Effect of acceptance and commitment therapy on mood, sleep quality and quality of life in menopausal women: a randomized controlled trial

The effectiveness of psychosocial interventions on non-physiological symptoms of menopause: A systematic review and meta-analysis

BACKGROUND

Menopause, a crucial transitioning stage for women, can significantly impact mood and wellbeing. We aimed to evaluate the effectiveness of psychosocial interventions on non-physiological symptoms of menopause (depression, anxiety, cognition, and quality of life) through systematic review and meta-analysis.

METHODS

Five databases were searched from inception to August 2023 for randomized controlled trials. Pre- and post-test means and standard deviations for groups were extracted and used to calculate effect sizes. The effectiveness of Cognitive Behavioral Therapy (CBT) and Mindfulness-Based Interventions (MBI) on depression and anxiety were examined by subgroup analysis.

RESULTS

Thirty studies comprising 3501 women were included. From meta-analysis, mood symptoms significantly benefited from CBT (anxiety: d = -0.22, 95 % CI = -0.35, -0.10; depression: d = -0.33, 95 % CI = -0.45, -0.21) and MBI (anxiety: d = -0.56, 95 % CI = -0.74, -0.39; depression: d = -0.27, 95 % CI = -0.45, -0.09). Psychosocial interventions were also found to significantly improve cognition (d = -0.23, 95 % CI = -0.40, -0.06) and quality of life (d = -0.78, 95 % CI = -0.93, -0.63). Mean total therapy hours ('dose') was lower for CBT (11.3) than MBI (18.6), indicating reduced costs and burden for women.

LIMITATIONS

Data regarding menopausal status were not collected, limiting our ability to identify the optimal timing of interventions. Potential longer-term, effects of interventions were not investigated.

CONCLUSION

Our review highlighted the value of psychosocial interventions in improving non-physiological symptoms (particularly depression and anxiety) during menopause, noting the heterogeneity of findings and importance of implementing effective interventions.

Effects of mind-body exercise on perimenopausal and postmenopausal women: a systematic review and meta-analysis

IMPORTANCE

The increasing attention to the management of perimenopausal and postmenopausal women parallels the growth of the aging population. Although hormone therapy is commonly used to alleviate menopausal symptoms, it carries a potential risk of cancer. Recently, mind-body exercises have emerged as innovative approaches for improving menopausal symptoms and bone health. However, research findings have needed to be more consistent, highlighting the significance of this study's systematic review of mind-body exercise effects on perimenopausal and postmenopausal women.

OBJECTIVE

This study aims to evaluate the impact of mind-body exercises, including tai chi, yoga, Pilates, qigong, baduanjin, and mindfulness-based stress reduction, on bone mineral density, sleep quality, anxiety, depression, and fatigue among perimenopausal and postmenopausal women.

EVIDENCE REVIEW

Four electronic databases-PubMed, Embase, Cochrane Central Register of Controlled Trials, and Web of Science-were systematically searched from inception until July 2023. The search focused exclusively on randomized controlled trials to examine the impact of mind-body exercise interventions on perimenopausal and postmenopausal women. The methodological quality of the included studies was evaluated using the Cochrane Bias Risk Assessment tool.

FINDINGS

A total of 11 randomized controlled trials, comprising 1,005 participants, were included in the analysis. Traditional meta-analysis indicated that mind-body exercise significantly enhanced bone mineral density in perimenopausal and postmenopausal women compared with control groups, with a standardized mean difference (SMD) of 0.41 (95% CI, 0.17 to 0.66; P = 0.001, I2 = 7%). In addition, significant improvements were observed in sleep quality (SMD, -0.48; 95% CI, -0.78 to -0.17; P = 0.002, I2 = 76%), anxiety reduction (SMD, -0.80; 95% CI, -1.23 to -0.38; P = 0.0002, I2 = 84%), depressive mood (SMD, -0.80; 95% CI, -1.17 to -0.44; P < 0.0001, I2 = 79%), and fatigue (SMD, -0.67; 95% CI, -0.97 to -0.37; P < 0.0001, I2 = 0%).

CONCLUSIONS AND RELEVANCE

The findings of this meta-analysis demonstrate that mind-body exercise positively influences bone mineral density, sleep quality, anxiety, depression, and fatigue among perimenopausal and postmenopausal women.

Could psychobiotics and fermented foods improve mood in middle-aged and older women?

Menopause is a natural physiological phase during which women experience dramatic hormonal fluctuations. These lead to many symptoms, such as depression and anxiety, which, in turn, can negatively affect quality of life. Proper nutrition has an influential role in alleviating depression as well as anxiety. It is well known that gut microbiota dysbiosis contributes to the development of mood disorder. There is mounting evidence that modulating the gut-brain axis may aid in improving mood swings. In this context, this narrative review summarizes recent findings on how aging changes the composition of the gut microbiota and on the association between gut microbiota and mood disorders. In addition, it evaluates the effectiveness of psychobiotics and fermented foods in treating mood swings in middle-aged and older women. A search was done using PubMed, Scopus, and Google Scholar, and thirteen recent articles are included in this review. It is evident that psychobiotic supplementation and fermented foods can improve mood swings via several routes. However, these conclusions are based on only a few studies in middle-aged and older women. Therefore, long-term, well-designed randomized controlled trials are required to fully evaluate whether psychobiotics and fermented foods can be used to treat mood swings in this population.

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.

Effectiveness of the acceptance and commitment therapy on resilience and quality of life in patients with post-acute COVID-19 syndrome

Post-acute COVID-19 syndrome (PCS) is defined as an ongoing symptomatic illness in patients who have recovered from their initial COVID-19 infection which causes long term respiratory problems, muscle atrophy, etc. So, the current research aimed to examine effectiveness of the acceptance and commitment therapy on resilience and health-related quality of life of PCS patients. The research deployed a quasi-experimental design with pre- and post-tests and 3-month follow-up with wait-list group. Thirty PCS patients from a specialized facility in Iran were recruited using available sampling method and were randomly assigned to either treatment or wait-list groups, each group 15 subjects. The subjects answered to Connor and Davidson's (2003) Resilience Scale (CD-RISC) and the World Health Organization's (1995) Quality of Life Questionnaire (WHOQOL-BREF). The posttest score of resilience in the treatment and wait-list groups were 19.6 and 14.47, respectively, and their follow-up scores were 17.13 and 14.55, respectively. Also, total score of HRQoL in the treatment and wait-list groups in the posttest were 65.07 and 55.73 and in the follow-up were 63.27 and 54.6, respectively. The results showed that there were significant differences in the posttest scores of the dependent variables based on the groups. Also, the MANCOVA showed that the acceptance and commitment therapy was still significantly effective on the dependent variables three months after the last session. The ACT can significantly increase PCS patients' resilience and HRQoL even 3months after the intervention. The implications and limitations of the research are further discussed.

Factors Determining the Quality of Life of Polish Women during Menopause Based on the Menopause-Specific Quality of Life Questionnaire

BACKGROUND

The aim of the study was to present the process of cultural adaptation to Polish conditions and the validation of a scale assessing the quality of life of Polish women during the menopause and to identify the factors determining this quality of life.

METHODS

The research tools were the menopause-specific quality of life (MENQOL) questionnaire and a standardized interview questionnaire comprising questions on the participants' characteristics. The study involved 516 women using health care services who had symptoms caused by the menopause.

RESULTS

The value of the Cronbach's alpha coefficient was 0.923. The discriminative power coefficients of all the questionnaire items were higher than 0.3. The study confirmed the validity and internal consistency of the Polish version of the MENQOL questionnaire for measuring the quality of life of postmenopausal women, suggesting that the tool can be used for screening menopausal symptoms in women. There was a relationship between general quality of life and age (p = 0.002), marital status (p < 0.001), education (p = 0.021), the impact of professional work (p < 0.001), the impact of physical activity (p < 0.001) and the impact of social life (p < 0.001).

CONCLUSION

In the group of women who took part in the study, the authors observed a lower quality of life during menopause reported by older women who were married/in a stable relationship, with no formal education (no formal education) and who, according to their subjective assessment, negatively evaluated the impact of the accompanying menopause-related symptoms on their work, physical activity and social life.

The effects of mindfulness-based interventions on anxiety, depression, stress, and mindfulness in menopausal women: A systematic review and meta-analysis

Background

Mindfulness-based interventions (MBIs) are psychological interventions widely used in menopausal women. Currently, there is no evidence summary on the effectiveness of MBIs on anxiety, depression, stress, and mindfulness in menopausal women. This meta-analysis examines the effectiveness of MBIs in improving anxiety, depression, stress, and mindfulness scores in menopausal women.

Methods

A systematic search was conducted in PubMed, Embase, Web of Science, the Cochrane Library, CNKI (China National Knowledge Infrastructure), and Wanfang, using relevant terms such as MBIs as keywords and covering all studies published before March 13, 2022. The outcomes were anxiety, depression, stress, and mindfulness. The screening and extraction of data were conducted by two independent reviewers.

Results

A total of 1,138 menopausal women participated in 13 studies. Meta-analysis results showed that MBIs significantly reduced stress in menopausal women (SMD = -0.84, 95% CI: -1.64 to -0.05, p = 0.04), but no statistical differences were found in reducing anxiety (SMD = -0.40, 95% CI: -0.81 to 0.01, p = 0.06) and depression (SMD = -0.19, 95% CI: -0.45 to 0.07, p = 0.16) and in raising the scores of mindfulness (SMD = 0.37, 95% CI: -0.06 to 0.81, p = 0.09) in menopausal women.

Conclusion

MBIs may reduce stress in menopausal women, but their effect on improving anxiety, depression, and mindfulness needs further validation.

Systematic review registration

https://www.crd.york.ac.uk/prospero/#recordDetails.