| Background:Women’psychological health is an important part of women’mental health, nowadays many researches show that the psychological health status of rural women is not optimistic, and some bad psychological status such as worry, anxiety and depression appear relatively prominent among rural women. Rural women’ psychological symptoms are one of the reasons that lead to the unique phenomenon that the suicide prevalence of rural women is higher than that of men in China. China’s Mental Health Plan (2002-2010) pointed out researches on women particular psychological behavior problems and mental disorders should be strengthened, and effective strategies and interventions should be carried out actively. Women of child-bearing age as a special population have the characteristics of their own. The time span of reproductive age is long, and during this period women will experience marriage, pregnancy, childbirth, parenting and menopause and so on. Female physical factors and various family and social environmental factors will have an effect on their psychological health. Of these factors, reproduction related factors such as menstruation and reproduction make an important effect on women’psychological health status. For example, the menopausal transition syndrome and postpartum depression. Compared with urban women, rural women’s education level is low, their reproductive health care knowledge is relatively lack and rural health condition is relatively backward. Rural women’s reproductive health is poor; the reproduction related factors could make certain effect on psychological health in rural women of child-bearing age.Objectives:To investigate the relationship between menstruation, reproduction and psychological health status in rural married women of child-bearing age, and to identify risk factors for psychological health, so as to make reasonable suggestions for the elevation of psychological health level of rural married women of child-bearing age in terms of tertiary prevention perspective and to provide scientific basis for the draft of psychological health interventions.Methods:Randomly selected five towns seventeen villages as study fields from Shandong University Health Research Base, Pingyin county, Liangshan county and Junan county. The research population included all of the15to49years old married women of child-bearing age who lived in the village for more than half year. The investigation was conducted by the means of questionnaire survey from October2009to December2009, and trained investigators gave face-to-face interviews to research population and filled in the questionnaire. The SCL-90scale was filled out by research population independently. The Access software was used to input survey data and data analysis was conducted by SPSS16.0software. Kruskal-Wallis test was used to make univariate analysis for SCL-90total scores and related factors. According to the third quantile of the SCL-90total scores, the research population was divided into two groups. One group was labeled "1", which meant worse psychological health, if the SCL-90total scores were higher than the third quantile, and the other group was labeled "0", which meant better psychological health, if the SCL-90total scores were lower than the third quantile. Binary Logistic model was used to analyze the association between psychological health status and menstrual or reproductive related factors.Results1. The general condition of research population.3397rural married women of child-bearing age comply with the inclusion criterion and are effective in this study. The average age of research population is38.38±7.43(19.33-49.75)years old. The distribution characteristics of the SCL-90total scores in research population:The total scores of SCL-90scale are statistically associated with ages, education levels, job occupations and marriage status among research population. The medians of the SCL-90total scores are higher in population of41-50years old, population with high school education level, population with business occupation and divorced or widowed population. The SCL-90total scores and every dimension scores are statistically associated with whether having injuries and sicknesses in two weeks, chronic diseases in half year and gynecological diseases. The medians of the SCL-90total scores are higher in population with injuries and sicknesses in two weeks, population with chronic diseases in half year and population with gynecological diseases. Social support status and whether having an experience of negative life events in one year are statistically associated with the SCL-90total scores.Among research population with menstruation the proportion of women who has irregular menstruation is10.31%, while the proportion of women who has menstruation pain is46.57%. The proportion of research population who has stopped menstruating is10.30%, and among these people who have stopped menstruation the proportion of population who is in menopause is44.00%, while the proportion of people with uterine or ovarian removal is12.00%. The average age of menopause is46.58±2.73(42.28-49.31) years old. The proportion of research people or their spouses who are infertile is0.44%in research population.2. The association between menstruation and psychological health status. The univariate analysis results show that the total scores of SCL-90scale are statistically associated with menstruation regularity, menstrual pain and the reason of menstruation cease in research population.①Menstruation regularity and psychological health status:Adjusted for general demographic situation, menstrual pain, physical health, social support and negative life events, the psychological health status of population with irregular menstruation are worse and the risk odds ratio is1.571time compared with population with regular menstruation (OR=1.571,95%CI:1.209-2.043).②Menstrual pain and psychological health status:Adjusted for general demographic situation, menstrual regularity, physical health, social support and negative life events, compared with population without menstrual pain, the risk of having worse psychological status is significantly higher in population with frequent menstrual pain.1.705time the risk (OR=1.705,95%CI:1.361-2.136) of having worse psychological status is shown in population with frequent menstrual pain and1.438time the risk (OR=1.43S,95%CI:1.181～1.752) is shown in population with occasional menstrual pain. The risk of having worse psychological status increases with the severity of menstrual pain symptoms.③The association between menopause situation and psychological health status:The univariate analysis results show that the total scores of SCL-90scale are statistically associated with the reason of menopause in research population. Adjusted for general demographic situation, physical health, social support and negative life events, compared with population with regular menstruation, the psychological health status of population in pregnancy is better (OR=0.877,95%CI:0.788～0.974), meanwhile the risk of having worse psychological status in postmenopausal population is1.918time(OR=1.918,95%CI:1.324-2.777). There is no statistical difference between the psychological health status of population with regular menstruation and population with uterine or ovarian removal.3. The association between reproduction situation and psychological health status.①The relationship of psychological health and the times of abortion or induced labor, the times of childbirth. The univariate analysis results show that the total scores of SCL-90scale are statistically associated with the times of abortion or induced labor. While there is no statistical association between the total scores of SCL-90scale and the times of childbirth in research population. Population who aborted or induced labored two times or more have higher total scores. Adjusted for general demographic situation, physical health, social support and negative life events, the psychological health status is statistically associated with the experience of abortion or induced labor. The risk of having worse psychological status in population who aborted or induced labored two times or more is1.612time compared with population who have no experience of abortion and induced labor(OR=1.612,95%CI:1.253-2.074).②The association between infertility (women or their spouses) and psychological health status. The univariate analysis results show that there is no statistical association between the total scores of SCL-90scale and infertility (women or their spouses). Adjusted for general demographic situation, physical health, social support and negative life events, multivariate analysis results show that there is also no statistical association between the psychological health and infertility in research population or their spouses.Conclusions1. There are statistical associations between psychological status and menstrual regularity, menstrual pain in rural married women of child-bearing age. Both irregular menstruation and menstrual pain will increase the risk of having worse psychological health status in rural women of child-bearing age, and the risk of having worse psychological status increases with the severity of menstrual pain symptoms.2. Miscarriage or induced abortion experiences are associated with the psychological health status of rural married women of child-bearing age. Miscarriage or induced abortion two times or more are risk factors that jeopardize psychological health of rural married women of child-bearing age.3. Menopause make negative effects on women’s psychological health and will increase the risk of having worse psychological health status.4. The level of psychological health status of rural married women of child-bearing age in pregnancy is higher in research population.Suggestion:The psychological health status of rural married women of child-bearing age is affected by menstrual and reproductive factors. We should strengthen propaganda, education and research on the psychological health problems related to menstruation and reproduction and improve the awareness of relative psychological health acknowledge. Some effective psychological interventions should be carried out for women with irregular menstruation, menstrual pain, women in perimenopause or women with abortion or induced labor experience so as to promote the psychological status of rural married women of child-bearing age. |
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