| Objective:To evaluate and compare the prevalence and severity of menopausal symptoms in pre-,peri-and postmenopausal women from rural areas;to explore the effects of positive emotion,positive trait and positive social relationship on menopausal symptoms from the perspective of positive psychology.Methods:A convenience sample was obtained from rural area of a prefecture-level city in Shandong Province.Participates were divided into three groups according to Stages of Reproductive Aging Workshop,including pre-,peri-and postmenopause.The Menopause Rating Scale(MRS),the Positive Affect Scale(PAS),the Connor-Davision Resilience Scale(CD-RISC),the Mindful Attention Awareness Scale(MAAS)and the Perceived Social Support Scale(PSSS)were used to measure the menopausal symptoms,positive affect,resilience,mindfulness and social support.A self-administered general questionnaire was developed to obtain sociodemographic and menstrual-related information.All the analyses were conducted with IBM SPSS22.0 version.Statistical description included means(M)and standard deviations(SDs),frequencies and percentages.Univariate analysis included independent sample t-test,ANOVA and chi-square test.Pearson’s correlations(r)and hierarchical linear regression were used to analyze the correlations of variables.Bias-Corrected Bootstrap was used to identify the mediating effect.Results:1.The general information in different menopausal stages among rural womenThe mean age of participants was 49.83 years(SD = 4.98 years),ranged from 40 to 60 years.Of them,262(40.5%)were in premenopause,170(26.3%)were in perimenopause and 215(33.2%)were in postmenopause.In pre,peri and postmenopause stages,the proportion of primary education level were 51.1%、48.8%、52.6%,most of them were married(99.2%,98.2%,96.3%,respectively),women with chronic disease were 33.2%,47.1%,52.1%,nearly half of respondents reported menarche between 13 and 16 years old(58.4%,48.3%,46.0%,separately),the proportions of developing gynecological diseases were 21.0%,30.0%,22.3%,the proportions of having accepted HT were 0.0%,2.8%,2.8%,respectively.2.The status of MRS and differences in general information in the three menopausal stagesTotal scores of MRS were(7.22± 5.55),(8.75± 6.01)and(9.80± 6.92)in pre,peri and postmenopause,there was a statistical difference(P<0.001).The prevalence of menopausal symptoms were 62.6%,73.5%and 75.3%in the three stages of menopause,respectively(according to MRS>4).The results of univariate analyses showed that family economy,chronic disease and gynecological diseases were significantly associated with MRS in premenopause(all P<0.001).In perimenopause,chronic disease,HT and gynecological diseases were related to MRS(all P<0.01).Education,chronic disease,gynecological diseases and whether or not understand the menopausal symptoms were associated with MRS in postmenopause(all P<0.05).3.The correlations of MRS with positive psychological variables in different menopausal stagesThe average of scores of positive affect were(33.15 ± 4.93)、(33.49 ± 5.40)、(32.86± 5.72)in pre,peri and postmenopausal women.The scores of resilience were(25.26± 6.25)、(25.43± 6.57)、(25.26± 6.99),separately.The scores of MAAS were(68.23± 10.18)、(66.80± 10.99)、(67.82± 11.80),respectively.The scores of social support were(66.81± 8.13)、(66.09± 10.04)、(65.21± 10.21),respectively.Meanwhile,there were no statistical differences in the three menopausal stages(all P>0.05).Pearson’s correlation analysis showed negative relationships between MRS and positive affect(r =-0.200～-0.254,P<0.01)in pre,peri and postmenopause,there were negative associations between MRS and resilience(r =-0.206～-0.261,P<0.01).Among them,MRS were negatively associated with mindfulness(r =-0.312～-0.507,P<0.001).MRS were negatively related to social support and subscales(r =-0.222～-0.306,P<0.01).In addition,there were significant positive correlations among psychological variables(r = 0.145～0.440,P>0.05).4.The mechanism of MRS and positive psychological variables in different menopausal stages among rural midlife womenThe mediation effect was analyzed by Wen’s test method.In regression analysis,MRS was regarded as the dependent variable;the significantly general variables were controlled in adjusted model.The subscales of social support as the independent variable entered the regression equation;positive affect,resilience and mindfulness were the mediating variables,respectively.In premenopause,results showed that family support not only had a direct effect on MRS(β =-0.156,P = 0.032),but also had an indirect effect on MRS through positive affect(β =-0.106,P = 0.054)and mindfulness(β =-0.374,P<0.001).The indirect effects were-0.050 and-0.073,separately.In perimenopause,results revealed that family support not only had direct effect on MRS(β =-0.183,P = 0.047),but also had an indirect effect on MRS via mindfulness(β=-0.237,P = 0.001).The indirect effect was-0.054.In postmenopause,results indicated that family support had a direct effect on MRS(β =-0.227,P = 0.002)and mindfulness mediated the relationship between family support and MRS(β ＝-0.371,P<0.001)and the indirect effect was-0.083.In premenopause,the bootstrapped 95%CI did not include zero(-0.092,-0.020)and(-0.133,-0.021),confirming a significant mediation effect of positive affect and mindfulness.In perimenopause and postmenopause,the bootstrapped 95%CI did not include zero(-0.119,-0.012)and(-0.142,-0.032),existing a mediating effect of mindfulness.Conclusions:1.In rural middle-aged women,the prevalence and severity of menopausal symptoms differed significantly in three menopausal stages;the severity of menopausal symptoms was the most in postmenopausal women.2.Positive affect,resilience,mindfulness and social support could predict MRS in different menopausal stages among rural women.3.In pre,peri and postmenopausal women,family support not only had significantly effect on MRS,but can predict MRS via mindfulness.Furthermore,positive affect mediated the associations between family support and MRS in premenopausal women. |
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