Women, marital status, and symptoms of depression in a midlife national sample

Emotional dysregulation in women with endometriosis with cyclical and non-cyclical chronic pelvic pain

BACKGROUND

Endometriosis is a pathophysiological condition characterized by glands and stroma outside the uterus in regions such as the bladder, ureter, fallopian tubes, peritoneum, ovaries, and even in extra pelvic sites. One of the main clinical problems of endometriosis is chronic pelvic pain (CPP), which considerably affects the patients' quality of life. Patients with endometriosis may, cyclically or non-cyclically (80% of cases) experience CPP. High levels of anxiety and depression have been described in patients with endometriosis related to CPP; however, this has not been evaluated in endometriosis women with different types of CPP. Therefore, the research question of this study was whether there is a difference in the emotional dysregulation due to the type of pain experienced by women with endometriosis?

METHODS

This work was performed in the National Institute of Perinatology (INPer) in Mexico City from January 2019 to March 2020 and aimed to determine if there are differences in emotional dysregulation in patients with cyclical and non-cyclical CPP. 49 women from 18 to 52 years-old diagnosed with endometriosis presenting cyclical and non-cyclical CPP answered several batteries made up of Mini-Mental State Examination, Visual Analog Scale, Beck's Depression Inventory, State Trait-Anxiety Inventory, and Generalized Anxiety Inventory. Mann-Whitney U and Student's t-test for independent samples to compare the difference between groups was used. Relative risk estimation was performed to determine the association between non-cyclical and cyclical CPP with probability of presenting emotional dysregulation.

RESULTS

We observed that patients with non-cyclical CPP exhibited higher levels of depression and anxiety (trait-state and generalized anxiety) than patients with cyclical pain, p < 0.05 was considered significant. No differences were observed in pain intensity, but there was a higher probability of developing emotional dysregulation (anxiety or depression) in patients with non-cyclical CPP. No differences were observed in cognitive impairment.

CONCLUSIONS

Our data suggest that patients with non-cyclical (persistent) CPP present a higher emotional dysregulation than those with cyclical pain.

Examining negative affect, sleep duration, and using food to cope as predictors of weight in midlife women

Midlife women are vulnerable to developing obesity. Behavioral and psychosocial factors including sleep duration, stress eating, and negative emotionality are risk factors. However, little is known about the complex daily interplay between sleep, eating, emotion, and weight among midlife women. The current study examined how daily sleep, using food to cope, and negative emotionality are associated with weight using a daily process research design. An archival analysis was performed using the Midlife in the United States-II study (MIDUS II). The sample consisted of 489 midlife women (40-64 years of age). Variables included ecological momentary assessments of daily sleep duration, using food to cope, and negative affect (means and intraindividual variability) and a standardized measurement of BMI. Sleep duration variability was a significant predictor of BMI, albeit the model only accounted for .8% of the variance in BMI (b = .019, p < .05). In the final adjusted model, sleep duration variability, using food to cope, age, and physical activity were all significant predictors of BMI F(5, 559) = 21.503, p < .001, R² = .161, ⨂R² = .024, p = .001. Variability in negative affect, mean sleep duration or negative affect and the interactions between sleep duration (mean, variability) and negative affect (mean, variability) were not significant. Greater variability in sleep duration and greater use of food to cope predicted higher BMI in this sample across age and physical activity levels. Results highlight that daily health and psychosocial factors play an important role in weight.

Exploring the Relationship between Marital Status and Women's Retirement Satisfaction

Increased divorce rates, declining marriage rates, and a predisposition to widowhood in later life all contribute to the heterogeneous marital histories of women approaching retirement. Existing research on retirement, however, has not considered the diversity in marital status that exists among retired women. The purpose of the present study was to explore the influence of marital status (i.e., married, remarried, widowed, divorced/separated, never-married) on women's retirement satisfaction. Using a purposive sampling method, self-administered questionnaires were distributed to retired women. Participants ( N = 331) were asked to report on their retirement satisfaction, psychological well-being, and perceived health. Results revealed retirement satisfaction and perceived health differed by marital status. Psychological well-being, however, did not differ significantly between marital groups. Future research exploring diversity in marital status among retired women is suggested.

Pragmatic and Internal Validity Issues in Sampling in Caregiver Studies

Objectives: Studies of caregivers illustrate a classic sampling dilemma: maximizing recruitment without compromising study validity. Because caregivers are defined in relation to a care recipient, sampling methods are often determined by pragmatic decisions such as access, efficiency, and costs. However, overlooking validity may result in selection bias, misclassification of caregiver status, and the confounding of results. Validity and pragmatic concerns were compared in four caregiver studies that used different sampling frames: community based, Alzheimer’s disease registry, and ancillary studies to existing epidemiologic studies. Methods: Systematic comparison of validity and of pragmatic aspects of sampling frames, recruitment methods, and participation rates, with attention to caregiver identification, inclusion criteria, and sample restriction. Results: All studies used task-based inclusion criteria. Caregiver participation rates ranged from 81% to 96%, with higher rates in community-based and registry-based studies than in ancillary studies. The latter studies benefited from unbiased selection of noncaregivers. Discussion: Regardless of sampling frame, standard task-based inclusion criteria to define caregivers may enhance validity.

Differences and similarities between functional and personal recovery in an Asian population: a cluster analytic approach

This study gathers empirical data to test whether two forms of recovery are related: (1) the traditional outcome-based notion of recovery from a mental illness, which is called "functional recovery," and (2) the more recent, consumer-based concept of recovery in mental illness, which is called "personal recovery." A total of 150 Chinese outpatients were recruited, 75 with bipolar disorder and 75 with schizophrenia, as determined by structured clinical interview. Participants were reported to be in clinical remission for at least the previous 6 months by treating psychiatrists. Personal recovery was measured with the Stages of Recovery Scale, and functional recovery was measured with residential and employment status. In addition to clinical and demographic data, self-report measures included functioning (confirmed through chart review) and a survey of the participant's assessment of the importance of various elements of recovery. Personal recovery was significantly correlated with functional recovery; small effect size suggested that the two domains are far from identical. The strength of this correlation was stronger for participants with schizophrenia than for those with bipolar disorder. A cluster analysis also suggested that residential and employment statuses, along with personal recovery scores, were useful in differentiating participants. Patients were more likely to reach better recovery outcomes if they were female, married, had higher family income, and perceived social roles as less important to their recovery. Consistent with the consumer literature, personal recovery is related but still distinct from functional recovery. Personal recovery has more to do with life circumstances than with functioning status alone.

Factors associated with functional recovery in bipolar disorder patients

OBJECTIVES

Among bipolar disorder (BPD) patients, functional recovery, defined as regaining individual premorbid residential and vocational status, is far less common than symptomatic recovery. As several factors have tentatively been implicated in outcomes in BPD, we investigated predictors of functional recovery among BPD patients, including demographic, clinical, and neurocognitive factors.

METHODS

We assessed functional recovery status with standardized residential and occupational indices, assessed neurocognitive functioning with performance-based neuropsychological tests, and collected demographic and clinical information for 65 euthymic or residually depressed Structured Clinical Interview for DSM-IV-defined type I or II BPD patients. We examined predictors of functional recovery with multiple logistic regression modeling.

RESULTS

More education (p = 0.006), fewer years of illness (p = 0.037), and being married (p = 0.045) were associated independently with functional recovery, even after controlling for residual depressive symptoms, diagnostic type (I versus II), and psychiatric comorbidity. Functionally unrecovered BPD patients performed less well than recovered patients on verbal fluency (effect size = 0.54, p = 0.03), a measure of executive functioning, but this difference was not significant when adjusted for residual mood symptoms and education.

CONCLUSIONS

Among euthymic or mildly depressed BPD patients, functional recovery was associated with more education, being married, and fewer years of illness.

Work and marital status in relation to depressive symptoms and social support among women with coronary artery disease

BACKGROUND

Work and marital status have been shown to be associated with health outcome in women. However, the effect of employment and marriage on psychosocial functioning has been studied predominantly in healthy subjects. We investigated whether work and marital status are associated with depressive symptoms, social support, and daily stress behavior in women with coronary artery disease (CAD).

METHODS

Data of 105 women with CAD and of working age were analyzed. General linear models were used to determine the association between work and marital status and depressive symptoms, social support, and daily stress behavior.

RESULTS

Women who were working at the time of measurement had lower levels of depressive symptoms (7.0 +/- 1.2 vs. 12.1 +/- 0.9, p < 0.01) and higher levels of social support (21.6 +/- 1.0 vs. 18.9 +/- 0.7, p = 0.03) than the nonworking women, whereas marital status was not related to any of the outcome variables. Results were similar after adjusting for potential confounders, that is, age, education, self-reported health, and risk factors for CAD. There was no significant interaction between marital status and working status on depressive symptoms, social support, or daily stress behavior.

CONCLUSIONS

In women with CAD, all <65 years of age, after a cardiac event, patients working had lower levels of depressive symptoms and a better social integration than those not working, regardless of reason for being nonemployed. Daily stress behavior, depression, and social support did not differ between cohabiting and not cohabiting women. Future interventions should take into consideration that women with CAD who are unemployed may have a higher risk for depression and social isolation and, therefore, poor clinical outcomes.

Factors associated with major depression among mothers in Los Angeles

PURPOSE

The aim of this study was to identify factors associated with major depression among a sample of diverse mothers in Los Angeles while paying special attention to racial and ethnic as well as immigration status differences.

METHODS

Using logistic regression models, we examined the association between major depression and race and ethnicity, immigration status, and other key covariates. Major depression was measured using the Comprehensive International Diagnostic Interview Short Form. This study was based on 1,856 racially and ethnically diverse mothers who participated in Wave 1 of the Los Angeles Family and Neighborhood Survey, which was fielded in 65 census tracts.

MAIN FINDINGS

After controlling for key covariates, we found that non-Hispanic white mothers had 1.67 times the odds of having major depression than Hispanic mothers (95% confidence interval [CI], 0.99-2.80). In addition, single mothers had elevated rates of major depression compared with married mothers (odds ratio [OR], 1.54; 95% CI, 1.00-2.37). Mothers with a college degree or higher had significantly lower odds of being depressed compared with mothers without a college degree (OR, 0.50; 95% CI, 0.29-0.86); mothers with only adolescents in the home had significantly higher odds of major depression than mothers with at least one preadolescent child in the home (OR, 1.73; 95% CI, 1.11-2.70).

CONCLUSION

Given the links between depressed mothers and child outcomes, our results have important implication for mothers with adolescent children, particularly those who are white, single, or less educated.

Relationship dynamics: understanding married women's mental health

Because married women are at increased risk for depression, it is important to identify factors that explain women's experience of mental health. Bowen Theory was used to examine differentiation of self and relationship factors, such as need fulfillment, as predictors of married woman's psychologic well-being. Multiple regression demonstrated that a significant proportion of women's well-being was attributable to interdependence in the marriage and the perception that interactional, emotional, and sexual needs were being met. Clinicians can support positive mental health outcomes through early identification of women who may be at risk for psychologic distress and referral for individual or marital counseling.

Moderating role of marital quality in older adults' depressed affect: beyond the main-effects model

We examine the role of three indicators of marital quality (marital disagreement, marital happiness, and time spent together) as moderators of the association between physical disability and depressed affect among married older individuals (N=1,044). We found support for the moderating role of marital disagreement wherein the detrimental effect of disability on depressed affect was significantly heightened among older adults with more disagreements with their spouse; a moderating effect was not detected for marital happiness or time spent together. We conclude that, in addition to its main effect on older adults' depressed affect, marital quality (as indicated by marital disagreement) plays a significant stress-moderating role in the physical disability-depressed affect link.

Marital transitions and mental health: are there gender differences in the short-term effects of marital status change?

Although there has been evidence to suggest that women exhibit more vulnerability to psychological distress than men when they lose a spouse or remarry, knowledge about the process by which men and women adjust to marital change remains fragmentary. This is due in part to the length of time between observations in longitudinal studies on marital change, with the result that mental health status is typically assessed long after a marital status transition has occurred. The purpose of the current study is to test for gender differences in the short-term mental health effects of a marital status transition using three waves of data collected at two year intervals in a Canadian population health survey (N=11,155). Growth curve analyses confirm the mental health advantage of marriage and reveal that the short-term effects of moving into and out of marriage on psychological distress are similar for men and women. We discuss the implications of these findings for resolving competing explanations regarding psychological adjustment to marital change.

Age differences in perceptions of control in social relationships

To date, few studies have examined perceptions of control in interpersonal relationships, and whether such perceptions reflect individual characteristics (e.g., age) and features of relationships (e.g., quality). One hundred and eighty-seven individuals aged 13 to 99 (M = 45.62, SD = 25.69) provided information about their close and problematic relationships and their perceptions of control over those relationships. Multilevel modeling revealed that both relationship features and individual characteristics were associated with perceptions of control in relationships. Specifically, individuals felt more control in their marital relationships, and in relationships characterized by higher quality and fewer worries. Age differences in individuals' perceptions of control in relationships appear to reflect age-related shifts in perceptions of control in the parent-child tie.

Adaptation to disability among middle-aged and older adults: the role of assimilative and accommodative coping

The purpose of this study was to investigate the links among coping, disability, and mental health among adults who are confronted with age-related vision loss. Drawing on the model of assimilative and accommodative coping (e.g., Brandtstädter, 1999), hierarchical regressions were designed to examine the effects of coping and disability on mental health. Participants were 55 middle-aged and 52 older adults who had been recruited from a community-based rehabilitation agency. Findings demonstrate a critical role of accommodative coping for adaptation, with beneficial effects on mental health that were more pronounced in the case of high disability for younger participants. Finally, findings suggest that dealing with disability may pose more of a mental health risk in middle than in late adulthood.

The menopause experience: a woman's perspective

OBJECTIVE

To understand the complexities of the experience of menopause in American women from diverse ethnic and socioeconomic backgrounds. The specific aims of this phenomenologic study were to (a) examine and interpret the reality of the menopausal transition as experienced by American women and (b) identify common elements and themes that occur as a result of the complexities of this experience.

DESIGN

Data for this qualitative study were gathered through semistructured interviews with 15 women who experienced natural menopause.

PARTICIPANTS

A multiethnic sample of 15 menopausal American women in Massachusetts was selected from a pool of voluntary participants from the Boston area.

DATA ANALYSIS

The interviews were analyzed to identify themes pertinent to the personal experience of menopause. Those themes, extracted from the similarities and differences described, represent broad aspects of these women's experiences.

RESULTS

Three major themes or phases were identified: expectations and realization, sorting things out, and a new life phase. Although some women expressed similar thoughts in particular categories, no two women had the same experience of menopause.

CONCLUSIONS

The data support the premise that the experience of menopause in American women is unique to each individual and that the meaning or perspective differs among women. The data revealed the complexities of this human experience by explicating personal meanings related to experiences, expectations, attitudes, and beliefs about menopause.

Surveys on sexual health: recent developments and future directions

The increasingly widespread adoption of the term sexual health reflects a move away from the medicalisation of this specialty. The focus has shifted from clinical practice to lifestyle and behaviour; from clinician to client, and from treatment to prevention. This article discusses these themes, identifying their implications for sexual health research. Recent times have seen, for example, a growing number of studies combining biological and behavioural measures conducted by interdisciplinary teams able to combine biomedical measurements of morbidity with insights into the subjective interpretations of symptoms and consequences. Considerable progress has been made, too, in mounting community based studies, and much has been achieved in gaining compliance and refining sampling methods. Integrated sexual health services, encompassing more than contraceptive or prophylactic service provision, have provided the impetus to investigation of the costs and benefits of coordinated family planning and genitourinary medicine services. Despite its broader focus, there remain opportunities for sexual health research to expand its remit. Studies to date may have focused too narrowly on pathological, to the neglect of health enhancing, consequences of sexual behaviour.