An integrative cognitive vulnerability model of menopausal hot flushes and night sweats
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1 An integrative cognitive vulnerability model of menopausal hot flushes and night sweats Valerie Brown Research Supervisors & Associates Associated Professor Christina Bryant, Professor Fiona Judd, Ms Lydia Brown
2 LARGE VARIATIONS IN THE EXPERIENCE OF VASOMOTOR SYMPTOMS Large differences across individuals and cultures in the experience of vasomotor symptoms (prevalence, duration, frequency, bothersomeness) There is increasing evidence that a range of factors plays a role in the experience of flushes: Ø hormonal and genetic differences, cultural attitudes, lifestyle factors (smoking, exercise, BMI), socio-economic status, climate Ø psychological factors What are those psychological factors (Freeman & Sherif, 2007; Na4onal Ins4tutes of Health, 2004; Sievert, 2006, Hunter et Chilcot, 2013)
3 THEORETICAL FRAMEWORK Hunter and colleagues cognitive models of hot flushes (1995, 2007, 2010, 2013) Strong evidence of a mediative pathway of beliefs about the menopause in the experience of flushes Internal & external factors Stress Anxiety Somatic amplification Education Beliefs about the menopause VMS problem rating Smoking Alcohol Optimism Somatic amplification Exercise VMS perceived frequency
4 RESEARCH QUESTIONS What cognitive/emotional factors influence menopausal beliefs What are the specific relationships between cognitive/emotional factors, menopausal representations, the appraisal of HF/NS, and coping strategies What is the best cognitive model to understand the experience of vasomotor symptoms
5 PROPOSED COGNITIVE VULNERABILITY MODEL OF VASOMOTOR SYMPTOMS Cogni-ve & Emo-onal factors Menopausal representa-ons VMS appraisal Coping strategies
6 SELECTION OF COGNITIVE/EMOTIONAL FACTORS Cogni-ons/emo-ons associated with VMS Hypervigilance to soma4c symptoms Nega-ve, catastrophic thoughts about self and consequences of VMS (irrita4on, panic, suffoca4on) Helplessness, nega-ve thinking (frustra4on, despair) Study cogni-ve and emo-onal factors Anxiety sensi-vity Catastrophic thinking Depressive thinking Embarrassment or social anxiety linked to appearance and unamrac4veness, especially in work seongs and/or company of men Body consciousness/shame Lack of self- efficacy/coping skills, thoughts of losing of control Mastery/control beliefs Stress Perceived stress
7 PROPOSED COGNITIVE VULNERABILITY MODEL OF VASOMOTOR SYMPTOMS Cogni-ve & Emo-onal factors Menopausal representa-ons VMS appraisal Coping strategies Catastrophic Thinking Control Beliefs Depressive thinking Perceived Stress Anxiety Sensi4vity Body Consciousness Cogni4ve & Emo4onal Representa4ons Perceived frequency Bothersomeness Daily interference Avoidance Cooling Posi4ve Strategies Dimensions of cogni-ve menopausal representa-on: Iden%ty: Number of symptoms iden4fied as part of my menopause Timeline: How long will my menopause last Consequences: Evalua4on of the seriousness of my menopause and its impact Control: How much control do I have over treatment/outcome
8 RESEARCH METHODOLOGY Study part of the ongoing Rural Mental Health Research Series research (Royal Women Hospital and Melbourne University) Random sample from electoral roll in a rural area from northern NSW to southern Victoria Inclusion criteria: women aged between years-old 1,644 questionnaires sent: 517 positive responses 31.4% response rate For this study, only peri- and postmenopausal women 1 who experienced vasomotor symptoms at time of responding and also completed the Menopause Representations Questionnaire 1 were included n = According to STRAW +10 criteria 2 (MRQ, Hunter & O Dea, 2001)
9 SOME SAMPLE DESCRIPTIVE STATISTICS HOT FLUSHES EXPERIENCE & MENOPAUSAL STATUS Sample menopausal status 14% Sample menopausal status Perceived frequency (per day/night) 14% 86% Hot flushes: mean = 2.97 (4.97) Night sweats: mean = 1.50 (1.67) Perimenopausal Postmenopausal 86% Bothersomeness: mean = 4.94 (2.09) 5 items Scale from = not at all bothered 10 = very bothered Perimenopausal Postmenopausal Daily Interference: mean = 3.01 (2.34) 10 items Scale from = completely interfere 10 = completely interfere Sleep: 5.98 (2.92) Mood: 3.43 (3.00) Sexual activity: 3.57 (3.40) Concentration: 3.52 (3.00)
10 SOME SAMPLE DESCRIPTIVE STATISTICS DEMOGRAPHICS Age 54.3 (3.5) BMI 27.9 (6.4) Overweight range Australian 94.2% Married 77.8% Have at least one child 92.4% Lives with partner (with or without children) 80.7% Working part- %me or full- %me 81.3% Educa%on: Secondary college 43.3% Educa%on: TAFE 30.4% Educa%on: University 22.8% Had an hysterectomy 5.3% Had a double oophorectomy 1.8% Had both above 5.8% Currently using HRT 1.2% Currently using an%depressants 12.3%
11 COGNITIVE VULNERABILITY MODEL OF VASOMOTOR SYMPTOMS Menopausal representa-ons Cogni4ve & Emo4onal Representa4ons VMS Bothersomeness Daily interference due to VMS VMS Perceived Frequency
12 COGNITIVE VULNERABILITY MODEL OF VASOMOTOR SYMPTOMS VMS Bothersomeness Menopausal representa-ons 1.07 Daily interference due to VMS.11 VMS Perceived Frequency
13 COGNITIVE VULNERABILITY MODEL OF VASOMOTOR SYMPTOMS Catastrophic thinking Control beliefs VMS Bothersomeness Depressive thinking Perceived stress Anxiety sensi-vity Menopausal representa-ons VMS Perceived Frequency 1.08 Daily interference due to VMS Body consciousness
14 COGNITIVE VULNERABILITY MODEL OF VASOMOTOR SYMPTOMS Catastrophic thinking.05 Control beliefs.23 VMS Bothersomeness Depressive thinking Perceived stress Anxiety sensi-vity Menopausal representa-ons VMS Perceived Frequency 1.08 Daily interference due to VMS Body consciousness
15 COGNITIVE VULNERABILITY MODEL OF VASOMOTOR SYMPTOMS.36 Catastrophic thinking Control beliefs VMS Bothersomeness Depressive thinking.07 Menopausal representa-ons 1.07 Daily interference due to VMS.11 Perceived stress.10 VMS Perceived Frequency.55
16 COGNITIVE VULNERABILITY MODEL OF VASOMOTOR SYMPTOMS Catastrophic thinking Control beliefs VMS Bothersomeness Coping Avoidance Depressive thinking.07 Menopausal representa-ons 1.07 Daily interference due to VMS.06 Coping Cooling Perceived stress VMS Perceived Frequency Body Consciousness -.30 Coping Posi-ve behaviour.55
17 COGNITIVE VULNERABILITY MODEL OF VASOMOTOR SYMPTOMS Catastrophic thinking Control beliefs VMS Bothersomeness R 2 =.61 R 2 =.44 Coping Avoidance Depressive thinking Menopausal representa-ons Daily interference due to VMS Coping Cooling R 2 =.48 R 2 =.65 R 2 =.11 Perceived stress VMS Perceived Frequency R 2 =.13 Body Consciousness Coping Posi-ve behaviour R 2 =.20 Table 1 Fit Indices of the Integrative Vulnerability Model of Vasomotor Symptoms df X 2 p TLI CFI RMSEA (90% CI) Model ( )
18 TAKE HOME MESSAGES Catastrophic thinking, control beliefs, depressive thinking and stress individually predict menopausal representations, which in turn predict appraisal of flushes (mediation pathway) but there are also direct effects. AND other factors certainly play a part in forming beliefs about the menopause: medical practitioners' opinions, media, cultural factors (stereotyping), friends and family (partners and mothers) Flushes bothersomeness is predicted by a range of factors: perceived frequency of flushes, menopausal representations (or beliefs), control beliefs, catastrophic thinking, depressive thinking. Menopausal representation, bothersomeness, not perceived frequency predicts daily interference due to flushes. Catastrophic thinking and perceived stress also predict daily interference due to flushes. Flushes appraisal predicts choice of coping strategies but coping strategies also likely to influence flushes appraisal (feedback loop).
19 CONCLUSIONS How women view their menopause is an important factor in flushes appraisal and, addressing the cognitive and emotional content of menopausal beliefs, as well as women s cognitive vulnerabilities, may greatly enhance symptom experience.
20 Thank you for your time
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