1. By Lora A. Connor B.A., 2008, California State University,
Long Beach A Thesis Proposal December 2014 Committee Members: James
Amirkhan, Ph.D. (Chair) Courtney Ahrens, Ph.D. Young-Hee Cho,
Ph.D.
2. Summarize Research Question Menopausal Symptoms Neuroticism
Stress & Menopause Exercise & Menopause The Present Study
Methods Participants Materials Procedure Results Discussion
Possible Limitations Implications Questions Agenda
3. Does the neuroticism personality trait influence menopausal
symptoms? Hypothesis It is hypothesized that high scores on a
neuroticism scale can predict increased negative menopausal
symptoms (i.e., hot flashes, insomnia, depressed mood, and
cognitive symptoms) above and beyond the effects of stressors and
exercise. Research Question
4. Vasomotor Symptoms (i.e., hot flashes) Most common complaint
due to changing hormone levels . A woman perspires profusely, her
skin becomes flush, and her heart rate suddenly drops followed
quickly by a raise in heart rate. Insomnia Insomnia may be caused
by other menopausal symptoms (vasomotor, mood, changes in
cognition, fluctuating hormone levels). Depressed Mood 19% to 29%
of menopausal women report depressed mood. Estrogen deficiency may
contribute to depressed mood. Forgetfulness (i.e., brain fog) Some
researchers dispute the idea that menopausal women experience
cognitive deficits. However, working memory and complex
attention/vigilance have been found to be affected. Menopausal
Symptoms
5. Definition The inclination to experience negative emotions
(i.e., anxiety, distress, fear, sadness, anger, dissatisfaction,
helplessness, irritability, and loneliness) and to react more
negatively to stressors with which individuals feel an inability to
cope. Implications Neurotic tendencies may have genetic influences,
as the personality trait tends to remain stable over time.
Individuals high in neuroticism are more prone to react strongly,
and negatively, to stressful life events. Neuroticism has been
shown to have negative effects on physical illnesses, which may
impact menopausal symptoms as well. Neuroticism
6. Stress Women in the menopausal age group often experience
significant stressors during this phase in their lives. High stress
has been found to be related to: More hot flashes Insomnia
Depressed mood Decreased cognitive function Stress &
Menopause
7. Stress-Neuroticism Relationship Stressors are common to this
age group (e.g., aging parents, children leaving, death of
significant others, employment uncertainty, aging, etc.). Stress
exacerbates menopausal symptoms. Neuroticism has been found to
contribute to physical symptomology as well. It is easy to confound
neuroticism with stress reactions, as variance attributed to stress
may be due to the neurotic personality trait since both are
evidenced by: Emotional instability Negative affect Psychological
distress Lack of resilience Horner found a complex interaction
between neuroticism, locus of control, and stressors to predict
illness. Stress-Neuroticism Relationship
8. Exercise Exercise may be related to improvements in
menopausal symptoms: Aerobic activity helps improve: Vasomotor
Insomnia Mood Memory symptoms Yoga helps improve: Insomnia Mood
Exercise & Menopause
9. The focus of this study was to investigate whether stress
alone or heightened sensitivity to stress is at the root of
menopausal symptoms. Past studies have demonstrated a significant
relationship between stressors and menopausal symptoms. Also,
studies have found positive effects of exercise on menopausal
symptoms. Therefore, to determine a clearer path between
neuroticism and menopausal symptoms, stressors and exercise were
important factors to control. The Present Study
10. Women 40 to 60 years old, average age 50.7 Of the 294 who
completed the study questionnaire, 169 surveys were included in
analysis 120 incomplete surveys 5 out-of-range responses
Respondents reported exercising more hours than possible in a day
Women having experienced surgical menopause were excluded. Methods:
Participants
11. Screening Survey Hot flashes (1 mo), abnormal menstruation
(6 mo), surgical menopause, HRT, or medications. Menopause Rating
Scale (MRS) Measures common complaints and severity of symptoms
Eysenck Personality Questionnaire - Brief Version (EPQ-BV) Measures
Neuroticism Social Readjustment Rating Scale (SRRS) Measures
objective stressors International Physical Activity Questionnaire
(IPAQ) Measures amount of exercise Demographics Survey Methods:
Materials
12. Recruited Through Social Media & Ads Posted in
Community Locations Facebook, Twitter and Google+ Respondents Visit
a Link to the Survey Survey Monkey Surveys Delivered in Same Order
for Each Participant Informed consent Screening Survey MRS EPQ-BV
SRRS IPAQ Demographics Study Incentive Enter email address to win a
drawing for one-of-two $100 Amazon gift card. Methods:
Procedure
13. The studys hypothesis was confirmed, high levels of
neuroticism are associated with increased negative menopausal
symptoms above and beyond the levels of stressors and exercise.
Results Hypothesis Confirmed
14. Results: Sample Characteristics 1 29 17 58 64 19 4 2 7 0 18
35 53 70 Grmr HghSch Voc/tech SomeCol Bachler Master Doctoral
Profess Other Frequency Educational Level Educational Level n =
201173 6 5 3 2 13 0 45 90 135 180 225 Cauc Lat/Hisp Af-Amer
Nat-Amer Asi/Pac-Isd Other Frequency Ethnicity/Race Race/Ethnicity
n = 201 22 53 65 20 15 26 0 18 35 53 70 0 to 29,999 30,000 to
59,999 60,000 to 119,999 120,000 to 179,999 180,000+ Prefer not to
answer Frequency Annuual Income Annual Income n = 201
15. Means and standard deviations were high for both scales A
lot of women reported having a lot of stress or getting a lot of
exercise. However, the scores were spread out. Social Readjustment
Rating Scale (SRRS), a measure of objective stressors M = 636.09 SD
= 874.62 n = 289 International Physical Activity Scale (IPAQ), a
measure of exercise M = 6000.30 SD = 7195.37 n = 227 Cronbachs
alpha for the IPAQ was moderate ( = .42) Results: Scale
Characteristics Cont.
16. Means were both close to midrange and standard deviations
were high Eysenck Personality Questionnaire Brief Version (EPQ-BV)
a measure of neuroticism M = 29.23 SD = 10.17 n = 256 Menopausal
Rating Scale (MRS) a measure of menopausal symptoms M = 18.35 SD =
7.92 n = 268 Internal Reliability for Neuroticism Menopausal
Symptoms Scales Approximate Normative Populations EPQ-BV ( = .93)
MRS ( = .87) Results: Scale Characteristics Cont.
17. Zero-order Correlations were calculated to determine any
possible confounding demographic variables with neuroticism and
menopausal symptoms Correlation found: Respondent's income Income
level had a negative relationship between the study variables
Results: Tests of Hypothesis Measure 1 2 3 4 5 M SD 1. Income 2.
Stressors .00 636.09 874.62 3. Exercise .06 .13 6000.30 7195.37 4.
Neuroticism .28** .19** .02 29.24 10.17 5. Menopausal Symptoms .18*
.28** .20** .68** 18.35 7.92
18. Hierarchical Regression was used to test the hypothesis
that high levels of neuroticism are associated with increased
menopausal symptoms Step 1: Income, Stressors, Exercise Step 2:
Neuroticism All four predictors were significant, F(4, 164) =
65.61, p < .001, adjusted R2 = .61 Four predictors explained by
61% of the variance in menopausal Results: Tests of Hypothesis
19. Step 1: 19% of Variance in Symptoms Income t (165) = 3.12,
p < .01 Stressors t (165) = 4.10, p < .001 Exercise t (165) =
3.15, p < .01 Step 2: 43% of the Variance in Symptoms
Neuroticism t (164) = 13.54, p < .001 Results: Tests of
Hypothesis Cont.
20. Zero-order Correlations Performed for Secondary Analyses
with Stressors/Exercise & Symptoms Sex Difficulties &
Change in Eating Habits Stressors Correlated with all Symptom
Subscales (psychological, somato- vegetative, and urogenital)
Personal Injury/Illness & Change in Financial Status Stressors
Related to Two Subscales (psychological and urogenital) Home
Mortgage & Living Alone Related to Two Subscales (psychological
and somato- vegetative) Results: Secondary Analyses Measure MRS
Psychological MRS-Somato- Vegetative MRS- Urogenital Divorce .13*
.01 .09 Marital Separation .12* .01 .07 Marriage .07 .03 .15* Sex
Difficulties .16* .18** .31** Death of Close Friend .12* .08 .07
Death of Family Member .11 .08 .15* Change Financial State .16* .09
.21** Mortgage over $100,000 .13* .16* .11 Personal Injury/Illness
.19** .12 .15*
21. One Negative Correlation: More Vigorous Leisure Time
Exercise Related to Less Psychological Symptoms More Vigorous
Exercise at Work Related to more Psychological Symptoms More
Exercise During Work, Transportation, and Domestic Chores the More
Urogenital Symptoms More Moderate & Vigorous Exercise at Work
Related to More Somato- Vegetative Symptoms Results: Secondary
Analyses Measure MRS Psychological MRS-Somato- Vegetative MRS-
Urogenital Total Exercise .13* .15* .22** Walking .10 .12 .22**
Moderate .12 .12 .17* Vigorous .08 .11 .15* Work Total .13 .17**
.20** Walking .12 .12 .22** Moderate .07 .16* .13* Vigorous .13*
.15* .16* Transportation Total .05 .08 .15*
22. Discussion The hypothesis was supported: high levels of the
neuroticism personality trait intensified menopausal symptoms even
after income level, stressors, and exercise had been statistically
controlled. As expected, women in this age group tended to report
high numbers of life stressors, however, causal direction cannot be
inferred. With the exception of the kind of exercise done during
ones leisure time on psychological symptoms, physical activity (at
work, at home, or in between) was related to more extreme symptoms.
Neuroticism Symptoms Stressors Symptoms Exercise Symptoms
23. Limitations Respondents were self-selecting and mostly
Caucasian May not have been taken by the person for whom it was
intended Only women with computer skills Respondents may have
answered differently from paper survey Because several surveys were
taken at the same time, response bleeding or response fatigue may
have occurred Since analysis was correlational, the direction of
causality remains undetermined Countermeasures After data was
screened, only 5 surveys were lost due to out-of-range responses.
Anonymity may have yielded more forthcoming answers To remedy
response bleeding, future studies may consider delivering the
questionnaires on different days or implementing distracting
activities. A longitudinal design might help with directionality.
Possible Limitations
24. The findings could potentially help healthcare
professionals identify women at risk for menopausal difficulties. A
simple personality questionnaire could be used to determine a
womans susceptibility to extreme menopausal symptoms. However, this
may not be appropriate for minority women. Since the causes are
vague why some women experience extreme symptoms and others do not,
it would be helpful to have a measurable vulnerability variable
such as neuroticismto target interventions for women most in need.
Secondary results may inform health care professionals on other
variables, like stress and exercise, that may impact severe
symptoms. Implications
25. Questions
26. Screening Survey After informed consent. Hot flash symptoms
within the previous month Experienced missed or abnormal menstrual
bleeding in the past 6 months Experienced menopause as a result of
surgery Medications or hormone replacement therapy (HRT) Menopause
Rating Scale (MRS) 11-item scale measuring common complaints and
severity of menopausal symptoms. 5-point Likert scales ranging from
0 (none) to 4 (very severe). High test-retest reliability across
countries: Cronbachs alphas from .83 to .87 Good validity with high
sub-scores to total-scores (r = 0.7 0.9) However, subscales may not
be fully independent, as sub-scales have been found to
intercorrelate (r = 0.50.7) Methods: Materials
27. Eysenck Personality Questionnaire Brief Version (EPQ-BV)
24-item questionnaire measuring both extraversion and neuroticism.
Using 12-item neuroticism subscale only. Uses a 5-point Likert
scales ranging from 1 (not at all) to 5 (extremely). High
test-retest reliability with coefficient alphas for neuroticism
from .92 to .90. Good validity when comparing with original
Eyseneck Personality QuestionnaireRevised (r = .88.89). Social
Readjustment Rating Scale (SRRS) 43-item checklist measuring
current objective stressors. Scores 150 or less are low, 150 to 299
are moderate, and 300 or more are high High test-retest reliability
with Cornbachs alphas from .72 to .80 This scale has been shown to
correlate with illness symptoms. Those with high scores were 80%
more likely to develop illness. Methods: Materials (cont.)
28. International Physical Activity Questionnaire (IPAQ)
27-item questionnaire measuring 5 activity domains (i.e., leisure,
domestic, gardening, work, transportation) over the previous week.
Total scores are computed by summing the duration (in minutes) and
frequency (days) of activities in all domains. High test-retest
reliability at one week with an average score of r =.80. Moderate
criterion validity of r =.30 measured by comparing summed scores
from motion detectors worn by study participants Demographics
Survey Gender Age Ethnicity Household size Income level Education
level Email address (optional: for entry into drawing for study
incentive). Methods: Materials (cont.)