Associations of sleep quality, anxiety symptoms and social support with subjective well-being among Chinese perimenopausal women

Protective and harmful social and psychological factors associated with mood and anxiety disorders in perimenopausal women: A narrative review

Perimenopause is often called a window of vulnerability for the development or exacerbation of mood and anxiety disorders. Evidence points to social and psychological factors contributing to the onset of mood and anxiety disorders or the symptoms of depression and anxiety during perimenopause. Therefore, the purpose of this narrative review was to synthesize the findings of studies examining associations between social and psychological factors and the development of mood and anxiety disorders and the symptoms of depression and anxiety during perimenopause. PsychINFO, Ovid MEDLINE, and CINAHL were searched for studies (published between January 2014 and November 2023) assessing the social and psychological factors associated with perimenopausal mood and anxiety disorders and the symptoms of depression and anxiety. These factors were categorized as either protective or harmful. Study quality was assessed using STROBE guidelines. The search yielded 17 studies. Social support was identified as a social factor protective against perimenopausal depression and anxiety. Resiliency characteristics were reported to be protective psychological factors associated with fewer depressive symptoms. Mental health history, family history of major depressive disorder, trait anxiety and neuroticism, stressful life events, adverse childhood events, and chronic stress were categorized as harmful psychological factors associated with depression during perimenopause. Limited research has been conducted to understand factors associated with perimenopausal anxiety. The identification of these social and psychological factors associated with mood and anxiety disorders during perimenopause will help lead to earlier detection of women at risk and the development of multifaceted interventions.

Experiences and Understanding of Well-Being in Lung Transplant Recipients in China: A Phenomenological Qualitative Study

AIM

To explore lung transplant recipients' perceptions of well-being when they are facing uncertain health outcomes, including identifying the factors to enhance well-being.

DESIGN

A qualitative descriptive study.

METHODS

A purposive sample of 11 lung transplantation recipients who were hospitalised in the Department of Organ Transplantation of a tertiary university hospital was recruited in China. A descriptive qualitative study using thematic analysis of semistructured interviews. Themes were organised within a PERMA model. Colaizzi's qualitative analysis was used to analyse the data.

RESULTS

Five major themes and 11 categories were generated: (1) mindset shift [optimism and hope and living in the moment]; (2) meaning in life [self-care, priority change and value realisation]; (3) health benefits [improved health and behavioural changes]; (4) perceived support [support from family, the health care team and others]; (5) unmet support needs.

CONCLUSION

Lung transplant recipients could perceive well-being from five aspects that caused significantly favourable transformation across a variety of aspects in patients' lives. These findings may support nursing staff when caring for this patient group, making them aware of multifaceted nature of well-being. They could offer insight into potential pathways for the development of nurse-led tailored interventions, based on specific elements of PERMA model.

IMPACT

This work adds to a growing body of knowledge about well-being amongst lung transplant patients. These findings may support nursing staff when caring for this patient group, making them aware of multifaceted nature of well-being and illustrating factors that promote positive well-being in this group, based on specific elements of PERMA model.

REPORTING METHOD

This study followed the Consolidated Criteria for Reporting Qualitative Research checklist.

PATIENT OR PUBLIC CONTRIBUTION

Two lung transplant recipients were involved in the early phases of this study. They helped in formulating the interview outline.

The association of stress perception on anxiety, depression and sleep quality in parents of children with burns: The moderating effect of social support

OBJECTIVE

Few studies have explored the mental health status of parents of children with burns and the moderating effect of social support on them.

METHODS

A survey was performed with parents of 112 burn-injured children at a burn center in China. Their perceived stress, anxiety, depression, sleep quality, and social support were measured by the Chinese Perceived Stress Scale, Hospital Anxiety and Depression Scale, Pittsburgh Sleep Quality Index, and Perceived Social Support Scale.

RESULTS

➀ The prevalence of anxiety (46.43%), depression (52.67%) and poor sleep quality (43.75%) of parents indicated that they experienced emotional and sleep disorders;➁ The perceived stress was positively correlated with sleep quality, anxiety and depression（P＜0.01), and negatively correlated with perceived social support (p＜0.05); ➂ Social support had a significant moderating effect on their perceived stress and anxiety, depression, but not on their sleep quality. With high social support, parental perceived stress had a significant positive association on anxiety and depression, while with low perceived social support, parental perceived stress had no significant association on anxiety and depression.

CONCLUSION

Parents of burned children had increased stress, obvious symptoms of anxiety and depression, and poor sleep quality. Social support had a significant buffering effect on them under low pressure, and high pressure will hinder the buffering effect of social support on stress. Therefore, the ideal services to improve mental health should be provided for them to face different levels of stress.

Signs of front-line healthcare professionals' information anxiety during the COVID-19 pandemic: Grounded theory study in a Wuhan hospital

AIM

Being front-line healthcare professionals is associated with possible severe information anxiety during the COVID-19 pandemic. Investigating signs of information anxiety is the first and key step of its targeted medical intervention. This study aims to explore the signs of front-line healthcare professionals' information anxiety during the COVID-19 pandemic.

DESIGN

This study is qualitative research. Grounded theory was used to classify information anxiety signs of front-line healthcare professionals.

METHODS

Twenty-four front-line healthcare professionals from a general hospital with over 5000 beds in Wuhan were recruited to participate in semi-structured interviews. According to the frequency and frequency variation of signs appearing in interviews, the trends of signs during the virus encounter, lockdown, flattening and second wave were compared. Based on the interviews, those signs that were conceptually related to each other were extracted to construct a conceptual model.

RESULTS

Psychological signs (emotion, worry, doubt, caution, hope), physical signs (insomnia, inattention, memory loss, appetite decreased) and behavioural signs (panic buying of goods, be at a loss, pay attention to relevant information, change habits) could be generalized from 13 subcategories of information anxiety signs. Psychological signs were the most in every period of the pandemic. Furthermore, psychological signs decreased significantly during lockdown, while behavioural and physical signs increased. Finally, severe psychological and behavioural signs were associated with physical signs.

Association between sleep duration and depression in menopausal women: a population-based study

Aims

This research investigated menopausal women older than 50 years to find whether there were any independent relationships between the duration of sleep they got and their prevalence of depression.

Methods

National Health and Nutrition Examination Survey (NHANES) datasets from 2011-2020 were utilized in a cross-sectional study. Using multivariate linear regression models, the linear relationship between sleep duration and depression in menopausal women was investigated. Fitted smoothing curves and thresholds impact evaluation were used to investigate the nonlinear relationship. Then, subgroup analyses were performed according to smoking, drinking alcohol, diabetes, hypertension, heart disease, and moderate activities.

Results

This population-based study included a total of 3,897 menopausal women (mean age 65.47 ± 9.06 years) aged≥50 years; 3,159 had a depression score <10, and 738 had a depression score≥10. After controlling for all covariates, the prevalence of depression was 17% higher among participants with short sleep duration [OR=1.17, 95%CI=(0.65, 1.70), P<0.0001] and 86% [OR=1.86, 95%CI=(1.05, 2.66), P<0.0001] compared to participants with normal sleep duration. In subgroup analyses stratified by smoking and diabetes, the sleep duration and depression scores of non-smokers [β=-0.18, 95%CI= (-0.33, -0.02), P=0.0241] and diabetics were independently negatively correlated [β=-0.32, 95%CI= (-0.63, -0.01), P=0.0416]. Using a two-segment linear regression model, we discovered a U-shaped relationship between sleep duration and depression scores with an inflection point of 7.5 hours. Less than 7.5 hours of sleep was associated with an increased risk of developing depression [β=-0.81, 95%CI= (-1.05, -0.57), P<0.001]. However, sleeping more than 7.5 hours per night increased the risk of depression considerably [β=0.80, 95%CI= (0.51, 1.08), P<0.001].

Conclusions

Depression is associated with sleep duration in menopausal women. Insufficient or excessive sleep may increase the risk of depression in menopausal women.

Efficacy of manual acupuncture vs. placebo acupuncture for generalized anxiety disorder (GAD) in perimenopausal women: a randomized, single-blinded controlled trial

Background

Generalized anxiety disorder (GAD) is common among perimenopausal women. Acupuncture may be an effective treatment for GAD, but evidence is limited. The pathogenesis of GAD is not yet clear, but it is related to the hypothalamic-pituitary-adrenal axis and its excretion, cortisol (CORT), and the adrenocorticotropic hormone (ACTH). The objective of this study is to evaluate the efficacy of manual acupuncture (MA) vs. placebo acupuncture (PA) for perimenopausal women with GAD.

Methods

This study is a single-center, randomized, single-blind clinical trial conducted in the First Affiliated Hospital of Guangzhou University of Chinese Medicine. A total of 112 eligible patients with GAD were randomly assigned (1:1) to receive MA (n = 56) or PA (n = 56) three times per week for 4 weeks. The primary outcome measure was the HAMA score. The secondary outcome measures were the GAD-7 and PSQI scores and the levels of CORT and ACTH. The evaluation will be executed at the baseline, 2 weeks, the end of the treatment, and a follow-up 3-month period.

Results

Significant improvements in HAMA (p < 0.001, η2p = 0.465), GAD-7 (p < 0.001, η2p = 0.359) and ACTH (p = 0.050) values were found between T0 and T2 in the MA group compared to the PA group. No difference in PSQI (p = 0.613, η2p = 0.011) and CORT (p = 0.903) was found between T0 and T2 in the MA group compared to the PA group. Long-term improvements in HAMA (p < 0.001, p < 0.001) were found in the MA group and PA group.

Conclusion

This study was the first completed study to evaluate the efficacy of acupuncture and placebo acupuncture for GAD in perimenopausal patients. Results suggested that placebo acupuncture has a therapeutic effect, however, acupuncture had a greater therapeutic effect than placebo acupuncture. This study supports the effectiveness of acupuncture and thereby contributes to extended treatment options for GAD.Clinical trial registration:http://www.chictr.org.cn, Chinese Clinical Trial Registry, ID: ChiCTR2100046604. Registered on 22 May 2021.

Socioeconomic status and subjective well-being: The mediating role of class identity and social activities

BACKGROUND

Subjective well-being has a significant impact on an individual's physical and mental health. Socioeconomic status, class identity, and social activity participation play important roles in subjective well-being. Therefore, the aim of this study was to uncover the mechanisms through which these factors influence subjective well-being.

METHODS

A total of 1926 valid samples were recruited using the Chinese General Social Survey 2021 (CGSS 2021). The Chinese Citizen's Subjective Well-Being Scale (SWBS-CC) was employed to assess subjective well-being. Socioeconomic status was measured using income and education, and class identity and social activity participation were measured using Likert scales. Pearson correlation analysis and the chain mediation model were conducted to explore the relationship between these factors. Finally, the Bootstrap method was used to examine the path coefficients.

RESULTS

A significant correlation was found between socioeconomic status, class identity, social activity, and subjective well-being (p < 0.01). The indirect effect of socioeconomic status on subjective well-being mediated by class identity was 0.351 (95% CI: 0.721, 1.587), while the indirect effect of socioeconomic status on subjective well-being mediated by social activity was 0.380 (95% CI: 0.059, 0.240). The effect mediated by both class status and social activities was 0.011 (95% CI: 0.010, 0.093).

CONCLUSIONS

The study showed that socioeconomic status, class identity, and social activity had significant effects on subjective well-being. Class identity and social activity partially mediated the effects of socioeconomic status on subjective well-being, and they had a chain mediating effect between socioeconomic status and subjective well-being. Therefore, policymakers have the opportunity to enhance subjective well-being in lower socioeconomic status groups by promoting individual class identity and encouraging greater social activity participation.

Acupuncture for comorbid depression and insomnia in perimenopause: A feasibility patient-assessor-blinded, randomized, and sham-controlled clinical trial

Background and objective

Whilst acupuncture is widely used for treating psychosomatic diseases, there is little high-quality evidence supporting its application in comorbid perimenopausal depression (PMD) and insomnia (PMI) which are common complaints during climacteric. This feasibility, patient-assessor-blinded, randomized, sham-controlled clinical trial addresses this gap by investigating the efficacy and safety of acupuncture on depressed mood and poor sleep in women with comorbid PMD and PMI.

Methods

Seventy eligible participants were randomly assigned to either real-acupuncture (RA) or sham-acupuncture (SA) groups. Either RA or SA treatment were delivered in 17 sessions over 8 weeks. The primary outcomes for mood and sleep were changes on 17-items Hamilton Depression Rating Scale (HAM-D₁₇) and Pittsburgh Sleep Quality Index (PSQI) scores, from baseline to 16-week follow-up. Secondary outcome measures involved anxiety symptoms, perimenopausal symptoms, quality of life, participants' experience of and satisfaction with the acupuncture treatment. Blood samples were taken to measure reproductive hormone levels. Intention-To-Treat and Per-Protocol analyses were conducted with linear mixed-effects models. The James' and Bang's blinding indices were used to assess the adequacy of blinding.

Results

Sixty-five participants completed all treatment sessions, and 54 and 41 participants completed the eight- and 16-week follow-ups, respectively. At post-treatment and 8-week follow-up, the RA group showed a significantly greater reduction in PSQI scores than the SA group did; although the reduction of HAM-D₁₇ scores in RA group was significant, the change was not statistically different from that of SA. There were no significant mean differences between baseline and 16-week follow-up in either HAM-D₁₇ or PSQI in either group. There were no significant between-group differences in serum reproductive hormone levels. All treatments were tolerable and no serious adverse events were reported, and the blinding was successful.

Conclusion

Acupuncture is safe and can contribute to clinically relevant improvements in comorbid PMD and PMI, with satisfactory short-and medium-term effects. Whether the anti-depressive benefit of acupuncture is specific or non-specific remains to be determined. No evidence was found for any longer-term benefit of acupuncture compared to sham at 16 weeks. Further research is required to elucidate mechanisms underlying the short to medium term effects of acupuncture.

The Relationship between Social Support and Mental Health Problems of Peri- and Postmenopausal Women during the SARS-CoV-2 Pandemic

The COVID-19 pandemic affects women's mental health, because they are more predisposed to vulnerabilities and adverse impacts. Therefore, is important to find strategies for preventing and treating these mental health consequences in the female population. The main purposes of our study were to determine the level of social support received by peri- and postmenopausal women during the SARS-CoV-2 pandemic, as well as factors related to this level with reference to health status and sociodemographic variables. A total of 218 women in peri- and postmenopausal status participated in the study. The study assessed depression (Beck Depression Inventory), anxiety (the Spielberg State-Trait Anxiety Scale), climacteric symptoms (the Blatt-Kupperman Index), social support (the Inventory of Social Supportive Behaviors). The majority of the respondents had a moderate level of anxiety as a state (40.8%), a low level of anxiety as a trait (51.4%), no depressive symptoms (75.2%) and no climacteric symptoms (52.3%). Age was found to significantly correlate with anxiety as a state (p = 0.036). The anxiety as state was significantly stronger in people with higher education than in people with secondary education (p = 0.019). Professionally inactive women had more emotional (p = 0.05) and appraisal (p = 0.014) support than women who work. The analysis demonstrated no statistically significant correlation between social support and depression, anxiety or climacteric symptoms (p > 0.05). The majority of peri- and postmenopausal women had no depressive symptoms and/or anxiety symptoms. Professionally inactive women had more emotional and appraisal support than women who work. The analysis demonstrated no statistically significant correlation between social support and depression, anxiety or climacteric symptoms.

Longitudinal associations between sleep quality and menopausal symptoms among community-dwelling climacteric women: A multi-centered study

STUDY OBJECTIVES

Menopausal symptoms exist in most climacteric women, which can harm the quality and satisfaction of life for them. Moreover, a series of ineluctable negative life changes experienced in middle-age usually make the situation more complicated and stressful. We aimed to determine the trajectories and influential factors of sleep quality and menopausal symptoms and their longitudinal interrelationships among climacteric women.

METHODS

A total of 1875 community-dwelling climacteric women were included in this study. The Pittsburgh Sleep Quality Index (PSQI) and the Menopause Rating Scale (MRS) were adopted to assess sleep quality and menopausal symptoms, respectively. Data were collected 4 times from March 2019 to December 2019, at a 3-month interval.

RESULTS

The Cross-lagged analysis showed that worse sleep quality and more severe menopausal symptoms over time after controlling for specified covariates, and more severe menopausal symptoms were predicted by declined sleep quality. The Generalized estimation equation model showed that education level, marital status, chronic diseases, life events, income, and age were the influential factors of sleep quality, while menopausal symptoms were impacted by marital status and income.

CONCLUSIONS

Increasing negative sleep quality and more severe menopausal symptoms over time contribute to the health burden of climacteric women. Menopausal symptoms could be alleviated by sleep quality improvement, which is influenced by education level, marital status, chronic diseases, life events, age, and economic factors.