SlideShare ist ein Scribd-Unternehmen logo
1 von 6
Downloaden Sie, um offline zu lesen
Menopause: The Journal of The North American Menopause Society
Vol. 21, No. 2, pp. 159/164
DOI: 10.1097/gme.0b013e31829479bb
* 2013 by The North American Menopause Society
Resilience, depressed mood, and menopausal symptoms in
postmenopausal women
Faustino R. Pe´rez-Lo´pez, MD, PhD,1,2
Gonzalo Pe´rez-Roncero, RN,1
Jose´ Ferna´ndez-In˜arrea, MD,3
Ana M. Ferna´ndez-Alonso, MD, PhD,1,4
Peter Chedraui, MD, MSc,1,5
Pla´cido Llaneza, MD, PhD,6
and for The MARIA (MenopAuse RIsk Assessment) Research Group
Abstract
Objective: This study aims to assess resilience, depressed mood, and menopausal symptoms in postmenopausal
women.
Methods: In this cross-sectional study, 169 postmenopausal women aged 48 to 68 years were asked to fill out the
Wagnild and Young Resilience Scale (WYRS), the Center for Epidemiologic Studies Depression Scale (CESD-10),
the Menopause Rating Scale (MRS), and a questionnaire containing personal and partner sociodemographic data.
Results: The median [interquartile range] age of participating women was 54 [10.0] years. Among the women,
55.6% had increased body mass index, 76.9% had a partner, 17.8% were current smokers, 14.2% had hypertension,
25.4% used psychotropic drugs, and 13.0% used hormone therapy. Forty-five percent of the women had depressed
mood (CESD-10 scores Q10), and 34.9% had severe menopausal symptoms (total MRS scores Q17). Less resilience
(lower WYRS scores) correlated with depressed mood (higher CESD-10 scores) and severe menopausal symptoms
(higher total, psychological, and urogenital MRS scores). Multiple linear regression analysis determined that WYRS
scores positively correlated with exercising regularly and inversely correlated with CESD-10 scores (depressed
mood). CESD-10 scores positively correlated with somatic and psychological MRS subscale scores and inversely
correlated with WYRS scores (less resilience).
Conclusions: In this postmenopausal sample, depressed mood and participation in regular exercise correlate with
lower and higher resilience, respectively. Depressed mood is associated with the severity of menopausal symptoms
(somatic and psychological).
Key Words: Postmenopausal women Y Depressive mood Y Resilience Y Menopausal symptoms Y Center for
Epidemiologic Studies Depression Scale Y Wagnild and Young Resilience Scale Y Menopause Rating Scale.
M
enopausal transition is a time when physical, psy-
chological, and social value changes take place, in
turn affecting women_s health. Despite this, the
importance of comorbid conditions and individual personali-
ties is still not clear.1<3
Psychological resilience is an indi-
vidual_s capacity to prevent, minimize, or overcome stressful
situations imposed by life adversity.4<7
It is a measure of how
individuals cope with, overcome, or become positively
strengthened by changes and challenges.8,9
Resilience is piv-
otal to healthy aging, maintains well being, and has been
correlated with mortality and longevity.10
Women who dis-
play higher resilience may in fact have fewer menopausal
complaints.11
Furthermore, complex relationships between de-
pressive symptoms and resilience exist. Resilience, life satis-
faction, perceived stress, and feelings of loneliness are not
routinely included in tools designed to assess menopausal
symptoms and related quality of life. These tools tend to spe-
cifically address symptom frequency and severity, and physical
and emotional aspects among perimenopausal or postmeno-
pausal women, as compared with premenopausal women
serving as controls.12<17
Although resilience is important for coping with meno-
pause, updated studies assessing resilience, depressive symp-
toms, and menopausal symptoms, specifically in postmenopausal
women, are still limited.5,11,18
Therefore, the aim of the present
study was to assess resilience, depressed mood, and meno-
pausal symptoms among postmenopausal women.
Received February 4, 2013; revised and accepted March 25, 2013.
From the 1
Red de Investigacio´n en Ginecologı´a, Obstetricia y Reproduccio´n,
Zaragoza, Spain; 2
Departamento de Obstetricia y Ginecologı´a, Universidad
de Zaragoza, Zaragoza, Spain; 3
Departamento de Obstetricia y Ginecologı´a,
Hospital de Cabuen˜es, Gijo´n, Asturias, Spain; 4
Departamento de Obstetricia
y Ginecologı´a, Hospital Torreca´rdenas, Almerı´a, Spain; 5
Instituto de
Biomedicina, A´ rea de Investigacio´n para la Salud de la Mujer, Facultad de
Ciencias Me´dicas, Universidad Cato´lica de Santiago de Guayaquil, Gua-
yaquil, Ecuador; and 6
Departamento de Obstetricia y Ginecologı´a, Hospital
Central de Asturias, Universidad de Oviedo, Oviedo, Spain.
Funding/support: None.
Financial disclosure/conflicts of interest: None reported.
Address correspondence to: Faustino R. Pe´rez-Lo´pez, MD, PhD, De-
partment of Obstetrics and Gynecology, University of Zaragoza Hos-
pital Clı´nico, Domingo Miral s/n, Zaragoza 50009, Spain. E-mail:
faustino.perez@unizar.es
Menopause, Vol. 21, No. 2, 2014 159
Copyright © 2014 The North American Menopause Society. Unauthorized reproduction of this article is prohibited.
METHODS
Study design and participants
This was a cross-sectional study carried out at the Asturias
Central University Hospital (Oviedo, Spain) and the Cabuen˜es
Hospital (Gijo´n, Spain), both affiliated with the University
of Oviedo (Oviedo, Spain), where postmenopausal women
(48-68 y) attending the outpatient clinics for their annual gyne-
cological checkup were asked to fill out an itemized general
questionnaire (personal and partner sociodemographic data),
the Wagnild and Young Resilience Scale (WYRS), the Center
for Epidemiologic Studies Depression Scale (CESD-10), and
the Menopause Rating Scale (MRS).16,19<24
Participants were
informed of the study and its objectives. Those who chose to
participate provided a written informed consent form. Women
who were unable to verbalize an adequate understanding of
the study, did not provide consent for participation, or had
psychological or physical incapacity imposing difficulties
during the interview were excluded. This research protocol
was reviewed and approved by the Asturias Ethical Commit-
tee (Oviedo, Spain).
General survey
The general questionnaire collected the following data on
women: age, parity, marital and partner status, educational
level, place of residency, current height and weight (to calculate
body mass index [BMI]), engagement in regular exercise
(yes/no), time since menopause, surgical menopause status,
smoking habit, hypertension, and use of hormone therapy
(HT), psychotropic drugs, or sleep-aiding drugs. Postmeno-
pause status was defined as amenorrhea in the past 12 months
or bilateral oophorectomy (surgical menopause). BMI was
calculated as body weight (kg) divided by height (m) squared
and categorized as low (G18.5 kg/m2
), normal (18.5-24.9 kg/m2
),
or high (Q25 kg/m2
). Women with high BMI were further cate-
gorized as overweight (25-29.99 kg/m2
) or obese (Q30 kg/m2
).25
Data related to the partner were provided by the participating
women and included age, educational level, engagement in
regular exercise (yes/no), alcohol abuse, and presence of
sexual dysfunction (erectile dysfunction, premature ejacula-
tion, or both).
Wagnild and Young Resilience Scale
The WYRS is a 14-item Likert-type scale used to assess
resilience status in various age groups and under different
conditions. Each item can be graded from B1[ (strongly dis-
agree) to B7[ (strongly agree).20,21
Graded items are summed
up to provide a total score. Although no cutoff value is
available to define abnormality, lower scores are indicative of
less resilience.
Center for Epidemiologic Studies Depression Scale
CESD-10 is a 10-item questionnaire used to assess how in-
dividuals felt during the past week. This is a short version of
the 20-item CESD tool.22<24
Each item can be graded according
to a Likert scale: 0, rarely or none of the time (G1 d); 1, some
or a little of the time (1-2 d); 2, occasionally or a moderate
amount of time (3-4 d); 3, all the time (5-7 d). Items 5 and
8 are scored inversely. All graded items are summed up to
provide a total score. Scores of 10 or greater were used to de-
fine depressed mood.23,24
Menopause Rating Scale
The MRS assesses the presence and severity of menopausal
symptoms through 11 items grouped into three subscales: so-
matic, psychological, and urogenital. Each item can be graded
as 0 (not present), 1 (mild), 2 (moderate), 3 (severe), or 4 (very
severe). Graded items within each subscale are summed up to
provide a total subscale score. The total MRS score is the sum
of subscale scores.16,19
A total MRS score of 17 or more is
defined as severe.
Sample size calculation
A minimal sample size of 160 participants was calculated,
assuming that 40% of participating women would present
lower resilience,11,19,20
with a 10% desired precision and a
99% confidence level.
Statistical methods
Predictive Analytics Software version 17 (SPSS Inc,
Chicago, IL) was used to perform the analyses. Data are
presented as mean (SD), median [interquartile range], percen-
tiles (25th-75th), percentages, coefficients, and 95% CI. The
internal consistency of the instruments used (WYRS, CESD-10,
and MRS) was assessed by computing Cronbach_s > co-
efficients. Kolmogorov-Smirnov test was used to determine the
normality of data distribution. According to this, nonparametric
continuous data were compared with Mann-Whitney U test
(two independent samples) or Kruskal-Wallis test (various in-
dependent samples). Student_s t test or analysis of variance was
used for parametric comparisons.
Spearman_s Q coefficients were calculated to determine
correlations between WYRS, CESD-10, and MRS scores and
various numeric variables (bivariate analysis). Multiple linear
regression analysis was performed to obtain two independent
models: the first model analyzes variables correlating with
WYRS scores (resilience, dependent variable), and the second
model analyzes variables correlating with CESD-10 scores
(depressed mood, dependent variable). These models were
constructed from independent variables (woman and partner)
achieving P e 0.10 during bivariate analysis. Entry of variables
into the models was performed using a forward/backward
stepwise procedure. For all calculations, P G 0.05 was con-
sidered statistically significant.
RESULTS
During the study period, a total of 205 postmenopausal
women were invited to participate. Eleven (5.4%) declined
participation, and 25 (12.2%) provided incomplete data. Hence,
169 women provided complete data for statistical analysis.
The general characteristics of the participants and their part-
ners are depicted in Table 1. The median [interquartile range]
age of participating women was 54 years [10], with 82.8%
residing in urban areas, 33.1% completing primary education,
75.1% being married, and 76.9% currently having a partner.
160 Menopause, Vol. 21, No. 2, 2014 * 2013 The North American Menopause Society
PE´REZ-LO´PEZ ET AL
Copyright © 2014 The North American Menopause Society. Unauthorized reproduction of this article is prohibited.
Regarding general health, 14.2% had hypertension, 55.6% had
increased BMI (overweight or obese), and 33.1% engaged in
regular exercise. Comorbidity, including gastric reflux, hypo-
thyroidism, and dyslipidemia (the three most frequent), was
present in 29.0% of women (data not shown in Table 1).
Among the women, 10.7% had surgical menopause, and
13.0% and 25.4% were taking HT and psychotropic drugs,
respectively. In addition, severe menopausal symptoms and
depressed mood were present in 34.9% and 45.0% of women,
respectively.
Data on men were available for 76.9% of women who
stated that they currently have a partner (n = 100/130). The
median [interquartile range] age was 59 years [7.0]. Twenty-
five percent of the women exercised regularly, 3.0% abused
alcohol, and 39.0% had primary education only. Erectile
dysfunction was present in 17.0%, and premature ejaculation
was present in 3.0%.
A descriptive analysis of MRS, WYRS, and CESD-10 scores
is depicted in Table 2. The computed Cronbach_s > coeffi-
cients for CESD-10, WYRS, and MRS were 0.813, 0.893, and
0.849, respectively. Spearman_s Q coefficients between tools
(CESD-10, WYRS, and MRS) and other numeric variables are
depicted in Table 3. There was a significant inverse correlation
between WYRS scores and depressed mood (higher CESD-10
scores) and severe menopausal symptoms (higher total, psy-
chological subscale, and urogenital subscale MRS scores).
There was also a positive correlation between CESD-10 scores
(more depressed mood) and MRS scores (total score and all
subscale scores).
Multiple linear regression analysis was used to obtain two
final reduced best-fit models displaying variables correlating
with WYRS and CESD-10 scores (Table 4). In the first model
(explaining 22.7% of the total variance), WYRS scores in-
versely correlated with depressed mood and positively corre-
lated with women_s regular exercise. In the second model
(explaining 53.2% of the total variance), CESD-10 scores
positively correlated with somatic and psychological MRS
scores and inversely correlated with WYRS scores.
DISCUSSION
The present study aimed to assess resilience in a sample of
postmenopausal women and to establish correlations with de-
pressed mood and menopausal symptoms after controlling for
several sociodemographic factors. The tools used in our study
have been widely validated under different conditions in other
studies, displaying high internal consistencies,5,6,11,16,20<24,26,27
in correlation with our results.
Severe menopausal symptoms (as assessed with the MRS)
were present in one third of the participating women, despite
the relatively low rate of HT use (13%). HT use is particularly
infrequent among Spanish women and those from other re-
gions. This occurred basically because of the negative infor-
mation on HT disseminated in the last decade after the
publication of the Women_s Health Initiative trial results.19,27,28
Three validated instruments were used in the present research
to render a more profound understanding of menopause-related
resilience. Overall, upon bivariate analysis, WYRS scores
displayed significant correlations with depressive scores and all
MRS scores (except for the somatic subscale). Depressive
scores correlated with resilience scores and all MRS subscale
scores (Table 3).
Resilience is the ability to be reinforced after overcoming
life difficulties or stressing events. This ability has genetic,
TABLE 1. General characteristics of the participants
and their partners
Parameters
Women (n = 169)
Age, y 54.0 [10.0]
e50 55 (32.5)
51-55 45 (26.6)
56-60 40 (23.7)
960 29 (17.2)
Parity 2.0 [1.0]
Nulliparous 33 (19.5)
1-2 114 (67.5)
Q3 22 (13.0)
Marital status
Married 127 (75.1)
Single 17 (10.1)
Widowed 9 (5.3)
Divorced 13 (7.7)
Cohabiting 3 (1.8)
Currently has a partner 130 (76.9)
Highest educational level achieved
Primary school 56 (33.1)
High school 77 (45.6)
University 36 (21.3)
Urban residency 140 (82.8)
Body mass index, kg/m2
25.1 [5.9]
Low 2 (1.2)
Normal 73 (43.2)
Overweight 63 (37.3)
Obese 31 (18.3)
Engages in regular exercise 56 (33.1)
Current smoker 30 (17.8)
Hypertension 24 (14.2)
Time since menopause onset, y 3.0 [8.0]
G5 92 (54.4)
5-7 77 (45.6)
Q8 45 (26.6)
Surgical menopause 18 (10.7)
Depressed mood (CESD-10 score Q10) 76 (45)
Severe menopausal symptoms (total MRS score Q17) 59 (34.9)
Current use of HT 22 (13.0)
Current use of psychotropic drugs 43 (25.4)
Current use of sleep-aiding drugs 64 (37.9)
Partner data (n = 100)
Age, y 59.0 [7.0]
e50 5 (5.0)
51-55 21 (21.0)
56-60 35 (35.0)
61-65 29 (29.0)
965 10 (10.0)
Highest educational level achieved
Primary school 39 (39.0)
High school 44 (44.0)
University 17 (17.0)
Engages in regular exercise 25 (25.0)
Alcohol abuse 3 (3.0)
Erectile dysfunction 17 (17.0)
Premature ejaculation 3 (3.0)
Data are presented as n (%) or median [interquartile range].
CESD-10, Center for Epidemiologic Studies Depression Scale; MRS, Meno-
pause Rating Scale; HT, hormone therapy.
Menopause, Vol. 21, No. 2, 2014 161
RESILIENCE IN POSTMENOPAUSAL WOMEN
Copyright © 2014 The North American Menopause Society. Unauthorized reproduction of this article is prohibited.
neural, health, learning, economic, stress, and social compo-
nents.3<6,11,18,29,30
Menopausal transition is a long process that
is lived, in many cases, with negative feelings and lack of
support. Therefore, a resilient woman can better cope with
adversity. However, assessing all the components of resilience
is not easy. Many tools assess indirect measures of resil-
ience such as self-esteem, sense of coherence, loneliness, or
happiness.26,30<32
The WYRS, on the other hand, displays
high measures of consistency and correlation with life satis-
faction scales.4,20,21
Few studies have analyzed resilience in middle-aged women,
specifically postmenopausal women. In a large female German
sample (18-92 y), life satisfaction was associated with younger
age, resilience, employment status, higher household income,
having a partner, lack of anxiety and depression, good self-
esteem, and religious affiliation.5
In this population, there was a
significant reduction of resilience between the ages of 61 and
70 years (most pronounced after 70 y). Resilience positively
correlated with life satisfaction and self-esteem and inversely
correlated with anxiety and depression.
In a previous study of middle-aged Ecuadorian women,
lower WYRS scores (less resilience) correlated with more se-
vere hot flushes.11
Duffy et al18
studied factors associated with
resilience and vulnerability to hot flushes and night sweats
during the menopausal transition in a female Scottish sample.
Women resilient to hot flushes had previously not been both-
ered by their menstrual periods, did not experience somatic
symptoms or night sweats, and perceived their symptoms
as having low consequences on their lives. Those vulnerable
to hot flushes had children, had high BMI, reported night
sweats, and perceived their symptoms as having high life
consequences. Women resilient to night sweats were non-
smokers, did not have sleep difficulties, were not treated for
psychological symptoms, and perceived their menopausal symp-
toms as having low life consequences. Those vulnerable to night
sweats had lower education, had previously been bothered by
their menstrual periods, had below-average physical health,
reported musculoskeletal symptoms and hot flushes, and per-
ceived their menopausal symptoms as having high life con-
sequences. In our study, although WYRS scores displayed
significant bivariate correlations with all MRS scores (except
for the somatic subscale), no correlation was found between
WYRS scores and any of the MRS scores, interestingly, after
multivariate linear regression analysis.
CESD-10 is a validated instrument for detecting depressed
mood, which accounted for 45.0% of our postmenopausal
population. Our multivariate analysis found that resilience
was inversely related to depressive mood (higher CESD-10
scores) and positively related to exercising regularly. Reports
indicate that the prevalence of depression is higher in women
than in men and tends to increase as women age. The causal
role of this increaseVwhether related to age, progressive
hormonal decrease, or bothVis still a matter of controversy.33
Using the long version of CESD in an 8-year longitudinal
study, Freeman et al34
demonstrated that total CESD scores of
16 or higher (depressed mood) and depressive disorders were,
respectively, 4 and 2.5 times more likely to occur during the
menopausal transition as compared with the premenopausal
years. In a middle-aged and multiethnic female sample, Woods
and Mitchell35
used CESD and other tools to develop a multi-
dimensional model for explaining depressed mood. Three as-
pects were identified as correlating with depressed mood:
TABLE 2. Descriptive analysis of MRS, WYRS, and CESD-10 scores (n = 169)
MRS (> = 0.849)a
WYRS (> = 0.893)a
CESD-10 (> = 0.813)a
Total Somatic Psychological Urogenital
Mean 13.9 5.3 5.1 3.4 77.7 9.3
Median 13.0 5.0 5.0 3.0 79.0 8.0
25th-75th percentiles 8.0-19.0 3.0-7.0 2.0-7.0 1.0-5.0 70.0-87.0 5.0-12.5
Interquartile range 11.0 4.0 5.0 4.0 17.0 7.5
MRS, Menopause Rating Scale; WYRS, Wagnild and Young Resilience Scale; CESD-10, Center for Epidemiologic Studies Depression Scale.
a
Values in parentheses represent the computed Cronbach’s > coefficient for the scale.
TABLE 3. Spearman_s Q coefficients obtained between tool scores and various numeric variables
WYRS CESD-10
MRS
Total Somatic Psychological Urogenital
Age j0.069 0.065 0.177 0.252 0.086 0.146
P 0.370 0.404 0.021 0.001 0.267 0.058
Parity 0.059 0.031 0.107 0.135 0.007 0.142
P 0.449 0.689 0.165 0.079 0.927 0.065
Body mass index j0.069 0.133 0.107 0.166 0.101 j0.007
P 0.371 0.085 0.166 0.031 0.190 0.932
WYRS Y j0.432 j0.248 j0.143 j0.295 j0.157
P G0.001 0.001 0.063 G0.001 0.042
CESD-10 Y Y 0.610 0.487 0.642 0.346
P G0.001 G0.001 G0.001 G0.001
WYRS, Wagnild and Young Resilience Scale; CESD-10, Center for Epidemiologic Studies Depression Scale; MRS, Menopause Rating Scale.
162 Menopause, Vol. 21, No. 2, 2014 * 2013 The North American Menopause Society
PE´REZ-LO´PEZ ET AL
Copyright © 2014 The North American Menopause Society. Unauthorized reproduction of this article is prohibited.
menopausal transition, health status, and stressful life context.
The latter was considered the most important factor, whereas
health status had a direct effect and an indirect effect through
stress, and menopausal changes had low explanatory power. A
large number of neurobiological and psychosocial factors are
associated with depression and resilience. Positive psychoso-
cial factors, such as optimism, humor, cognitive flexibility, so-
cial support, role models, coping style, and capacity to recover,
are reduced in depressed individuals, which may explain the
inverse correlation between resilience and depression found in
our study. It is probable that neurobiological changes associated
with depressive mood may secondarily affect resilience capac-
ity36
orVseen the other way aroundVthat less resilient persons
may be more vulnerable to developing depression. Further
research may indeed give insights into determining which is
cause and which is consequence. Cognitive vulnerable indivi-
duals have a severe risk of losing resilience because of de-
pression, whereas social support and positive life events may
enhance their resilience.35
Therefore, cognitive education aimed
at highlighting positive experiences during menopause may
boost resilience. It is interesting to recall that our population
displayed comorbid conditions (hypertension and sleep disor-
ders) that may also contribute to the alteration of the neuro-
biology of resilience and depression in labile women. A stressful
life context and associated issues may be important determi-
nants of depressed mood. It has been reported that bad health
status has a direct effect on mood and an indirect effect on per-
ceived stress, whereas menopausal changes have low power at
explaining depressive mood.33,35
Our regression model found that women who exercised
regularly displayed higher resilience. In one study, low spiri-
tuality among individuals with depression and anxiety was
revealed as a leading predictor of lower resilience, and less
frequent exercise was associated with moderate resilience.37
Our results seem to suggest that exercising may contribute to
increased resilience and may improve treatment response
among those who display depressed mood. This may in fact
be true for those women who display higher BMI (who may
engage in less exercises). Unfortunately, our regression model
did not find a correlation between resilience and depressive
scores and BMI. Nevertheless, we have previously reported11
that women with higher abdominal circumference (obesity)
display lower resilience. Hence, in this high-risk group, ex-
ercise may have a positive impact on mood and resilience. In
any case, further studies are needed to delineate the separate
influences of exercise intensity and exercise-related body
changes associated with both depressed mood and resilience.
The regression model for CESD-10 scores in our study found
a significant and positive correlation between depressive scores
and menopausal somatic and psychological symptoms. This is
in agreement with our previous research in which middle-aged
women (premenopausal, perimenopausal, and postmenopausal)
displayed a high prevalence of depressed mood in correlation
with more severe menopausal symptoms (somatic and psycho-
logical) assessed with the same MRS.38
It is very well known
that estradiol deprivation in postmenopausal women may in-
crease depressive39
and menopausal1,2,28
symptoms.
Finally, the cross-sectional design, which does not allow for
the determination of causality for neither resilience nor de-
pressed mood, is a limitation of this study. Although surveying
only postmenopausal women does not allow for an analysis of
the effects of age or menopause status on resilience or depres-
sion status, selecting them (who may in fact be consulting for
morbidity) from a gynecological outpatient service or a single
Spanish site does not allow for a generalization of results to the
rest of the Spanish population. Other potential drawbacks in-
clude not assessing exercise intensity and finding moderate
Q values upon bivariate analysis. Despite all the aforementioned
limitations, there have been few reports addressing resilience
during the menopausal transition and even fewer studies
reporting specifically on postmenopausal women. Hence, to the
best of our knowledge, the present study seems to be among the
few studies reported to date.
More studies that analyze psychosocial and sociodemographic
factors, using resilience scales, among middle-aged women
(including premenopausal, perimenopausal, and postmeno-
pausal women) are needed.
CONCLUSIONS
In this postmenopausal female sample, depressed mood and
participation in regular exercise correlate with lower and higher
resilience, respectively. Depressed mood is associated with the
severity of menopausal symptoms, specifically somatic and
psychological symptoms. Although these correlations do not
explain causality, they do, however, highlight the need to in-
clude resilience, mood, and other life satisfaction aspects in the
design of future tools assessing menopausal symptoms.
TABLE 4. Factors correlating with WYRS and CESD-10 scores: multiple linear regression analysis
Factors A SE 95% CI t P
Model for WYRS scores (n = 169)
Total CESD-10 score j0.911 0.148 j1.204 to j0.617 j6.133 G0.001
Regular exercise 2.439 0.984 0.496 to 4.382 2.478 0.014
r2
= 0.237; adjusted r2
= 0.227; P = 0.014
Model for CESD-10 scores (n = 169)
Total WYRS score j0.130 0.026 j0.181 to j0.079 j5.007 G0.001
MRS somatic score 0.463 0.141 0.184 to 0.741 3.280 0.001
MRS psychological score 0.752 0.117 0.521 to 0.982 6.422 G0.001
r2
= 0.541; adjusted r2
= 0.532; P G 0.001
WYRS, Wagnild and Young Resilience Scale; CESD-10, Center for Epidemiologic Studies Depression Scale; MRS, Menopause Rating Scale.
Menopause, Vol. 21, No. 2, 2014 163
RESILIENCE IN POSTMENOPAUSAL WOMEN
Copyright © 2014 The North American Menopause Society. Unauthorized reproduction of this article is prohibited.
REFERENCES
1. Pe´rez-Lo´pez FR. The Menopause. Madrid, Spain: Temas de Hoy, 1992.
2. Greer G. The Change. Women, Ageing and the Menopause. London,
England: Penguin Book, 1992.
3. Castelo-Branco C, Palacios S, Ferrer-Barriendos J, et al. Cervantes Study
Group. Understanding how personality factors may influence quality of
life: development and validation of the Cervantes Personality Scale.
Menopause 2008;15:914-918.
4. Grotberg E. Countering depression with the five building blocks of re-
silience. Reach Today_s Youth 1999;4:66-72.
5. Beutel ME, Glaesmer H, Decker O, Fischbeck S, Bra¨hler E. Life satis-
faction, distress, and resiliency across the life span of women. Menopause
2009;16:1132-1138.
6. Beutel ME, Glaesmer H, Wiltink J, Marian H, Bra¨hler E. Life satisfac-
tion, anxiety, depression and resilience across the life span of men. Aging
Male 2010;13:32-39.
7. Harville EW, Xiong X, Buekens P, Pridjian G, Elkind-Hirsch K. Resil-
ience after Hurricane Katrina among pregnant and postpartum women.
Womens Health Issues 2010;20:20-27.
8. Boukydis Z. Ultrasound consultation to reduce risk and increase resil-
ience in pregnancy. Ann N Y Acad Sci 2006;1094:268-271.
9. Erdem G, Slesnick N. That which does not kill you makes you stronger:
runaway youth_s resilience to depression in the family context. Am J
Orthopsychiatry 2010;80:195-203.
10. Walter-Ginzburg A, Shmotkin D, Blumstein T, Shorek A. A gender-
based dynamic multidimensional longitudinal analysis of resilience and
mortality in the old-old in Israel: the Cross-Sectional and Longitudinal
Aging Study (CALAS). Soc Sci Med 2005;60:1705-1715.
11. Chedraui P, Pe´rez-Lo´pez FR, Schwager G, et al. Resilience and related
factors during female Ecuadorian mid-life. Maturitas 2012;72:152-156.
12. Hilditch JR, Lewis J, Peter A, et al. A menopause-specific quality of
life questionnaire: development and psychometric properties. Maturitas
1996;24:161-175.
13. Greene JG. Constructing a standard climacteric scale. Maturitas 1998;29:25-31.
14. Utian WH, Janata JW, Kingsberg SA, Schluchter M, Hamilton JC. The
Utian Quality of Life (UQOL) Scale: development and validation of an
instrument to quantify quality of life through and beyond menopause.
Menopause 2002;9:402-410.
15. Matthews KA, Bromberger JT. Does the menopausal transition affect
health-related quality of life? Am J Med 2005;118:25-36.
16. Heinemann LA, Potthoff P, Schneider HP. International versions of the
Menopause Rating Scale (MRS). Health Qual Life Outcomes 2003;1:28.
17. Monterrosa-Castro A, Romero-Pe´rez I, Marrugo-Flo´rez M, Ferna´ndez-
Alonso AM, Chedraui P, Pe´rez-Lo´pez FR. Quality of life in a large cohort
of mid-aged Colombian women assessed using the Cervantes Scale.
Menopause 2012;19:924-930.
18. Duffy OK, Iversen L, Aucott L, Hannaford PC. Factors associated with
resilience or vulnerability to hot flushes and night sweats during the
menopausal transition [published online ahead of print December 17,
2012]. Menopause.
19. Cuadros JL, Ferna´ndez-Alonso AM, Cuadros-Celorrio AM, et al; Men-
opAuse RIsk Assessment (MARIA) Research Group. Perceived stress,
insomnia and related factors in women around the menopause. Maturitas
2012;72:367-372.
20. Wagnild G, Young H. Development and psychometric evaluation of the
Resilience Scale. J Nurs Meas 1993;1:165-178.
21. The Resilience Scale. Available at: https://www.resiliencescale.com/
index.html. Accessed December 23, 2012.
22. Radloff LS. The CES-D scale: a self-report depression scale for research
in the general population. Appl Psychol Meas 1977;1:385-401.
23. Andresen EM, Malmgren JA, Carter WB, Patrick DL. Screening for de-
pression in well older adults: evaluation of a short form of the CES-D
(Center for Epidemiologic Studies Depression Scale). Am J Prev Med
1994;10:77-84.
24. Irwin M, Artin KH, Oxman MN. Screening for depression in the older
adult. Criterion validity of the 10-item Center for Epidemiological Studies
Depression Scale (CES-D). Arch Intern Med 1999;159:1701-1704.
25. WHO. Physical status: the use and interpretation of anthropometry. WHO
Technical Report Series 854, Geneva, Switzerland: World Health Orga-
nization, 1995.
26. Salazar-Pousada D, Arroyo D, Hidalgo L, Pe´rez-Lo´pez FR, Chedraui P.
Depressive symptoms and resilience among pregnant adolescents: a case-
control study. Obstet Gynecol Int 2010;2010:952493.
27. Ferna´ndez-Alonso AM, Trabalo´n-Pastor M, Vara C, Chedraui P, Pe´rez-
Lo´pez FR; ; MenopAuse RIsk Assessment (MARIA) Research Group.
Life satisfaction, loneliness and related factors during female midlife.
Maturitas 2012;72:88-92.
28. Nelson HD, Walker M, Zakher B, Mitchell J. Menopausal hormone
therapy for the primary prevention of chronic conditions: a systematic
review to update the U.S. Preventive Services Task Force recommenda-
tions. Ann Intern Med 2012;157:104-113.
29. Franklin TB, Saab BJ, Mansuy IM. Neural mechanisms of stress resil-
ience and vulnerability. Neuron 2012;75:747-761.
30. Serrano-Parra MD, Garrido-Abejar M, Notario-Pacheco B, Bartolome´-
Gutie´rrez R, Solera-Martı´nez M, Martı´nez-Vizcaı´no V. Validity of the
Connor-Davidson Resilience Scale (10 items) in a population of elderly.
Enferm Clin 2013;23:14-21.
31. Svartvik L, Lidfeldt J, Nerbrand C, Samsioe G, Scherste´n B, Nilsson PM.
Dyslipidaemia and impaired well-being in middle-aged women reporting
low sense of coherence. The Women_s Health in the Lund Area (WHLA)
Study. Scand J Prim Health Care 2000;18:177-182.
32. Marttila A, Johansson E, Whitehead M, Burstro¨m B. Keep going in
adversityVusing a resilience perspective to understand the narratives of
long-term social assistance recipients in Sweden. Int J Equity Health
2013;12:8.
33. Llaneza P, Garcı´a-Portilla MP, Llaneza-Sua´rez D, Armott B, Pe´rez-
Lo´pez FR. Depressive disorders and the menopause transition. Maturitas
2012;71:120-130.
34. Freeman EW, Sammel MD, Lin H, Nelson DB. Associations of hor-
mones and menopausal status with depressed mood in women with no
history of depression. Arch Gen Psychiatry 2006;63:375-382.
35. Woods NF, Mitchell ES. Pathways to depressed mood for midlife
women: observations from the Seattle Midlife Women_s Health Study.
Res Nurs Health 1997;20:119-129.
36. Southwick SM, Vythilingam M, Charney DS. The psychobiology of
depression and resilience to stress: implications for prevention and
treatment. Annu Rev Clin Psychol 2005;1:255-291.
37. Min JA, Jung YE, Kim DJ, et al. Characteristics associated with low
resilience in patients with depression and/or anxiety disorders. Qual Life
Res 2013;22:231-241.
38. Chedraui P, Pe´rez-Lo´pez FR, Morales B, Hidalgo L. Depressive symp-
toms in climacteric women are related to menopausal symptom intensity
and partner factors. Climacteric 2009;12:395-403.
39. Colangelo LA, Craft LL, Ouyang P, et al. Association of sex hormones
and sex hormoneYbinding globulin with depressive symptoms in post-
menopausal women: the Multiethnic Study of Atherosclerosis. Meno-
pause 2012;19:877-885.
164 Menopause, Vol. 21, No. 2, 2014 * 2013 The North American Menopause Society
PE´REZ-LO´PEZ ET AL
Copyright © 2014 The North American Menopause Society. Unauthorized reproduction of this article is prohibited.

Weitere ähnliche Inhalte

Was ist angesagt?

When cherished beliefs clash with evidence
When cherished beliefs clash with evidenceWhen cherished beliefs clash with evidence
When cherished beliefs clash with evidenceJames Coyne
 
Carle Palliative Care Journal Club for 7/3/18
Carle Palliative Care Journal Club for 7/3/18Carle Palliative Care Journal Club for 7/3/18
Carle Palliative Care Journal Club for 7/3/18Mike Aref
 
Disorganized Diseases: Are they a Simple Explosion of Random Energy and there...
Disorganized Diseases: Are they a Simple Explosion of Random Energy and there...Disorganized Diseases: Are they a Simple Explosion of Random Energy and there...
Disorganized Diseases: Are they a Simple Explosion of Random Energy and there...asclepiuspdfs
 
Infertility corrected
Infertility correctedInfertility corrected
Infertility correctedjesse105
 
Palliative Care in TBI
Palliative Care in TBIPalliative Care in TBI
Palliative Care in TBIMike Aref
 
Proposed Beneficial Effects of Cardiac Coherence Training on Gestational Hype...
Proposed Beneficial Effects of Cardiac Coherence Training on Gestational Hype...Proposed Beneficial Effects of Cardiac Coherence Training on Gestational Hype...
Proposed Beneficial Effects of Cardiac Coherence Training on Gestational Hype...CrimsonpublishersNTNF
 
Fricchione psychosomatic medicine in mental health
Fricchione psychosomatic medicine in mental healthFricchione psychosomatic medicine in mental health
Fricchione psychosomatic medicine in mental healthjasonharlow
 
Efficacy of individualized homeopathic treatment and fluoxetine for moderate ...
Efficacy of individualized homeopathic treatment and fluoxetine for moderate ...Efficacy of individualized homeopathic treatment and fluoxetine for moderate ...
Efficacy of individualized homeopathic treatment and fluoxetine for moderate ...home
 
LRI05 - Self Help for Distress in Cancer - Is It Time For An RCT [Oct 2005]
LRI05 - Self Help for Distress in Cancer - Is It Time For An RCT [Oct 2005]LRI05 - Self Help for Distress in Cancer - Is It Time For An RCT [Oct 2005]
LRI05 - Self Help for Distress in Cancer - Is It Time For An RCT [Oct 2005]Alex J Mitchell
 

Was ist angesagt? (17)

Scientific Journal of Depression & Anxiety
Scientific Journal of Depression & AnxietyScientific Journal of Depression & Anxiety
Scientific Journal of Depression & Anxiety
 
Scientifi c Journal of Depression & Anxiety
Scientifi c Journal of Depression & AnxietyScientifi c Journal of Depression & Anxiety
Scientifi c Journal of Depression & Anxiety
 
corrected NRS 452
corrected NRS 452corrected NRS 452
corrected NRS 452
 
Weissman_GerPsych
Weissman_GerPsychWeissman_GerPsych
Weissman_GerPsych
 
When cherished beliefs clash with evidence
When cherished beliefs clash with evidenceWhen cherished beliefs clash with evidence
When cherished beliefs clash with evidence
 
Carle Palliative Care Journal Club for 7/3/18
Carle Palliative Care Journal Club for 7/3/18Carle Palliative Care Journal Club for 7/3/18
Carle Palliative Care Journal Club for 7/3/18
 
Communicating risk
Communicating riskCommunicating risk
Communicating risk
 
Personality, Attitude and Cancer
Personality, Attitude and CancerPersonality, Attitude and Cancer
Personality, Attitude and Cancer
 
International Journal of Reproductive Medicine & Gynecology
International Journal of Reproductive Medicine & GynecologyInternational Journal of Reproductive Medicine & Gynecology
International Journal of Reproductive Medicine & Gynecology
 
Disorganized Diseases: Are they a Simple Explosion of Random Energy and there...
Disorganized Diseases: Are they a Simple Explosion of Random Energy and there...Disorganized Diseases: Are they a Simple Explosion of Random Energy and there...
Disorganized Diseases: Are they a Simple Explosion of Random Energy and there...
 
Infertility corrected
Infertility correctedInfertility corrected
Infertility corrected
 
May 2019 – Cancer and Trauma Webinar
May 2019 – Cancer and Trauma Webinar May 2019 – Cancer and Trauma Webinar
May 2019 – Cancer and Trauma Webinar
 
Palliative Care in TBI
Palliative Care in TBIPalliative Care in TBI
Palliative Care in TBI
 
Proposed Beneficial Effects of Cardiac Coherence Training on Gestational Hype...
Proposed Beneficial Effects of Cardiac Coherence Training on Gestational Hype...Proposed Beneficial Effects of Cardiac Coherence Training on Gestational Hype...
Proposed Beneficial Effects of Cardiac Coherence Training on Gestational Hype...
 
Fricchione psychosomatic medicine in mental health
Fricchione psychosomatic medicine in mental healthFricchione psychosomatic medicine in mental health
Fricchione psychosomatic medicine in mental health
 
Efficacy of individualized homeopathic treatment and fluoxetine for moderate ...
Efficacy of individualized homeopathic treatment and fluoxetine for moderate ...Efficacy of individualized homeopathic treatment and fluoxetine for moderate ...
Efficacy of individualized homeopathic treatment and fluoxetine for moderate ...
 
LRI05 - Self Help for Distress in Cancer - Is It Time For An RCT [Oct 2005]
LRI05 - Self Help for Distress in Cancer - Is It Time For An RCT [Oct 2005]LRI05 - Self Help for Distress in Cancer - Is It Time For An RCT [Oct 2005]
LRI05 - Self Help for Distress in Cancer - Is It Time For An RCT [Oct 2005]
 

Andere mochten auch

Andere mochten auch (8)

Adult combined-schedule
Adult combined-scheduleAdult combined-schedule
Adult combined-schedule
 
Piis074937970300120 x
Piis074937970300120 xPiis074937970300120 x
Piis074937970300120 x
 
In vivo assessment of the biomechanical properties of the uterine
In vivo assessment of the biomechanical properties of the uterineIn vivo assessment of the biomechanical properties of the uterine
In vivo assessment of the biomechanical properties of the uterine
 
Association between obstetrician_forceps_volume.5
Association between obstetrician_forceps_volume.5Association between obstetrician_forceps_volume.5
Association between obstetrician_forceps_volume.5
 
Satisfaction in patients_undergoing_concurrent.5
Satisfaction in patients_undergoing_concurrent.5Satisfaction in patients_undergoing_concurrent.5
Satisfaction in patients_undergoing_concurrent.5
 
Controversies in prenatal diagnosis 3 should everyone
Controversies in prenatal diagnosis 3 should everyoneControversies in prenatal diagnosis 3 should everyone
Controversies in prenatal diagnosis 3 should everyone
 
Sonographic fetal weight estimation –
Sonographic fetal weight estimation –Sonographic fetal weight estimation –
Sonographic fetal weight estimation –
 
Prevention of childhood_obesity_risk_from_a.6
Prevention of childhood_obesity_risk_from_a.6Prevention of childhood_obesity_risk_from_a.6
Prevention of childhood_obesity_risk_from_a.6
 

Ähnlich wie Resilience, depressed mood,_and_menopausal.10

Smith_Practice Brief
Smith_Practice BriefSmith_Practice Brief
Smith_Practice BriefBreona Smith
 
Anxiety and depression_associated_with_urinary_inc
Anxiety and depression_associated_with_urinary_incAnxiety and depression_associated_with_urinary_inc
Anxiety and depression_associated_with_urinary_incCarlos Quiroz
 
Deconstructing Modern Illness: Idiopathic or Iatrogenic?
Deconstructing Modern Illness: Idiopathic or Iatrogenic? Deconstructing Modern Illness: Idiopathic or Iatrogenic?
Deconstructing Modern Illness: Idiopathic or Iatrogenic? Lucine Health Sciences
 
Levels of Anxiety and Quality of Life in Overweight Individuals Under Nutriti...
Levels of Anxiety and Quality of Life in Overweight Individuals Under Nutriti...Levels of Anxiety and Quality of Life in Overweight Individuals Under Nutriti...
Levels of Anxiety and Quality of Life in Overweight Individuals Under Nutriti...CrimsonPublishersIOD
 
Efficacy of Interpersonal Psychotherapy for Postpartum Depression. (O'hara et...
Efficacy of Interpersonal Psychotherapy for Postpartum Depression. (O'hara et...Efficacy of Interpersonal Psychotherapy for Postpartum Depression. (O'hara et...
Efficacy of Interpersonal Psychotherapy for Postpartum Depression. (O'hara et...Sharon
 
Prevalence of premenstrual dysphoric disorder in female students of medical s...
Prevalence of premenstrual dysphoric disorder in female students of medical s...Prevalence of premenstrual dysphoric disorder in female students of medical s...
Prevalence of premenstrual dysphoric disorder in female students of medical s...Merry Jeans
 
Research Methods in PsychologyThe Effectiveness of Psychodyn.docx
Research Methods in PsychologyThe Effectiveness of Psychodyn.docxResearch Methods in PsychologyThe Effectiveness of Psychodyn.docx
Research Methods in PsychologyThe Effectiveness of Psychodyn.docxronak56
 
Assessing anxiety and depression with HADS Scale in a spanish cancer populati...
Assessing anxiety and depression with HADS Scale in a spanish cancer populati...Assessing anxiety and depression with HADS Scale in a spanish cancer populati...
Assessing anxiety and depression with HADS Scale in a spanish cancer populati...José Ignacio Leyda Menéndez
 
Articulo gineco 2
Articulo gineco 2Articulo gineco 2
Articulo gineco 2kacm20
 
Articulo gineco 2
Articulo gineco 2Articulo gineco 2
Articulo gineco 2kacm20
 
Articulo gineco 2
Articulo gineco 2Articulo gineco 2
Articulo gineco 2kacm20
 

Ähnlich wie Resilience, depressed mood,_and_menopausal.10 (20)

PSI posterFinal
PSI posterFinalPSI posterFinal
PSI posterFinal
 
Smith_Practice Brief
Smith_Practice BriefSmith_Practice Brief
Smith_Practice Brief
 
Anxiety and depression_associated_with_urinary_inc
Anxiety and depression_associated_with_urinary_incAnxiety and depression_associated_with_urinary_inc
Anxiety and depression_associated_with_urinary_inc
 
Deconstructing Modern Illness: Idiopathic or Iatrogenic?
Deconstructing Modern Illness: Idiopathic or Iatrogenic? Deconstructing Modern Illness: Idiopathic or Iatrogenic?
Deconstructing Modern Illness: Idiopathic or Iatrogenic?
 
Levels of Anxiety and Quality of Life in Overweight Individuals Under Nutriti...
Levels of Anxiety and Quality of Life in Overweight Individuals Under Nutriti...Levels of Anxiety and Quality of Life in Overweight Individuals Under Nutriti...
Levels of Anxiety and Quality of Life in Overweight Individuals Under Nutriti...
 
Efficacy of Interpersonal Psychotherapy for Postpartum Depression. (O'hara et...
Efficacy of Interpersonal Psychotherapy for Postpartum Depression. (O'hara et...Efficacy of Interpersonal Psychotherapy for Postpartum Depression. (O'hara et...
Efficacy of Interpersonal Psychotherapy for Postpartum Depression. (O'hara et...
 
Scientifi c Journal of Depression & Anxiety
Scientifi c Journal of Depression & AnxietyScientifi c Journal of Depression & Anxiety
Scientifi c Journal of Depression & Anxiety
 
Scientific Journal of Depression & Anxiety
Scientific Journal of Depression & AnxietyScientific Journal of Depression & Anxiety
Scientific Journal of Depression & Anxiety
 
Prevalence of premenstrual dysphoric disorder in female students of medical s...
Prevalence of premenstrual dysphoric disorder in female students of medical s...Prevalence of premenstrual dysphoric disorder in female students of medical s...
Prevalence of premenstrual dysphoric disorder in female students of medical s...
 
IVF Treatment Centre Delhi
IVF Treatment Centre Delhi  IVF Treatment Centre Delhi
IVF Treatment Centre Delhi
 
Research Methods in PsychologyThe Effectiveness of Psychodyn.docx
Research Methods in PsychologyThe Effectiveness of Psychodyn.docxResearch Methods in PsychologyThe Effectiveness of Psychodyn.docx
Research Methods in PsychologyThe Effectiveness of Psychodyn.docx
 
Session 5.4: Moody
Session 5.4: MoodySession 5.4: Moody
Session 5.4: Moody
 
Session 5.4: Moody
Session 5.4: MoodySession 5.4: Moody
Session 5.4: Moody
 
Session 5.4 Moody
Session 5.4 MoodySession 5.4 Moody
Session 5.4 Moody
 
05.4 moody pc
05.4 moody pc05.4 moody pc
05.4 moody pc
 
Assessing anxiety and depression with HADS Scale in a spanish cancer populati...
Assessing anxiety and depression with HADS Scale in a spanish cancer populati...Assessing anxiety and depression with HADS Scale in a spanish cancer populati...
Assessing anxiety and depression with HADS Scale in a spanish cancer populati...
 
Multivariate Data analysis.pptx
Multivariate Data analysis.pptxMultivariate Data analysis.pptx
Multivariate Data analysis.pptx
 
Articulo gineco 2
Articulo gineco 2Articulo gineco 2
Articulo gineco 2
 
Articulo gineco 2
Articulo gineco 2Articulo gineco 2
Articulo gineco 2
 
Articulo gineco 2
Articulo gineco 2Articulo gineco 2
Articulo gineco 2
 

Mehr von Luis Carlos Murillo Valencia

Significance of cervical ripening in pre induction
Significance of cervical ripening in pre inductionSignificance of cervical ripening in pre induction
Significance of cervical ripening in pre inductionLuis Carlos Murillo Valencia
 
Jog12130 effect of estradiol valerate on endometrium thickness
Jog12130 effect of estradiol valerate on endometrium thicknessJog12130 effect of estradiol valerate on endometrium thickness
Jog12130 effect of estradiol valerate on endometrium thicknessLuis Carlos Murillo Valencia
 
Functional echocardiography in the fetus with non cardiac disease
Functional echocardiography in the fetus with non cardiac diseaseFunctional echocardiography in the fetus with non cardiac disease
Functional echocardiography in the fetus with non cardiac diseaseLuis Carlos Murillo Valencia
 
Current controversies in prenatal diagnosis 2 should incidental
Current controversies in prenatal diagnosis 2 should incidentalCurrent controversies in prenatal diagnosis 2 should incidental
Current controversies in prenatal diagnosis 2 should incidentalLuis Carlos Murillo Valencia
 
Current controversies in prenatal diagnosis 1 should noninvasive
Current controversies in prenatal diagnosis 1 should noninvasiveCurrent controversies in prenatal diagnosis 1 should noninvasive
Current controversies in prenatal diagnosis 1 should noninvasiveLuis Carlos Murillo Valencia
 
Cross sectional study of gestational weight gain and
Cross sectional study of gestational weight gain andCross sectional study of gestational weight gain and
Cross sectional study of gestational weight gain andLuis Carlos Murillo Valencia
 
Agonist treatment avoids hysterectomy in premenopausal
Agonist treatment avoids hysterectomy in premenopausalAgonist treatment avoids hysterectomy in premenopausal
Agonist treatment avoids hysterectomy in premenopausalLuis Carlos Murillo Valencia
 

Mehr von Luis Carlos Murillo Valencia (20)

Urinary tract injuries
Urinary tract injuriesUrinary tract injuries
Urinary tract injuries
 
Unusual ectopic pregnancies
Unusual ectopic pregnanciesUnusual ectopic pregnancies
Unusual ectopic pregnancies
 
Tubal patency tests
Tubal patency testsTubal patency tests
Tubal patency tests
 
The renaissance of_endocrine_therapy_in_breast.9
The renaissance of_endocrine_therapy_in_breast.9The renaissance of_endocrine_therapy_in_breast.9
The renaissance of_endocrine_therapy_in_breast.9
 
Significance of cervical ripening in pre induction
Significance of cervical ripening in pre inductionSignificance of cervical ripening in pre induction
Significance of cervical ripening in pre induction
 
Selective progesterone
Selective progesteroneSelective progesterone
Selective progesterone
 
Retinoids and pregnancy
Retinoids and pregnancyRetinoids and pregnancy
Retinoids and pregnancy
 
Nerve injuries
Nerve injuriesNerve injuries
Nerve injuries
 
Mdg 4
Mdg 4Mdg 4
Mdg 4
 
Litigation
LitigationLitigation
Litigation
 
Jog12130 effect of estradiol valerate on endometrium thickness
Jog12130 effect of estradiol valerate on endometrium thicknessJog12130 effect of estradiol valerate on endometrium thickness
Jog12130 effect of estradiol valerate on endometrium thickness
 
Functional echocardiography in the fetus with non cardiac disease
Functional echocardiography in the fetus with non cardiac diseaseFunctional echocardiography in the fetus with non cardiac disease
Functional echocardiography in the fetus with non cardiac disease
 
Current controversies in prenatal diagnosis 2 should incidental
Current controversies in prenatal diagnosis 2 should incidentalCurrent controversies in prenatal diagnosis 2 should incidental
Current controversies in prenatal diagnosis 2 should incidental
 
Current controversies in prenatal diagnosis 1 should noninvasive
Current controversies in prenatal diagnosis 1 should noninvasiveCurrent controversies in prenatal diagnosis 1 should noninvasive
Current controversies in prenatal diagnosis 1 should noninvasive
 
Cross sectional study of gestational weight gain and
Cross sectional study of gestational weight gain andCross sectional study of gestational weight gain and
Cross sectional study of gestational weight gain and
 
Agonist treatment avoids hysterectomy in premenopausal
Agonist treatment avoids hysterectomy in premenopausalAgonist treatment avoids hysterectomy in premenopausal
Agonist treatment avoids hysterectomy in premenopausal
 
Abdominal incisions
Abdominal incisionsAbdominal incisions
Abdominal incisions
 
Vulvovaginal candidiasis as_a_chronic_disease__.6
Vulvovaginal candidiasis as_a_chronic_disease__.6Vulvovaginal candidiasis as_a_chronic_disease__.6
Vulvovaginal candidiasis as_a_chronic_disease__.6
 
Parent version-schedule-7-18yrs-sp
Parent version-schedule-7-18yrs-spParent version-schedule-7-18yrs-sp
Parent version-schedule-7-18yrs-sp
 
Parent version-schedule-7-18yrs
Parent version-schedule-7-18yrsParent version-schedule-7-18yrs
Parent version-schedule-7-18yrs
 

Kürzlich hochgeladen

Hemostasis Physiology and Clinical correlations by Dr Faiza.pdf
Hemostasis Physiology and Clinical correlations by Dr Faiza.pdfHemostasis Physiology and Clinical correlations by Dr Faiza.pdf
Hemostasis Physiology and Clinical correlations by Dr Faiza.pdfMedicoseAcademics
 
Book Call Girls in Yelahanka - For 7001305949 Cheap & Best with original Photos
Book Call Girls in Yelahanka - For 7001305949 Cheap & Best with original PhotosBook Call Girls in Yelahanka - For 7001305949 Cheap & Best with original Photos
Book Call Girls in Yelahanka - For 7001305949 Cheap & Best with original Photosnarwatsonia7
 
Call Girls Jayanagar Just Call 7001305949 Top Class Call Girl Service Available
Call Girls Jayanagar Just Call 7001305949 Top Class Call Girl Service AvailableCall Girls Jayanagar Just Call 7001305949 Top Class Call Girl Service Available
Call Girls Jayanagar Just Call 7001305949 Top Class Call Girl Service Availablenarwatsonia7
 
call girls in Connaught Place DELHI 🔝 >༒9540349809 🔝 genuine Escort Service ...
call girls in Connaught Place  DELHI 🔝 >༒9540349809 🔝 genuine Escort Service ...call girls in Connaught Place  DELHI 🔝 >༒9540349809 🔝 genuine Escort Service ...
call girls in Connaught Place DELHI 🔝 >༒9540349809 🔝 genuine Escort Service ...saminamagar
 
Call Girl Service Bidadi - For 7001305949 Cheap & Best with original Photos
Call Girl Service Bidadi - For 7001305949 Cheap & Best with original PhotosCall Girl Service Bidadi - For 7001305949 Cheap & Best with original Photos
Call Girl Service Bidadi - For 7001305949 Cheap & Best with original Photosnarwatsonia7
 
Call Girl Lucknow Mallika 7001305949 Independent Escort Service Lucknow
Call Girl Lucknow Mallika 7001305949 Independent Escort Service LucknowCall Girl Lucknow Mallika 7001305949 Independent Escort Service Lucknow
Call Girl Lucknow Mallika 7001305949 Independent Escort Service Lucknownarwatsonia7
 
Call Girls Thane Just Call 9910780858 Get High Class Call Girls Service
Call Girls Thane Just Call 9910780858 Get High Class Call Girls ServiceCall Girls Thane Just Call 9910780858 Get High Class Call Girls Service
Call Girls Thane Just Call 9910780858 Get High Class Call Girls Servicesonalikaur4
 
Call Girls Jp Nagar Just Call 7001305949 Top Class Call Girl Service Available
Call Girls Jp Nagar Just Call 7001305949 Top Class Call Girl Service AvailableCall Girls Jp Nagar Just Call 7001305949 Top Class Call Girl Service Available
Call Girls Jp Nagar Just Call 7001305949 Top Class Call Girl Service Availablenarwatsonia7
 
Call Girl Koramangala | 7001305949 At Low Cost Cash Payment Booking
Call Girl Koramangala | 7001305949 At Low Cost Cash Payment BookingCall Girl Koramangala | 7001305949 At Low Cost Cash Payment Booking
Call Girl Koramangala | 7001305949 At Low Cost Cash Payment Bookingnarwatsonia7
 
Call Girls Service Noida Maya 9711199012 Independent Escort Service Noida
Call Girls Service Noida Maya 9711199012 Independent Escort Service NoidaCall Girls Service Noida Maya 9711199012 Independent Escort Service Noida
Call Girls Service Noida Maya 9711199012 Independent Escort Service NoidaPooja Gupta
 
College Call Girls Vyasarpadi Whatsapp 7001305949 Independent Escort Service
College Call Girls Vyasarpadi Whatsapp 7001305949 Independent Escort ServiceCollege Call Girls Vyasarpadi Whatsapp 7001305949 Independent Escort Service
College Call Girls Vyasarpadi Whatsapp 7001305949 Independent Escort ServiceNehru place Escorts
 
VIP Call Girls Mumbai Arpita 9910780858 Independent Escort Service Mumbai
VIP Call Girls Mumbai Arpita 9910780858 Independent Escort Service MumbaiVIP Call Girls Mumbai Arpita 9910780858 Independent Escort Service Mumbai
VIP Call Girls Mumbai Arpita 9910780858 Independent Escort Service Mumbaisonalikaur4
 
See the 2,456 pharmacies on the National E-Pharmacy Platform
See the 2,456 pharmacies on the National E-Pharmacy PlatformSee the 2,456 pharmacies on the National E-Pharmacy Platform
See the 2,456 pharmacies on the National E-Pharmacy PlatformKweku Zurek
 
Call Girls Service In Shyam Nagar Whatsapp 8445551418 Independent Escort Service
Call Girls Service In Shyam Nagar Whatsapp 8445551418 Independent Escort ServiceCall Girls Service In Shyam Nagar Whatsapp 8445551418 Independent Escort Service
Call Girls Service In Shyam Nagar Whatsapp 8445551418 Independent Escort Serviceparulsinha
 
Call Girls ITPL Just Call 7001305949 Top Class Call Girl Service Available
Call Girls ITPL Just Call 7001305949 Top Class Call Girl Service AvailableCall Girls ITPL Just Call 7001305949 Top Class Call Girl Service Available
Call Girls ITPL Just Call 7001305949 Top Class Call Girl Service Availablenarwatsonia7
 
Call Girl Bangalore Nandini 7001305949 Independent Escort Service Bangalore
Call Girl Bangalore Nandini 7001305949 Independent Escort Service BangaloreCall Girl Bangalore Nandini 7001305949 Independent Escort Service Bangalore
Call Girl Bangalore Nandini 7001305949 Independent Escort Service Bangalorenarwatsonia7
 
College Call Girls Pune Mira 9907093804 Short 1500 Night 6000 Best call girls...
College Call Girls Pune Mira 9907093804 Short 1500 Night 6000 Best call girls...College Call Girls Pune Mira 9907093804 Short 1500 Night 6000 Best call girls...
College Call Girls Pune Mira 9907093804 Short 1500 Night 6000 Best call girls...Miss joya
 
Low Rate Call Girls Pune Esha 9907093804 Short 1500 Night 6000 Best call girl...
Low Rate Call Girls Pune Esha 9907093804 Short 1500 Night 6000 Best call girl...Low Rate Call Girls Pune Esha 9907093804 Short 1500 Night 6000 Best call girl...
Low Rate Call Girls Pune Esha 9907093804 Short 1500 Night 6000 Best call girl...Miss joya
 
Call Girls Hosur Just Call 7001305949 Top Class Call Girl Service Available
Call Girls Hosur Just Call 7001305949 Top Class Call Girl Service AvailableCall Girls Hosur Just Call 7001305949 Top Class Call Girl Service Available
Call Girls Hosur Just Call 7001305949 Top Class Call Girl Service Availablenarwatsonia7
 
Glomerular Filtration and determinants of glomerular filtration .pptx
Glomerular Filtration and  determinants of glomerular filtration .pptxGlomerular Filtration and  determinants of glomerular filtration .pptx
Glomerular Filtration and determinants of glomerular filtration .pptxDr.Nusrat Tariq
 

Kürzlich hochgeladen (20)

Hemostasis Physiology and Clinical correlations by Dr Faiza.pdf
Hemostasis Physiology and Clinical correlations by Dr Faiza.pdfHemostasis Physiology and Clinical correlations by Dr Faiza.pdf
Hemostasis Physiology and Clinical correlations by Dr Faiza.pdf
 
Book Call Girls in Yelahanka - For 7001305949 Cheap & Best with original Photos
Book Call Girls in Yelahanka - For 7001305949 Cheap & Best with original PhotosBook Call Girls in Yelahanka - For 7001305949 Cheap & Best with original Photos
Book Call Girls in Yelahanka - For 7001305949 Cheap & Best with original Photos
 
Call Girls Jayanagar Just Call 7001305949 Top Class Call Girl Service Available
Call Girls Jayanagar Just Call 7001305949 Top Class Call Girl Service AvailableCall Girls Jayanagar Just Call 7001305949 Top Class Call Girl Service Available
Call Girls Jayanagar Just Call 7001305949 Top Class Call Girl Service Available
 
call girls in Connaught Place DELHI 🔝 >༒9540349809 🔝 genuine Escort Service ...
call girls in Connaught Place  DELHI 🔝 >༒9540349809 🔝 genuine Escort Service ...call girls in Connaught Place  DELHI 🔝 >༒9540349809 🔝 genuine Escort Service ...
call girls in Connaught Place DELHI 🔝 >༒9540349809 🔝 genuine Escort Service ...
 
Call Girl Service Bidadi - For 7001305949 Cheap & Best with original Photos
Call Girl Service Bidadi - For 7001305949 Cheap & Best with original PhotosCall Girl Service Bidadi - For 7001305949 Cheap & Best with original Photos
Call Girl Service Bidadi - For 7001305949 Cheap & Best with original Photos
 
Call Girl Lucknow Mallika 7001305949 Independent Escort Service Lucknow
Call Girl Lucknow Mallika 7001305949 Independent Escort Service LucknowCall Girl Lucknow Mallika 7001305949 Independent Escort Service Lucknow
Call Girl Lucknow Mallika 7001305949 Independent Escort Service Lucknow
 
Call Girls Thane Just Call 9910780858 Get High Class Call Girls Service
Call Girls Thane Just Call 9910780858 Get High Class Call Girls ServiceCall Girls Thane Just Call 9910780858 Get High Class Call Girls Service
Call Girls Thane Just Call 9910780858 Get High Class Call Girls Service
 
Call Girls Jp Nagar Just Call 7001305949 Top Class Call Girl Service Available
Call Girls Jp Nagar Just Call 7001305949 Top Class Call Girl Service AvailableCall Girls Jp Nagar Just Call 7001305949 Top Class Call Girl Service Available
Call Girls Jp Nagar Just Call 7001305949 Top Class Call Girl Service Available
 
Call Girl Koramangala | 7001305949 At Low Cost Cash Payment Booking
Call Girl Koramangala | 7001305949 At Low Cost Cash Payment BookingCall Girl Koramangala | 7001305949 At Low Cost Cash Payment Booking
Call Girl Koramangala | 7001305949 At Low Cost Cash Payment Booking
 
Call Girls Service Noida Maya 9711199012 Independent Escort Service Noida
Call Girls Service Noida Maya 9711199012 Independent Escort Service NoidaCall Girls Service Noida Maya 9711199012 Independent Escort Service Noida
Call Girls Service Noida Maya 9711199012 Independent Escort Service Noida
 
College Call Girls Vyasarpadi Whatsapp 7001305949 Independent Escort Service
College Call Girls Vyasarpadi Whatsapp 7001305949 Independent Escort ServiceCollege Call Girls Vyasarpadi Whatsapp 7001305949 Independent Escort Service
College Call Girls Vyasarpadi Whatsapp 7001305949 Independent Escort Service
 
VIP Call Girls Mumbai Arpita 9910780858 Independent Escort Service Mumbai
VIP Call Girls Mumbai Arpita 9910780858 Independent Escort Service MumbaiVIP Call Girls Mumbai Arpita 9910780858 Independent Escort Service Mumbai
VIP Call Girls Mumbai Arpita 9910780858 Independent Escort Service Mumbai
 
See the 2,456 pharmacies on the National E-Pharmacy Platform
See the 2,456 pharmacies on the National E-Pharmacy PlatformSee the 2,456 pharmacies on the National E-Pharmacy Platform
See the 2,456 pharmacies on the National E-Pharmacy Platform
 
Call Girls Service In Shyam Nagar Whatsapp 8445551418 Independent Escort Service
Call Girls Service In Shyam Nagar Whatsapp 8445551418 Independent Escort ServiceCall Girls Service In Shyam Nagar Whatsapp 8445551418 Independent Escort Service
Call Girls Service In Shyam Nagar Whatsapp 8445551418 Independent Escort Service
 
Call Girls ITPL Just Call 7001305949 Top Class Call Girl Service Available
Call Girls ITPL Just Call 7001305949 Top Class Call Girl Service AvailableCall Girls ITPL Just Call 7001305949 Top Class Call Girl Service Available
Call Girls ITPL Just Call 7001305949 Top Class Call Girl Service Available
 
Call Girl Bangalore Nandini 7001305949 Independent Escort Service Bangalore
Call Girl Bangalore Nandini 7001305949 Independent Escort Service BangaloreCall Girl Bangalore Nandini 7001305949 Independent Escort Service Bangalore
Call Girl Bangalore Nandini 7001305949 Independent Escort Service Bangalore
 
College Call Girls Pune Mira 9907093804 Short 1500 Night 6000 Best call girls...
College Call Girls Pune Mira 9907093804 Short 1500 Night 6000 Best call girls...College Call Girls Pune Mira 9907093804 Short 1500 Night 6000 Best call girls...
College Call Girls Pune Mira 9907093804 Short 1500 Night 6000 Best call girls...
 
Low Rate Call Girls Pune Esha 9907093804 Short 1500 Night 6000 Best call girl...
Low Rate Call Girls Pune Esha 9907093804 Short 1500 Night 6000 Best call girl...Low Rate Call Girls Pune Esha 9907093804 Short 1500 Night 6000 Best call girl...
Low Rate Call Girls Pune Esha 9907093804 Short 1500 Night 6000 Best call girl...
 
Call Girls Hosur Just Call 7001305949 Top Class Call Girl Service Available
Call Girls Hosur Just Call 7001305949 Top Class Call Girl Service AvailableCall Girls Hosur Just Call 7001305949 Top Class Call Girl Service Available
Call Girls Hosur Just Call 7001305949 Top Class Call Girl Service Available
 
Glomerular Filtration and determinants of glomerular filtration .pptx
Glomerular Filtration and  determinants of glomerular filtration .pptxGlomerular Filtration and  determinants of glomerular filtration .pptx
Glomerular Filtration and determinants of glomerular filtration .pptx
 

Resilience, depressed mood,_and_menopausal.10

  • 1. Menopause: The Journal of The North American Menopause Society Vol. 21, No. 2, pp. 159/164 DOI: 10.1097/gme.0b013e31829479bb * 2013 by The North American Menopause Society Resilience, depressed mood, and menopausal symptoms in postmenopausal women Faustino R. Pe´rez-Lo´pez, MD, PhD,1,2 Gonzalo Pe´rez-Roncero, RN,1 Jose´ Ferna´ndez-In˜arrea, MD,3 Ana M. Ferna´ndez-Alonso, MD, PhD,1,4 Peter Chedraui, MD, MSc,1,5 Pla´cido Llaneza, MD, PhD,6 and for The MARIA (MenopAuse RIsk Assessment) Research Group Abstract Objective: This study aims to assess resilience, depressed mood, and menopausal symptoms in postmenopausal women. Methods: In this cross-sectional study, 169 postmenopausal women aged 48 to 68 years were asked to fill out the Wagnild and Young Resilience Scale (WYRS), the Center for Epidemiologic Studies Depression Scale (CESD-10), the Menopause Rating Scale (MRS), and a questionnaire containing personal and partner sociodemographic data. Results: The median [interquartile range] age of participating women was 54 [10.0] years. Among the women, 55.6% had increased body mass index, 76.9% had a partner, 17.8% were current smokers, 14.2% had hypertension, 25.4% used psychotropic drugs, and 13.0% used hormone therapy. Forty-five percent of the women had depressed mood (CESD-10 scores Q10), and 34.9% had severe menopausal symptoms (total MRS scores Q17). Less resilience (lower WYRS scores) correlated with depressed mood (higher CESD-10 scores) and severe menopausal symptoms (higher total, psychological, and urogenital MRS scores). Multiple linear regression analysis determined that WYRS scores positively correlated with exercising regularly and inversely correlated with CESD-10 scores (depressed mood). CESD-10 scores positively correlated with somatic and psychological MRS subscale scores and inversely correlated with WYRS scores (less resilience). Conclusions: In this postmenopausal sample, depressed mood and participation in regular exercise correlate with lower and higher resilience, respectively. Depressed mood is associated with the severity of menopausal symptoms (somatic and psychological). Key Words: Postmenopausal women Y Depressive mood Y Resilience Y Menopausal symptoms Y Center for Epidemiologic Studies Depression Scale Y Wagnild and Young Resilience Scale Y Menopause Rating Scale. M enopausal transition is a time when physical, psy- chological, and social value changes take place, in turn affecting women_s health. Despite this, the importance of comorbid conditions and individual personali- ties is still not clear.1<3 Psychological resilience is an indi- vidual_s capacity to prevent, minimize, or overcome stressful situations imposed by life adversity.4<7 It is a measure of how individuals cope with, overcome, or become positively strengthened by changes and challenges.8,9 Resilience is piv- otal to healthy aging, maintains well being, and has been correlated with mortality and longevity.10 Women who dis- play higher resilience may in fact have fewer menopausal complaints.11 Furthermore, complex relationships between de- pressive symptoms and resilience exist. Resilience, life satis- faction, perceived stress, and feelings of loneliness are not routinely included in tools designed to assess menopausal symptoms and related quality of life. These tools tend to spe- cifically address symptom frequency and severity, and physical and emotional aspects among perimenopausal or postmeno- pausal women, as compared with premenopausal women serving as controls.12<17 Although resilience is important for coping with meno- pause, updated studies assessing resilience, depressive symp- toms, and menopausal symptoms, specifically in postmenopausal women, are still limited.5,11,18 Therefore, the aim of the present study was to assess resilience, depressed mood, and meno- pausal symptoms among postmenopausal women. Received February 4, 2013; revised and accepted March 25, 2013. From the 1 Red de Investigacio´n en Ginecologı´a, Obstetricia y Reproduccio´n, Zaragoza, Spain; 2 Departamento de Obstetricia y Ginecologı´a, Universidad de Zaragoza, Zaragoza, Spain; 3 Departamento de Obstetricia y Ginecologı´a, Hospital de Cabuen˜es, Gijo´n, Asturias, Spain; 4 Departamento de Obstetricia y Ginecologı´a, Hospital Torreca´rdenas, Almerı´a, Spain; 5 Instituto de Biomedicina, A´ rea de Investigacio´n para la Salud de la Mujer, Facultad de Ciencias Me´dicas, Universidad Cato´lica de Santiago de Guayaquil, Gua- yaquil, Ecuador; and 6 Departamento de Obstetricia y Ginecologı´a, Hospital Central de Asturias, Universidad de Oviedo, Oviedo, Spain. Funding/support: None. Financial disclosure/conflicts of interest: None reported. Address correspondence to: Faustino R. Pe´rez-Lo´pez, MD, PhD, De- partment of Obstetrics and Gynecology, University of Zaragoza Hos- pital Clı´nico, Domingo Miral s/n, Zaragoza 50009, Spain. E-mail: faustino.perez@unizar.es Menopause, Vol. 21, No. 2, 2014 159 Copyright © 2014 The North American Menopause Society. Unauthorized reproduction of this article is prohibited.
  • 2. METHODS Study design and participants This was a cross-sectional study carried out at the Asturias Central University Hospital (Oviedo, Spain) and the Cabuen˜es Hospital (Gijo´n, Spain), both affiliated with the University of Oviedo (Oviedo, Spain), where postmenopausal women (48-68 y) attending the outpatient clinics for their annual gyne- cological checkup were asked to fill out an itemized general questionnaire (personal and partner sociodemographic data), the Wagnild and Young Resilience Scale (WYRS), the Center for Epidemiologic Studies Depression Scale (CESD-10), and the Menopause Rating Scale (MRS).16,19<24 Participants were informed of the study and its objectives. Those who chose to participate provided a written informed consent form. Women who were unable to verbalize an adequate understanding of the study, did not provide consent for participation, or had psychological or physical incapacity imposing difficulties during the interview were excluded. This research protocol was reviewed and approved by the Asturias Ethical Commit- tee (Oviedo, Spain). General survey The general questionnaire collected the following data on women: age, parity, marital and partner status, educational level, place of residency, current height and weight (to calculate body mass index [BMI]), engagement in regular exercise (yes/no), time since menopause, surgical menopause status, smoking habit, hypertension, and use of hormone therapy (HT), psychotropic drugs, or sleep-aiding drugs. Postmeno- pause status was defined as amenorrhea in the past 12 months or bilateral oophorectomy (surgical menopause). BMI was calculated as body weight (kg) divided by height (m) squared and categorized as low (G18.5 kg/m2 ), normal (18.5-24.9 kg/m2 ), or high (Q25 kg/m2 ). Women with high BMI were further cate- gorized as overweight (25-29.99 kg/m2 ) or obese (Q30 kg/m2 ).25 Data related to the partner were provided by the participating women and included age, educational level, engagement in regular exercise (yes/no), alcohol abuse, and presence of sexual dysfunction (erectile dysfunction, premature ejacula- tion, or both). Wagnild and Young Resilience Scale The WYRS is a 14-item Likert-type scale used to assess resilience status in various age groups and under different conditions. Each item can be graded from B1[ (strongly dis- agree) to B7[ (strongly agree).20,21 Graded items are summed up to provide a total score. Although no cutoff value is available to define abnormality, lower scores are indicative of less resilience. Center for Epidemiologic Studies Depression Scale CESD-10 is a 10-item questionnaire used to assess how in- dividuals felt during the past week. This is a short version of the 20-item CESD tool.22<24 Each item can be graded according to a Likert scale: 0, rarely or none of the time (G1 d); 1, some or a little of the time (1-2 d); 2, occasionally or a moderate amount of time (3-4 d); 3, all the time (5-7 d). Items 5 and 8 are scored inversely. All graded items are summed up to provide a total score. Scores of 10 or greater were used to de- fine depressed mood.23,24 Menopause Rating Scale The MRS assesses the presence and severity of menopausal symptoms through 11 items grouped into three subscales: so- matic, psychological, and urogenital. Each item can be graded as 0 (not present), 1 (mild), 2 (moderate), 3 (severe), or 4 (very severe). Graded items within each subscale are summed up to provide a total subscale score. The total MRS score is the sum of subscale scores.16,19 A total MRS score of 17 or more is defined as severe. Sample size calculation A minimal sample size of 160 participants was calculated, assuming that 40% of participating women would present lower resilience,11,19,20 with a 10% desired precision and a 99% confidence level. Statistical methods Predictive Analytics Software version 17 (SPSS Inc, Chicago, IL) was used to perform the analyses. Data are presented as mean (SD), median [interquartile range], percen- tiles (25th-75th), percentages, coefficients, and 95% CI. The internal consistency of the instruments used (WYRS, CESD-10, and MRS) was assessed by computing Cronbach_s > co- efficients. Kolmogorov-Smirnov test was used to determine the normality of data distribution. According to this, nonparametric continuous data were compared with Mann-Whitney U test (two independent samples) or Kruskal-Wallis test (various in- dependent samples). Student_s t test or analysis of variance was used for parametric comparisons. Spearman_s Q coefficients were calculated to determine correlations between WYRS, CESD-10, and MRS scores and various numeric variables (bivariate analysis). Multiple linear regression analysis was performed to obtain two independent models: the first model analyzes variables correlating with WYRS scores (resilience, dependent variable), and the second model analyzes variables correlating with CESD-10 scores (depressed mood, dependent variable). These models were constructed from independent variables (woman and partner) achieving P e 0.10 during bivariate analysis. Entry of variables into the models was performed using a forward/backward stepwise procedure. For all calculations, P G 0.05 was con- sidered statistically significant. RESULTS During the study period, a total of 205 postmenopausal women were invited to participate. Eleven (5.4%) declined participation, and 25 (12.2%) provided incomplete data. Hence, 169 women provided complete data for statistical analysis. The general characteristics of the participants and their part- ners are depicted in Table 1. The median [interquartile range] age of participating women was 54 years [10], with 82.8% residing in urban areas, 33.1% completing primary education, 75.1% being married, and 76.9% currently having a partner. 160 Menopause, Vol. 21, No. 2, 2014 * 2013 The North American Menopause Society PE´REZ-LO´PEZ ET AL Copyright © 2014 The North American Menopause Society. Unauthorized reproduction of this article is prohibited.
  • 3. Regarding general health, 14.2% had hypertension, 55.6% had increased BMI (overweight or obese), and 33.1% engaged in regular exercise. Comorbidity, including gastric reflux, hypo- thyroidism, and dyslipidemia (the three most frequent), was present in 29.0% of women (data not shown in Table 1). Among the women, 10.7% had surgical menopause, and 13.0% and 25.4% were taking HT and psychotropic drugs, respectively. In addition, severe menopausal symptoms and depressed mood were present in 34.9% and 45.0% of women, respectively. Data on men were available for 76.9% of women who stated that they currently have a partner (n = 100/130). The median [interquartile range] age was 59 years [7.0]. Twenty- five percent of the women exercised regularly, 3.0% abused alcohol, and 39.0% had primary education only. Erectile dysfunction was present in 17.0%, and premature ejaculation was present in 3.0%. A descriptive analysis of MRS, WYRS, and CESD-10 scores is depicted in Table 2. The computed Cronbach_s > coeffi- cients for CESD-10, WYRS, and MRS were 0.813, 0.893, and 0.849, respectively. Spearman_s Q coefficients between tools (CESD-10, WYRS, and MRS) and other numeric variables are depicted in Table 3. There was a significant inverse correlation between WYRS scores and depressed mood (higher CESD-10 scores) and severe menopausal symptoms (higher total, psy- chological subscale, and urogenital subscale MRS scores). There was also a positive correlation between CESD-10 scores (more depressed mood) and MRS scores (total score and all subscale scores). Multiple linear regression analysis was used to obtain two final reduced best-fit models displaying variables correlating with WYRS and CESD-10 scores (Table 4). In the first model (explaining 22.7% of the total variance), WYRS scores in- versely correlated with depressed mood and positively corre- lated with women_s regular exercise. In the second model (explaining 53.2% of the total variance), CESD-10 scores positively correlated with somatic and psychological MRS scores and inversely correlated with WYRS scores. DISCUSSION The present study aimed to assess resilience in a sample of postmenopausal women and to establish correlations with de- pressed mood and menopausal symptoms after controlling for several sociodemographic factors. The tools used in our study have been widely validated under different conditions in other studies, displaying high internal consistencies,5,6,11,16,20<24,26,27 in correlation with our results. Severe menopausal symptoms (as assessed with the MRS) were present in one third of the participating women, despite the relatively low rate of HT use (13%). HT use is particularly infrequent among Spanish women and those from other re- gions. This occurred basically because of the negative infor- mation on HT disseminated in the last decade after the publication of the Women_s Health Initiative trial results.19,27,28 Three validated instruments were used in the present research to render a more profound understanding of menopause-related resilience. Overall, upon bivariate analysis, WYRS scores displayed significant correlations with depressive scores and all MRS scores (except for the somatic subscale). Depressive scores correlated with resilience scores and all MRS subscale scores (Table 3). Resilience is the ability to be reinforced after overcoming life difficulties or stressing events. This ability has genetic, TABLE 1. General characteristics of the participants and their partners Parameters Women (n = 169) Age, y 54.0 [10.0] e50 55 (32.5) 51-55 45 (26.6) 56-60 40 (23.7) 960 29 (17.2) Parity 2.0 [1.0] Nulliparous 33 (19.5) 1-2 114 (67.5) Q3 22 (13.0) Marital status Married 127 (75.1) Single 17 (10.1) Widowed 9 (5.3) Divorced 13 (7.7) Cohabiting 3 (1.8) Currently has a partner 130 (76.9) Highest educational level achieved Primary school 56 (33.1) High school 77 (45.6) University 36 (21.3) Urban residency 140 (82.8) Body mass index, kg/m2 25.1 [5.9] Low 2 (1.2) Normal 73 (43.2) Overweight 63 (37.3) Obese 31 (18.3) Engages in regular exercise 56 (33.1) Current smoker 30 (17.8) Hypertension 24 (14.2) Time since menopause onset, y 3.0 [8.0] G5 92 (54.4) 5-7 77 (45.6) Q8 45 (26.6) Surgical menopause 18 (10.7) Depressed mood (CESD-10 score Q10) 76 (45) Severe menopausal symptoms (total MRS score Q17) 59 (34.9) Current use of HT 22 (13.0) Current use of psychotropic drugs 43 (25.4) Current use of sleep-aiding drugs 64 (37.9) Partner data (n = 100) Age, y 59.0 [7.0] e50 5 (5.0) 51-55 21 (21.0) 56-60 35 (35.0) 61-65 29 (29.0) 965 10 (10.0) Highest educational level achieved Primary school 39 (39.0) High school 44 (44.0) University 17 (17.0) Engages in regular exercise 25 (25.0) Alcohol abuse 3 (3.0) Erectile dysfunction 17 (17.0) Premature ejaculation 3 (3.0) Data are presented as n (%) or median [interquartile range]. CESD-10, Center for Epidemiologic Studies Depression Scale; MRS, Meno- pause Rating Scale; HT, hormone therapy. Menopause, Vol. 21, No. 2, 2014 161 RESILIENCE IN POSTMENOPAUSAL WOMEN Copyright © 2014 The North American Menopause Society. Unauthorized reproduction of this article is prohibited.
  • 4. neural, health, learning, economic, stress, and social compo- nents.3<6,11,18,29,30 Menopausal transition is a long process that is lived, in many cases, with negative feelings and lack of support. Therefore, a resilient woman can better cope with adversity. However, assessing all the components of resilience is not easy. Many tools assess indirect measures of resil- ience such as self-esteem, sense of coherence, loneliness, or happiness.26,30<32 The WYRS, on the other hand, displays high measures of consistency and correlation with life satis- faction scales.4,20,21 Few studies have analyzed resilience in middle-aged women, specifically postmenopausal women. In a large female German sample (18-92 y), life satisfaction was associated with younger age, resilience, employment status, higher household income, having a partner, lack of anxiety and depression, good self- esteem, and religious affiliation.5 In this population, there was a significant reduction of resilience between the ages of 61 and 70 years (most pronounced after 70 y). Resilience positively correlated with life satisfaction and self-esteem and inversely correlated with anxiety and depression. In a previous study of middle-aged Ecuadorian women, lower WYRS scores (less resilience) correlated with more se- vere hot flushes.11 Duffy et al18 studied factors associated with resilience and vulnerability to hot flushes and night sweats during the menopausal transition in a female Scottish sample. Women resilient to hot flushes had previously not been both- ered by their menstrual periods, did not experience somatic symptoms or night sweats, and perceived their symptoms as having low consequences on their lives. Those vulnerable to hot flushes had children, had high BMI, reported night sweats, and perceived their symptoms as having high life consequences. Women resilient to night sweats were non- smokers, did not have sleep difficulties, were not treated for psychological symptoms, and perceived their menopausal symp- toms as having low life consequences. Those vulnerable to night sweats had lower education, had previously been bothered by their menstrual periods, had below-average physical health, reported musculoskeletal symptoms and hot flushes, and per- ceived their menopausal symptoms as having high life con- sequences. In our study, although WYRS scores displayed significant bivariate correlations with all MRS scores (except for the somatic subscale), no correlation was found between WYRS scores and any of the MRS scores, interestingly, after multivariate linear regression analysis. CESD-10 is a validated instrument for detecting depressed mood, which accounted for 45.0% of our postmenopausal population. Our multivariate analysis found that resilience was inversely related to depressive mood (higher CESD-10 scores) and positively related to exercising regularly. Reports indicate that the prevalence of depression is higher in women than in men and tends to increase as women age. The causal role of this increaseVwhether related to age, progressive hormonal decrease, or bothVis still a matter of controversy.33 Using the long version of CESD in an 8-year longitudinal study, Freeman et al34 demonstrated that total CESD scores of 16 or higher (depressed mood) and depressive disorders were, respectively, 4 and 2.5 times more likely to occur during the menopausal transition as compared with the premenopausal years. In a middle-aged and multiethnic female sample, Woods and Mitchell35 used CESD and other tools to develop a multi- dimensional model for explaining depressed mood. Three as- pects were identified as correlating with depressed mood: TABLE 2. Descriptive analysis of MRS, WYRS, and CESD-10 scores (n = 169) MRS (> = 0.849)a WYRS (> = 0.893)a CESD-10 (> = 0.813)a Total Somatic Psychological Urogenital Mean 13.9 5.3 5.1 3.4 77.7 9.3 Median 13.0 5.0 5.0 3.0 79.0 8.0 25th-75th percentiles 8.0-19.0 3.0-7.0 2.0-7.0 1.0-5.0 70.0-87.0 5.0-12.5 Interquartile range 11.0 4.0 5.0 4.0 17.0 7.5 MRS, Menopause Rating Scale; WYRS, Wagnild and Young Resilience Scale; CESD-10, Center for Epidemiologic Studies Depression Scale. a Values in parentheses represent the computed Cronbach’s > coefficient for the scale. TABLE 3. Spearman_s Q coefficients obtained between tool scores and various numeric variables WYRS CESD-10 MRS Total Somatic Psychological Urogenital Age j0.069 0.065 0.177 0.252 0.086 0.146 P 0.370 0.404 0.021 0.001 0.267 0.058 Parity 0.059 0.031 0.107 0.135 0.007 0.142 P 0.449 0.689 0.165 0.079 0.927 0.065 Body mass index j0.069 0.133 0.107 0.166 0.101 j0.007 P 0.371 0.085 0.166 0.031 0.190 0.932 WYRS Y j0.432 j0.248 j0.143 j0.295 j0.157 P G0.001 0.001 0.063 G0.001 0.042 CESD-10 Y Y 0.610 0.487 0.642 0.346 P G0.001 G0.001 G0.001 G0.001 WYRS, Wagnild and Young Resilience Scale; CESD-10, Center for Epidemiologic Studies Depression Scale; MRS, Menopause Rating Scale. 162 Menopause, Vol. 21, No. 2, 2014 * 2013 The North American Menopause Society PE´REZ-LO´PEZ ET AL Copyright © 2014 The North American Menopause Society. Unauthorized reproduction of this article is prohibited.
  • 5. menopausal transition, health status, and stressful life context. The latter was considered the most important factor, whereas health status had a direct effect and an indirect effect through stress, and menopausal changes had low explanatory power. A large number of neurobiological and psychosocial factors are associated with depression and resilience. Positive psychoso- cial factors, such as optimism, humor, cognitive flexibility, so- cial support, role models, coping style, and capacity to recover, are reduced in depressed individuals, which may explain the inverse correlation between resilience and depression found in our study. It is probable that neurobiological changes associated with depressive mood may secondarily affect resilience capac- ity36 orVseen the other way aroundVthat less resilient persons may be more vulnerable to developing depression. Further research may indeed give insights into determining which is cause and which is consequence. Cognitive vulnerable indivi- duals have a severe risk of losing resilience because of de- pression, whereas social support and positive life events may enhance their resilience.35 Therefore, cognitive education aimed at highlighting positive experiences during menopause may boost resilience. It is interesting to recall that our population displayed comorbid conditions (hypertension and sleep disor- ders) that may also contribute to the alteration of the neuro- biology of resilience and depression in labile women. A stressful life context and associated issues may be important determi- nants of depressed mood. It has been reported that bad health status has a direct effect on mood and an indirect effect on per- ceived stress, whereas menopausal changes have low power at explaining depressive mood.33,35 Our regression model found that women who exercised regularly displayed higher resilience. In one study, low spiri- tuality among individuals with depression and anxiety was revealed as a leading predictor of lower resilience, and less frequent exercise was associated with moderate resilience.37 Our results seem to suggest that exercising may contribute to increased resilience and may improve treatment response among those who display depressed mood. This may in fact be true for those women who display higher BMI (who may engage in less exercises). Unfortunately, our regression model did not find a correlation between resilience and depressive scores and BMI. Nevertheless, we have previously reported11 that women with higher abdominal circumference (obesity) display lower resilience. Hence, in this high-risk group, ex- ercise may have a positive impact on mood and resilience. In any case, further studies are needed to delineate the separate influences of exercise intensity and exercise-related body changes associated with both depressed mood and resilience. The regression model for CESD-10 scores in our study found a significant and positive correlation between depressive scores and menopausal somatic and psychological symptoms. This is in agreement with our previous research in which middle-aged women (premenopausal, perimenopausal, and postmenopausal) displayed a high prevalence of depressed mood in correlation with more severe menopausal symptoms (somatic and psycho- logical) assessed with the same MRS.38 It is very well known that estradiol deprivation in postmenopausal women may in- crease depressive39 and menopausal1,2,28 symptoms. Finally, the cross-sectional design, which does not allow for the determination of causality for neither resilience nor de- pressed mood, is a limitation of this study. Although surveying only postmenopausal women does not allow for an analysis of the effects of age or menopause status on resilience or depres- sion status, selecting them (who may in fact be consulting for morbidity) from a gynecological outpatient service or a single Spanish site does not allow for a generalization of results to the rest of the Spanish population. Other potential drawbacks in- clude not assessing exercise intensity and finding moderate Q values upon bivariate analysis. Despite all the aforementioned limitations, there have been few reports addressing resilience during the menopausal transition and even fewer studies reporting specifically on postmenopausal women. Hence, to the best of our knowledge, the present study seems to be among the few studies reported to date. More studies that analyze psychosocial and sociodemographic factors, using resilience scales, among middle-aged women (including premenopausal, perimenopausal, and postmeno- pausal women) are needed. CONCLUSIONS In this postmenopausal female sample, depressed mood and participation in regular exercise correlate with lower and higher resilience, respectively. Depressed mood is associated with the severity of menopausal symptoms, specifically somatic and psychological symptoms. Although these correlations do not explain causality, they do, however, highlight the need to in- clude resilience, mood, and other life satisfaction aspects in the design of future tools assessing menopausal symptoms. TABLE 4. Factors correlating with WYRS and CESD-10 scores: multiple linear regression analysis Factors A SE 95% CI t P Model for WYRS scores (n = 169) Total CESD-10 score j0.911 0.148 j1.204 to j0.617 j6.133 G0.001 Regular exercise 2.439 0.984 0.496 to 4.382 2.478 0.014 r2 = 0.237; adjusted r2 = 0.227; P = 0.014 Model for CESD-10 scores (n = 169) Total WYRS score j0.130 0.026 j0.181 to j0.079 j5.007 G0.001 MRS somatic score 0.463 0.141 0.184 to 0.741 3.280 0.001 MRS psychological score 0.752 0.117 0.521 to 0.982 6.422 G0.001 r2 = 0.541; adjusted r2 = 0.532; P G 0.001 WYRS, Wagnild and Young Resilience Scale; CESD-10, Center for Epidemiologic Studies Depression Scale; MRS, Menopause Rating Scale. Menopause, Vol. 21, No. 2, 2014 163 RESILIENCE IN POSTMENOPAUSAL WOMEN Copyright © 2014 The North American Menopause Society. Unauthorized reproduction of this article is prohibited.
  • 6. REFERENCES 1. Pe´rez-Lo´pez FR. The Menopause. Madrid, Spain: Temas de Hoy, 1992. 2. Greer G. The Change. Women, Ageing and the Menopause. London, England: Penguin Book, 1992. 3. Castelo-Branco C, Palacios S, Ferrer-Barriendos J, et al. Cervantes Study Group. Understanding how personality factors may influence quality of life: development and validation of the Cervantes Personality Scale. Menopause 2008;15:914-918. 4. Grotberg E. Countering depression with the five building blocks of re- silience. Reach Today_s Youth 1999;4:66-72. 5. Beutel ME, Glaesmer H, Decker O, Fischbeck S, Bra¨hler E. Life satis- faction, distress, and resiliency across the life span of women. Menopause 2009;16:1132-1138. 6. Beutel ME, Glaesmer H, Wiltink J, Marian H, Bra¨hler E. Life satisfac- tion, anxiety, depression and resilience across the life span of men. Aging Male 2010;13:32-39. 7. Harville EW, Xiong X, Buekens P, Pridjian G, Elkind-Hirsch K. Resil- ience after Hurricane Katrina among pregnant and postpartum women. Womens Health Issues 2010;20:20-27. 8. Boukydis Z. Ultrasound consultation to reduce risk and increase resil- ience in pregnancy. Ann N Y Acad Sci 2006;1094:268-271. 9. Erdem G, Slesnick N. That which does not kill you makes you stronger: runaway youth_s resilience to depression in the family context. Am J Orthopsychiatry 2010;80:195-203. 10. Walter-Ginzburg A, Shmotkin D, Blumstein T, Shorek A. A gender- based dynamic multidimensional longitudinal analysis of resilience and mortality in the old-old in Israel: the Cross-Sectional and Longitudinal Aging Study (CALAS). Soc Sci Med 2005;60:1705-1715. 11. Chedraui P, Pe´rez-Lo´pez FR, Schwager G, et al. Resilience and related factors during female Ecuadorian mid-life. Maturitas 2012;72:152-156. 12. Hilditch JR, Lewis J, Peter A, et al. A menopause-specific quality of life questionnaire: development and psychometric properties. Maturitas 1996;24:161-175. 13. Greene JG. Constructing a standard climacteric scale. Maturitas 1998;29:25-31. 14. Utian WH, Janata JW, Kingsberg SA, Schluchter M, Hamilton JC. The Utian Quality of Life (UQOL) Scale: development and validation of an instrument to quantify quality of life through and beyond menopause. Menopause 2002;9:402-410. 15. Matthews KA, Bromberger JT. Does the menopausal transition affect health-related quality of life? Am J Med 2005;118:25-36. 16. Heinemann LA, Potthoff P, Schneider HP. International versions of the Menopause Rating Scale (MRS). Health Qual Life Outcomes 2003;1:28. 17. Monterrosa-Castro A, Romero-Pe´rez I, Marrugo-Flo´rez M, Ferna´ndez- Alonso AM, Chedraui P, Pe´rez-Lo´pez FR. Quality of life in a large cohort of mid-aged Colombian women assessed using the Cervantes Scale. Menopause 2012;19:924-930. 18. Duffy OK, Iversen L, Aucott L, Hannaford PC. Factors associated with resilience or vulnerability to hot flushes and night sweats during the menopausal transition [published online ahead of print December 17, 2012]. Menopause. 19. Cuadros JL, Ferna´ndez-Alonso AM, Cuadros-Celorrio AM, et al; Men- opAuse RIsk Assessment (MARIA) Research Group. Perceived stress, insomnia and related factors in women around the menopause. Maturitas 2012;72:367-372. 20. Wagnild G, Young H. Development and psychometric evaluation of the Resilience Scale. J Nurs Meas 1993;1:165-178. 21. The Resilience Scale. Available at: https://www.resiliencescale.com/ index.html. Accessed December 23, 2012. 22. Radloff LS. The CES-D scale: a self-report depression scale for research in the general population. Appl Psychol Meas 1977;1:385-401. 23. Andresen EM, Malmgren JA, Carter WB, Patrick DL. Screening for de- pression in well older adults: evaluation of a short form of the CES-D (Center for Epidemiologic Studies Depression Scale). Am J Prev Med 1994;10:77-84. 24. Irwin M, Artin KH, Oxman MN. Screening for depression in the older adult. Criterion validity of the 10-item Center for Epidemiological Studies Depression Scale (CES-D). Arch Intern Med 1999;159:1701-1704. 25. WHO. Physical status: the use and interpretation of anthropometry. WHO Technical Report Series 854, Geneva, Switzerland: World Health Orga- nization, 1995. 26. Salazar-Pousada D, Arroyo D, Hidalgo L, Pe´rez-Lo´pez FR, Chedraui P. Depressive symptoms and resilience among pregnant adolescents: a case- control study. Obstet Gynecol Int 2010;2010:952493. 27. Ferna´ndez-Alonso AM, Trabalo´n-Pastor M, Vara C, Chedraui P, Pe´rez- Lo´pez FR; ; MenopAuse RIsk Assessment (MARIA) Research Group. Life satisfaction, loneliness and related factors during female midlife. Maturitas 2012;72:88-92. 28. Nelson HD, Walker M, Zakher B, Mitchell J. Menopausal hormone therapy for the primary prevention of chronic conditions: a systematic review to update the U.S. Preventive Services Task Force recommenda- tions. Ann Intern Med 2012;157:104-113. 29. Franklin TB, Saab BJ, Mansuy IM. Neural mechanisms of stress resil- ience and vulnerability. Neuron 2012;75:747-761. 30. Serrano-Parra MD, Garrido-Abejar M, Notario-Pacheco B, Bartolome´- Gutie´rrez R, Solera-Martı´nez M, Martı´nez-Vizcaı´no V. Validity of the Connor-Davidson Resilience Scale (10 items) in a population of elderly. Enferm Clin 2013;23:14-21. 31. Svartvik L, Lidfeldt J, Nerbrand C, Samsioe G, Scherste´n B, Nilsson PM. Dyslipidaemia and impaired well-being in middle-aged women reporting low sense of coherence. The Women_s Health in the Lund Area (WHLA) Study. Scand J Prim Health Care 2000;18:177-182. 32. Marttila A, Johansson E, Whitehead M, Burstro¨m B. Keep going in adversityVusing a resilience perspective to understand the narratives of long-term social assistance recipients in Sweden. Int J Equity Health 2013;12:8. 33. Llaneza P, Garcı´a-Portilla MP, Llaneza-Sua´rez D, Armott B, Pe´rez- Lo´pez FR. Depressive disorders and the menopause transition. Maturitas 2012;71:120-130. 34. Freeman EW, Sammel MD, Lin H, Nelson DB. Associations of hor- mones and menopausal status with depressed mood in women with no history of depression. Arch Gen Psychiatry 2006;63:375-382. 35. Woods NF, Mitchell ES. Pathways to depressed mood for midlife women: observations from the Seattle Midlife Women_s Health Study. Res Nurs Health 1997;20:119-129. 36. Southwick SM, Vythilingam M, Charney DS. The psychobiology of depression and resilience to stress: implications for prevention and treatment. Annu Rev Clin Psychol 2005;1:255-291. 37. Min JA, Jung YE, Kim DJ, et al. Characteristics associated with low resilience in patients with depression and/or anxiety disorders. Qual Life Res 2013;22:231-241. 38. Chedraui P, Pe´rez-Lo´pez FR, Morales B, Hidalgo L. Depressive symp- toms in climacteric women are related to menopausal symptom intensity and partner factors. Climacteric 2009;12:395-403. 39. Colangelo LA, Craft LL, Ouyang P, et al. Association of sex hormones and sex hormoneYbinding globulin with depressive symptoms in post- menopausal women: the Multiethnic Study of Atherosclerosis. Meno- pause 2012;19:877-885. 164 Menopause, Vol. 21, No. 2, 2014 * 2013 The North American Menopause Society PE´REZ-LO´PEZ ET AL Copyright © 2014 The North American Menopause Society. Unauthorized reproduction of this article is prohibited.