By Lora A. Connor B.A., 2008, California State University, Long Beach

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1 By Lora A. Connor B.A., 2008, California State University, Long Beach A Thesis Proposal December 2014 Committee Members: James Amirkhan, Ph.D. (Chair) Courtney Ahrens, Ph.D. Young-Hee Cho, Ph.D.

2 Agenda Summarize Research Question Menopausal Symptoms Neuroticism Stress & Menopause Exercise & Menopause The Present Study Methods Participants Materials Procedure Results Discussion Possible Limitations Implications Questions

3 Research Question Does the neuroticism personality trait influence menopausal symptoms? Hypothesis It is hypothesized that high scores on a neuroticism scale can predict increased negative menopausal symptoms (i.e., hot flashes, insomnia, depressed mood, and cognitive symptoms) above and beyond the effects of stressors and exercise.

4 Menopausal Symptoms Vasomotor Symptoms (i.e., hot flashes) Most common complaint due to changing hormone levels. A woman perspires profusely, her skin becomes flush, and her heart rate suddenly drops followed quickly by a raise in heart rate. Insomnia Insomnia may be caused by other menopausal symptoms (vasomotor, mood, changes in cognition, fluctuating hormone levels). Depressed Mood 19% to 29% of menopausal women report depressed mood. Estrogen deficiency may contribute to depressed mood. Forgetfulness (i.e., brain fog) Some researchers dispute the idea that menopausal women experience cognitive deficits. However, working memory and complex attention/vigilance have been found to be affected.

5 Definition The inclination to experience negative emotions (i.e., anxiety, distress, fear, sadness, anger, dissatisfaction, helplessness, irritability, and loneliness) and to react more negatively to stressors with which individuals feel an inability to cope. Implications Neuroticism Neurotic tendencies may have genetic influences, as the personality trait tends to remain stable over time. Individuals high in neuroticism are more prone to react strongly, and negatively, to stressful life events. Neuroticism has been shown to have negative effects on physical illnesses, which may impact menopausal symptoms as well.

6 Stress & Menopause Stress Women in the menopausal age group often experience significant stressors during this phase in their lives. High stress has been found to be related to: More hot flashes Insomnia Depressed mood Decreased cognitive function

7 Stress-Neuroticism Relationship Stress-Neuroticism Relationship Stressors are common to this age group (e.g., aging parents, children leaving, death of significant others, employment uncertainty, aging, etc.). Stress exacerbates menopausal symptoms. Neuroticism has been found to contribute to physical symptomology as well. It is easy to confound neuroticism with stress reactions, as variance attributed to stress may be due to the neurotic personality trait since both are evidenced by: Emotional instability Negative affect Psychological distress Lack of resilience Horner found a complex interaction between neuroticism, locus of control, and stressors to predict illness.

8 Exercise & Menopause Exercise Exercise may be related to improvements in menopausal symptoms: Aerobic activity helps improve: Vasomotor Insomnia Mood Memory symptoms Yoga helps improve: Insomnia Mood

9 The Present Study The focus of this study was to investigate whether stress alone or heightened sensitivity to stress is at the root of menopausal symptoms. Past studies have demonstrated a significant relationship between stressors and menopausal symptoms. Also, studies have found positive effects of exercise on menopausal symptoms. Therefore, to determine a clearer path between neuroticism and menopausal symptoms, stressors and exercise were important factors to control.

10 Methods: Participants Women 40 to 60 years old, average age 50.7 Of the 294 who completed the study questionnaire, 169 surveys were included in analysis 120 incomplete surveys 5 out-of-range responses Respondents reported exercising more hours than possible in a day Women having experienced surgical menopause were excluded.

11 Methods: Materials Screening Survey Hot flashes (1 mo), abnormal menstruation (6 mo), surgical menopause, HRT, or medications. Menopause Rating Scale (MRS) Measures common complaints and severity of symptoms Eysenck Personality Questionnaire - Brief Version (EPQ-BV) Measures Neuroticism Social Readjustment Rating Scale (SRRS) Measures objective stressors International Physical Activity Questionnaire (IPAQ) Measures amount of exercise Demographics Survey

12 Methods: Procedure Recruited Through Social Media & Ads Posted in Community Locations Facebook, Twitter and Google+ Respondents Visit a Link to the Survey Survey Monkey Surveys Delivered in Same Order for Each Participant Informed consent Screening Survey MRS EPQ-BV SRRS IPAQ Demographics Study Incentive Enter address to win a drawing for one-of-two $100 Amazon gift card.

13 Results Hypothesis Confirmed The study s hypothesis was confirmed, high levels of neuroticism are associated with increased negative menopausal symptoms above and beyond the levels of stressors and exercise.

14 Frequency Cauc Lat/Hisp Af-Amer Nat-Amer Asi/Pac-Isd Other Grmr HghSch Voc/tech SomeCol Bachler Master Doctoral Profess Other Frequency Frequency Results: Sample Characteristics Race/Ethnicity n = Educational Level n = Ethnicity/Race Educational Level to 29,999 Annual Income 53 30,000 to 59, ,000 to 119, ,000 to 179,999 Annuual Income n = ,000+ Prefer not to answer

15 Results: Scale Characteristics Cont. Means and standard deviations were high for both scales A lot of women reported having a lot of stress or getting a lot of exercise. However, the scores were spread out. Social Readjustment Rating Scale (SRRS), a measure of objective stressors M = SD = n = 289 International Physical Activity Scale (IPAQ), a measure of exercise M = SD = n = 227 Cronbach s alpha for the IPAQ was moderate (α =.42)

16 Means were both close to midrange and standard deviations were high Eysenck Personality Questionnaire Brief Version (EPQ-BV) a measure of neuroticism M = SD = n = 256 Menopausal Rating Scale (MRS) a measure of menopausal symptoms M = SD = 7.92 Results: Scale Characteristics n = 268 Cont. Internal Reliability for Neuroticism Menopausal Symptoms Scales Approximate Normative Populations EPQ-BV (α =.93) MRS (α =.87)

17 Results: Tests of Hypothesis Zero-order Correlations were calculated to determine any possible confounding demographic variables with neuroticism and menopausal symptoms Correlation found: Respondent's income Income level had a negative relationship between the study variables Measure M SD 1. Income 2. Stressors Exercise Neuroticism.28**.19** Menopausal Symptoms.18*.28**.20**.68**

18 Results: Tests of Hypothesis Hierarchical Regression was used to test the hypothesis that high levels of neuroticism are associated with increased menopausal symptoms Step 1: Income, Stressors, Exercise Step 2: Neuroticism All four predictors were significant, F(4, 164) = 65.61, p <.001, adjusted R 2 =.61 Four predictors explained by 61% of the variance in menopausal symptoms

19 Results: Tests of Hypothesis Step 1: 19% of Variance in Symptoms Income t (165) = 3.12, p <.01 Stressors t (165) = 4.10, p <.001 Exercise t (165) = 3.15, p <.01 Step 2: 43% of the Variance in Symptoms Neuroticism t (164) = 13.54, p <.001 Cont.

20 Results: Secondary Analyses Measure MRS Psychological Zero-order Correlations Performed for Secondary Analyses with Stressors/Exercise & Symptoms Sex Difficulties & Change in Eating Habits Stressors Correlated with all Symptom Subscales (psychological, somatovegetative, and urogenital) Personal Injury/Illness & Change in Financial Status Stressors Related to Two Subscales (psychological and urogenital) Home Mortgage & Living Alone Related to Two Subscales (psychological and somatovegetative) MRS-Somato- Vegetative MRS- Urogenital Divorce.13* Marital Separation.12* Marriage * Sex Difficulties.16*.18**.31** Death of Close Friend.12* Death of Family Member Change Financial State Mortgage over $100,000 Personal Injury/Illness *.16*.09.21**.13*.16*.11.19**.12.15*

21 Transportation Total * Results: Secondary One Negative Correlation: More Vigorous Leisure Time Exercise Related to Less Psychological Symptoms More Vigorous Exercise at Work Related to more Psychological Symptoms Analyses More Exercise During Work, Transportation, and Domestic Chores the More Urogenital Symptoms More Moderate & Vigorous Exercise at Work Related to More Somato- Vegetative Symptoms Measure MRS Psychological MRS-Somato- Vegetative MRS- Urogenital Total Exercise.13*.15*.22** Walking ** Moderate * Vigorous * Work Total.13.17**.20** Walking ** Moderate.07.16*.13* Vigorous.13*.15*.16*

22 Symptoms Discussion The hypothesis was supported: high levels of the neuroticism personality trait intensified menopausal symptoms even after income level, stressors, and exercise had been statistically controlled. As expected, women in this age group tended to report high numbers of life stressors, however, causal direction cannot be inferred. Stressors Neuroticism Symptoms With the exception of the kind of exercise done during one s leisure time on psychological symptoms, physical activity (at work, at home, or in between) was related to more extreme symptoms. Exercise Symptoms

23 Possible Limitations Limitations Respondents were self-selecting and mostly Caucasian May not have been taken by the person for whom it was intended Only women with computer skills Respondents may have answered differently from paper survey Because several surveys were taken at the same time, response bleeding or response fatigue may have occurred Since analysis was correlational, the direction of causality remains undetermined Countermeasures After data was screened, only 5 surveys were lost due to out-of-range responses. Anonymity may have yielded more forthcoming answers To remedy response bleeding, future studies may consider delivering the questionnaires on different days or implementing distracting activities. A longitudinal design might help with directionality.

24 Implications The findings could potentially help healthcare professionals identify women at risk for menopausal difficulties. A simple personality questionnaire could be used to determine a woman s susceptibility to extreme menopausal symptoms. However, this may not be appropriate for minority women. Since the causes are vague why some women experience extreme symptoms and others do not, it would be helpful to have a measurable vulnerability variable such as neuroticism to target interventions for women most in need. Secondary results may inform health care professionals on other variables, like stress and exercise, that may impact severe symptoms.

25 Questions

26 Methods: Materials Screening Survey After informed consent. Hot flash symptoms within the previous month Experienced missed or abnormal menstrual bleeding in the past 6 months Experienced menopause as a result of surgery Medications or hormone replacement therapy (HRT) Menopause Rating Scale (MRS) 11-item scale measuring common complaints and severity of menopausal symptoms. 5-point Likert scales ranging from 0 (none) to 4 (very severe). High test-retest reliability across countries: Cronbach s alphas from.83 to.87 Good validity with high sub-scores to total-scores (r = ) However, subscales may not be fully independent, as sub-scales have been found to intercorrelate (r = )

27 Methods: Materials (cont.) Eysenck Personality Questionnaire Brief Version (EPQ-BV) 24-item questionnaire measuring both extraversion and neuroticism. Using 12-item neuroticism subscale only. Uses a 5-point Likert scales ranging from 1 (not at all) to 5 (extremely). High test-retest reliability with coefficient alphas for neuroticism from.92 to.90. Good validity when comparing with original Eyseneck Personality Questionnaire Revised (r =.88.89). Social Readjustment Rating Scale (SRRS) 43-item checklist measuring current objective stressors. Scores 150 or less are low, 150 to 299 are moderate, and 300 or more are high High test-retest reliability with Cornbach s alphas from.72 to.80 This scale has been shown to correlate with illness symptoms. Those with high scores were 80% more likely to develop illness.

28 Methods: Materials (cont.) International Physical Activity Questionnaire (IPAQ) 27-item questionnaire measuring 5 activity domains (i.e., leisure, domestic, gardening, work, transportation) over the previous week. Total scores are computed by summing the duration (in minutes) and frequency (days) of activities in all domains. High test-retest reliability at one week with an average score of r =.80. Moderate criterion validity of r =.30 measured by comparing summed scores from motion detectors worn by study participants Demographics Survey Gender Age Ethnicity Household size Income level Education level address (optional: for entry into drawing for study incentive).

The Study of Relationship between Neuroticism, Stressor and Stress Response

International Journal of Economics and Finance; Vol. 7, No. 8; 2015 ISSN 1916-971X E-ISSN 1916-9728 Published by Canadian Center of Science and Education The Study of Relationship between Neuroticism,