological, and social domains were most often actually discussed in the visit.     

Perceived stress and everyday memory complaints among older adult women

Abstract

Memory complaints among older adults are often influenced by depression and anxiety, but the association of stress to memory complaints has received little attention. We examined the associations of perceived stress, life events, and activity level to everyday memory complaints among healthy older women, while controlling for the influence of depression and anxiety. Participants (N=54) completed self-report questionnaires on memory complaints, perceived stress, recent life events, activity level, depression, and anxiety. Partial correlation analyses indicated that higher levels of perceived stress were associated with higher levels of memory complaints when controlling for the influence of depression and anxiety, but that life events and activity level were not related to memory complaints. This study highlights that perceived stress, like depression and anxiety, is a psychological factor that influences the appraisal of cognitive ability; however, larger and more heterogeneous samples will be needed to better understand the multifactorial nature of memory complaints in older adulthood.     

Debit and credit. Menopause between illusion and reality]

Middle-aged women in patriarchial societies are still widely considered as deficient and damaged and therefore can easily become objects of medical attention. The authors seek the reasons for this in fact that the different changes of male and female potency in the 45 to 55 age-group provoke defense mechanisms. These are meant to ensure the intactness of the male--who then is supposedly in his 'best age'--for the sake of both men and women. Apart from this, psychoanalytical theories--like the one of the "depressive position", held by Melanie Klein--confirm the prejudice that a woman going through the change of life is damaged, and thus has to mourn the "desease" of menopause.     

Sexuality and Perimenopause: What Counselors Need to Know

Perimenopause, which recently has been recognized as separate from menopause, affects approximately 22 million U.S. women. It is a time when women are at greater risk for emotional, relationship, and sexual problems. The authors describe the symptoms of perimenopause, discuss the resulting psychosocial and sexual impact, and present treatment implications for counselors.     

Correlates of Happiness Among Older Spanish Institutionalised and Non-Institutionalised Adults

The overall objective of this study was to explore the current (i.e., at the time of the study) and past (i.e., over their lifetimes) happiness of 65-year-old and older men and women who had different personal and socio-demographic characteristics. We also investigated the role of affect balance and life satisfaction as sources of participants’ subjective well-being, as well as the contribution of other psychosocial variables, including self-efficacy, optimism, health and quality of life, stress, social support and leisure, and of socio-demographic conditions. Further, we examined the influence of institutionalisation on happiness and on the aforementioned psychosocial variables. Participants voluntarily completed self-reports regarding all of these variables. Participants’ current happiness (M = 6.6 on a 0–10 scale) was significantly lower than their past happiness (M = 7.7). The happiness of the institutionalised participants did not differ from that of the non-institutionalised participants, although significant differences were found for a number of psychosocial variables. Affect balance and life satisfaction were significant correlates and predictors of current happiness, which was also associated with many psychosocial variables and was further predicted by past happiness, health indicators and some life dimensions assessed as perceived sources of one’s own happiness, such as a sense of autonomy and independence. Our results highlight the importance of establishing both happiness and its correlates to develop interventions aimed at promoting subjective well-being in older people, given that, compared to earlier periods in life, happiness may be reduced in late adulthood.     

(Un)Changing Menopausal Bodies: How Women Think and Act in the Face of a Reproductive Transition and Gendered Beauty Ideals

Biomedical literature suggests that menopause primarily represents negative change in women’s lives. Feminist literature on menopause proposes that it can represent positive change or is a neutral experience for individual women. Conflicting characterizations result from different empirical emphases; biomedical research has focused on bodily change, and feminist research has highlighted social contexts for menopause. Results from interviews with a snowball sample of 61 women in 2001 illustrate how a change discourse on menopause and gendered beauty ideals combine to create a context within which some women believe that changes in their physical appearances can be attributed to menopause and that bodily change is problematic. In addition, during focus groups and in-depth interviews, women suggested that, in the face of these discourses or ideologies and changing external bodies, they face a “category crisis.’’ Interviewees also discussed how they attempt to prevent/mask bodily change in order to remain attractive, visibly feminine, and desirable in the eyes of men. Findings from this qualitative study illustrate that we must continue to explore women’s perceptions and experiences of bodily change during menopause, as we lack a full understanding of this developmental transition and its biosocial contexts.     

The relationship between post-trauma problem reporting and carer quality of life after severe head injury

Abstract

Head injury is a significant cause of death and disability. This study examined the quality of life of carers of individuals following severe head injury from the acute neurosurgical care period to one year post discharge from hospital. The contribution of patterns of problem reporting by patients and their carers to quality of life was examined. Carer psychosocial adjustment and individual quality of life evaluations were significantly poorer than general population levels and did not change over a one year period. However, significant increases in the number of problems reported were noted over time. No significant differences were found between patients and carers in the numbers of problems identified at each of three assessments, although the level of agreement about problems identified was quite low. Female patients reported significantly more problems than male patients. Carer problem reporting was found to significantly predict carer quality of life and psychosocial functioning to a greater extent than patient problem reporting, a pattern which emerged after the patient had been discharged from hospital. The study demonstrates increasing problem profiles and differing perceptions of patients and carers over time. Combined with a lack of improvement in carer quality of life over a one year recovery period, this highlights the need for longer-term professional support and advice services aimed at both patients and carers.     

Thinking ahead: complexity of expectations and the transition to parenthood

This study examined the integrative complexity of thinking in individuals making the transition to parenthood, and the relationship between complexity and adjustment during this period. Sixty-nine couples were interviewed 3 months before their babies were born, and 6 months after the birth. The prenatal interview focussed on individuals' expectations about what it would be like being a parent; the postnatal interview focussed on individuals' actual experiences as parents. In addition, participants completed measures of depression, self-esteem, and marital satisfaction after each interview, and a measure of stress after the 6-month postnatal interview. Both men and women demonstrated a significant increase in the complexity of their thinking from the prenatal to the postnatal interview, with women demonstrating higher levels of complexity at both times. In addition, women with more complex expectations demonstrated better adjustment after their babies were born than did women with simpler expectations; these results were not obtained for men. Results are discussed with regard to the way in which thinking about the self changes as one negotiates major life transitions, and the way in which complex thinking can help counter some of the stresses that individuals may experience at these times.     

The Relationship of Positive Psychological Variables with the Age of Destitute Women in Psychosocial Adaptation

The purpose of the present investigation was to examine the importance of positive psychological variables like self-efficacy, optimism, hope, resilience, and well-being in the context of psychosocial adaptation of destitute women staying in rescue homes/short-stay homes in the coastal districts of Odisha, India and their relationship with their age and the implications for old age. The participants were individually administered measures of self-efficacy, optimism, resilience, hope, and well-being. Destitute and non-destitute women were compared on each of these measures. The sample consisted of 300 women (150 destitute women and 150 non-destitute women). The destitute women were randomly sampled from the short-stay homes/rescue homes in the coastal districts of Odisha. Though the age range was from 18 to 45 years (as that is the age they normally have the courage to raise a voice against injustice done to them), there are implications for their later life; if proper intervention programs are done to increase their positive psychological capital, better well-being can be ensured for their old age. The analysis of data involved Product Moment Correlation Coefficient between age and other dimensions. The major implications of the study were formulated and directions for future research were also outlined.     

Women and anxiety disorders: implications for diagnosis and treatment. Proceedings of a conference, November 19-21, 2003, Chantilly, Virginia, USA

Community studies indicate that 19% of men and 31% of women will develop some type of anxiety disorder during their lifetime. The impact of gender is profound in that it increases the likelihood of developing an anxiety disorder by 85% in women compared to men. Sex difference in prevalence rates are apparent as early as age 6, when girls are twice as likely as boys to have an anxiety disorder. In the National Comorbidity Survey, the prevalence rates for panic disorder in women and men were 5% and 2%, respectively. Agoraphobia, which often coexists with panic disorder, has a lifetime prevalence rate of 7% in women and 3.5% in men. Prevalence of trauma is increased in young women as well, and is experienced earlier in life; 62% of sexual assaults are inflicted on females < or = 18 years of age, and 29% occur in children < 11 years of age. Comorbidity of anxiety in women complicates other medical conditions as well. For example, panic disorder is highly comorbid with CHD, which remains the leading cause of death in women in developed countries. Fluctuations in reproductive hormone levels during the female life cycle is thought to be responsible for modulating anxiety. This is often implicated in the later age of onset, the more sudden and acute symptom emergence, and the more episodic course of OCD in women, and in the high prevalence(47.4%) of PMDD. Pregnancy appears to be a protective period for some anxiety disorders, including panic, while for others, such as OCD, it may be associated with onset. Hormonal changes during pregnancy, such as increased prolactin, oxytocin, and cortisol, may contribute to the suppression of stress response that occurs during this period. Despite a large and growing body of literature on anxiety disorders in general, the available data relating to women and girls falls short of informing aspects of diagnosis, treatment, and prevention that may entail sex differences. Additional work is required to understand the biological and psychosocial causes of these differences.