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Relationship between personality, psychological and somatic symptoms, and the menstrual cycle
Perron. indicrd. Dt# Vol.I I. No. 5, pp. 457461. Printed in Grca~ Britain. All nghts reserved
1990
0191-8869 90 53.00 + 0.00 Copyright c 1990 Pergamon Press plc
RELATIONSHIP BETWEEN PERSONALITY, PSYCHOLOGICAL AND SOMATIC SYMPTOMS, AND THE MENSTRUAL CYCLE EVA
HERRERA,’J&s
G~MEZ-AMOR,‘* Jo& M. MARTiNEZ-SELVA’ and MANUELATO’
’ Departamento
de Ciencias Metodologia y An&is
Morfologicas, Anatomia Patologica de1 Comportamiento, Universidad (Received
I5 August
y Psicobiogia and 2Departamento de Murcia, 30071, Murcia, Spain
de
1989)
Summary-The relationship between personality variables and menstrual cycle symptomatology was studied in a sample of 40 young women (19-24 yr) with different scores in neuroticism and depression. Subjects were grouped into spontaneous ovulatory and anovulatory cycles according to basal body temperature data. Women were asked to complete Spielberger’s State-Trait Anxiety Inventory, Moos’ Menstrual Distress Questionnaire and a psychosomatic symptoms questionnaire during the menstrual, ovulatory and premenstrual phases. Significant changes in the total scores and in the subscales of pain, water retention and negative affect of the Menstrual Distress Questionnaire throughout the menstrual cycle regardless of neuroticism and depression were observed, with the highest symptomatology levels in the menstrual phase. Depressive women showed higher degrees of pain during the menstrual phase, and those depressive women with spontaneous anovulatory cycles reported the highest symptomatology in the total scores of the Menstrual Distress Questionnaire during the menstrual phase. In conclusion. neuroticism, depression and cycle condition can not explain by themselves all the changes during the menstrual cycle phases found in this research.
INTRODUCTION Menstrual cycle symptomatology has been associated with individual differences in neuroticism and depression, there being a greater intensity of psychological and somatic symptoms in women with the highest neuroticism or depression levels (Coppen & Kessel, 1963; Ladisich, 1977; Taylor, 1979; Siegel, Meyers & Dineen, 1986; Van der Ploeg, 1987). In addition, psychological changes during the menstrual cycle appear to be minimal in healthy populations (Abplanalp, Donnelly & Rose, 1979). Therefore, a consideration of the influence of personality variables in menstrual cycle symptomatology is needed. On the other hand, significant differences in menstrual cycle symptomatology have been found between women taking and not taking oral contraceptives with some relief of menstrual symptoms among pill users (Silbergeld, Brast & Noble, 1971). Also, menstrual fluctuations in mood are reported not to be present in pilltaking women (Rossi & Rossi, 1980). However, differences in symptomatology between spontaneous ovulatory (SO) and spontaneous anovulatory (SA) cycles have not been studied, in spite of the fact that there is an important proportion of SA cycles among young women (Metcalf & Mackenzie, 1980). In the present study changes in cycle-related psychological and somatic symptoms were examined in a sample of young women with different scores in neuroticism and depression. It was expected that women with higher scores in neuroticism and/or depression would show higher levels of symptomatology related to the menstrual cycle, and that women with SO cycles would present a higher degree of symptomatology than women with SA cycles. To minimize the effects of social expectations on menstrual symptomatology (Sommer, 1973; Parlee, 1974), the method of assessment of women’s symptomatology was concurrent and the purpose of the study was disguised. METHOD Subjects
Forty volunteers, psychology female undergraduates at the University of Murcia, constituted the sample of the present study. All were unmarried, nulliparous, aged between 19-24 yr (mean *To whom
all correspondence
should
be addressed. 457
EVA HERRERAer al.
458
age = 21.9, SD = 1.36). Ss were not taking oral contraceptives and drugs that could affect their neuroendocrine system. All women reported regular cycles (mean length = 28.7, SD = 2.1) in the previous 3 months and no history of gynaecological disorders. The aim of this study was disguised. Once the experiment was finished the Ss were informed about the actual aim of the research. Questionnaires
Depression was assessed by the Beck Depression Inventory (Beck, Ward, Mendelson, Mock & Erbaug, 1961; Conde & Useros, 1975) and neuroticism was measured by the Eysenck Personality Questionnaire (EPQ-Eysenck & Eysenck, 1975; TEA, 1986). Psychological and somatic symptoms related to the menstrual cycle were assessed by the Menstrual Distress Questionnaire (MDQ-Moos, 1968), the State-Trait Anxiety Inventory (STAI-Spielberger, Gorsuch & Luschene, 1970; TEA, 1982), and a Psychosomatic Symptoms Questionnarie (PSQGomez-Amor, 1987). Procedure
Three groups were formed from neuroticism scores on the EPQ: High Neuroticism (HN; per centile scores 99-75; n = 11; mean = 87.18, SD = 6.29), Mean Neuroticism (MN; per centile scores 70-30; n = 14; mean = 45.35, SD = 13.81), and Low Neuroticism (LN; per centile scores 25-l; n = 15; mean = 18.66, SD = 7.40). Two groups were formed according to depression scores on the Beck Depression Inventory: Depressive (D; direct scores > 11; mean = 15.00, SD = 4.67) and Nondepressive (ND; direct scores < 11; mean = 4.24, SD = 2.78). Thus, each S was included in two groups, one of neuroticism and one of depression. Menstrual cycles were divided in three phases: menstrual (l-4 days), ovulatory (12-16 days), and premenstrual (24-28 days). The Ss were instructed to record on a graph, before getting out of bed, their morning sublingual temperature during a complete menstrual cycle to estimate the ovulation point. This point was defined as a drop in Basal Body Temperature (BBT) between 0.2 and 0.4’C, followed by a steady temperature rise for two or three consecutive days of, at least, O.l”C above the normal BBT prior to the temperature drop. In our study, 23 women (57.5%) showed SO cycles, and 17 women (42.5%) SA cycles. The proportion of SA and SO cycles found in our sample of young women are similar to those found in previous reports (Metcalf & Mackenzie, 1980). All Ss were asked to complete MDQ, STAI, and PSQ questionnaires during the menstrual, ovulatory, and premenstrual phases. Data analysis
Neuroticism was analysed by a 2 x 3 x 3 mixed design with Cycle Condition (spontaneous ovulatory; spontaneous anovulatory) and Neuroticism (high neuroticism; mean neuroticism; low neuroticism) as between-Ss factors, and Phase (menstrual; ovulatory; premenstrual) as within-Ss factor. Depression was analysed by a 2 x 2 x 3 mixed design with Cycle Condition and Depression (depressive; nondepressive) as between Ss factors, and Phase as within-Ss factor. An univariate analysis of variance (ANOVA) was performed for each dependent variable, and multivariate analysis of variance (MANOVA) on the within-Ss portion (O’Brien & Kaiser, 1985). A variable of the within-Ss portion was considered significant only when the Pilai’s trace multivariate statistic showed it (Wilkinson, 1988). Multiple comparison tests were performed according to the Bonferroni procedure. All multivariate analysis of variance and multiple comparison tests were analysed with the 4.0 version of the SYSTAT statistical package (Wilkinson, 1988). RESULTS State-Trait
Anxiety Incentory
Significant differences were found between the neuroticism groups on state [F(2,34) = 3.934, P < 0.051 and trait anxiety [F(2,34) = 13.628, P < O.OOl]. Means were on state anxiety 63.96 (SD = 24.86), 53.57 (SD = 24.43), and 39.68 (SD = 29.46) for the HN, MN, and LN groups respectively. The HN, MN, and LN groups had mean trait anxiety scores of 72.63 (SD = 20.51),
Personality.
psychological
and somatic
459
symptoms
Table I. F values for multiple comparisons with Bonferroni’s procedure Measure
Variable
STAI State-Anxiety Trait-Anxiety
MDQ Pain
N N
High vs Low High vs Low High vs Mean
P
Menstrual Menstrual Ovulatory Menstrual Menstrual Menstrual Menstrual Menstrual Menstrual Menstrual Menstrual
Water retention
DxP P
Negative affect
P
Total scores
P
F values
Comparison
CxDxP
f(1.34)=7.277* F(l.34) =23&X?*‘* F(1.34) = 1&x531***
vs Premenstrual VI (Ovulatory + vs Premenstrual YS Premenstrual vs Ovulatory vs (Ovulatory + vs Premenstrual vs (Ovulatory + vs Premenstrual vs (Ovulatory + vs Premenstrual
Premenstrual)
Premenstrual) Premenstrual) Premenstrual)
F(l.34) F‘(1.34) F(l,36) P(l.34) F(l.34) P(1.34) P(1.34) F(l.34) P(1.34) F(l.34) F(l.36)
= 13.441*** = 10.810” = 7.071. 16.729’ = 22.122*** = 16.749’** = 9.641.. = 8.702** = 15.321*** = 10.920** = 12.867***
N = Neuroticism; D = Depression; C = Cycle condition; P = Phase. * = P < 0.05; l * = P < 0.01; l ** = P < 0.001.
41.47 (SD = 21.08), and 26.93 (SD = 22.11) respectively. F values for comparisons between the neuroticism groups are shown in Table 1. Pearson product moment correlations showed significant correlations between neuroticism and state anxiety (r = 0.437, P < O.Ol), and neuroticism and trait anxiety (r = 0.718, P < 0.01). In addition, there were significant differences between the two groups of depression on state [F(1,36) = 6.079, P < 0.051 and trait anxiety [F(1,36) = 26.404, P < O.OOl]. State anxiety was greater in the D group (mean = 65.18, SD = 24.17) than the ND (mean = 45.93, SD = 27.95), and trait anxiety was also greater in the D -group (mean = 72.81, SD = 19.98) than the ND (mean = 33.88, SD = 22.87). Pearson product moment correlations showed significant correlations between depression and state anxiety (r = 0.417, P < 0.02), and depression and trait anxiety (r = 0.727, P < 0.01). Psychosomatic Symptoms Questionnaire
Symptomatology scores did not show significant differences between the menstrual cycle phases. Significant effects due to neuroticism, depression, or cycle condition were not observed. Menstrual Distress Questionnaire
There were significant cycle-related changes on the total scores of the MDQ and on the subscales of pain, water retention, and negative affect, with the highest symptomatology levels in the menstrual phase (see Table 2). Table 1 shows F values for comparisons between phases. Significant differences were obtained between the two depression groups on concentration [F(1,36) = 4.178, P < 0.051. Mean for the D group was 14.57 (SD = 5.79) and 11.81 (SD = 4.83) for the ND group. A significant Depression x Phase interaction was observed on the pain subscale (see Table 2). Significant differences were observed between ovulatory and premenstrual phases (see Table 1). Pain was greater in the D group (mean = 17.72, SD = 5.46) than the ND group (mean = 15.24, SD = 4.34) in the ovulatory phase. Mean pain scores in the D group were 13.81 (SD = 4.64) and 15.72 (SD = 5.58) in the ND group during the premenstrual phase. However, the highest levels of Table 2. Means, standard deviations and F values of ANOVA and MANOVA for the significant MDQ scales Significant interaction
Phase Means (SD in parentheses)
MDQ Pain Behavioral change Water retention Negative affect Total scores
Menstrual 18.40 14.05 8.07 21.60 103.10
(5.57) (6.09) (3.46) (8.03) (27.21)
Ovulatory 15.92 12.25 5.85 19.62 94.05
(4.80) (5.68) (2.53) (8.10) (27.62)
Premenstrual
Univariate
Multivariate
IS.20 12.65 7.20 18.75 94.45
6.883* 2.229NS 10.743*** 3.259. 4.372’
7.112’* 2.04ONS 9.49v** 3.465’ 5.832”
P = Phase; D = Depression; C = Cycle condition. Univariate d.f. = 2.72: Multivariate d.f. = 2.35. ‘P -z 0.05; l*f < 0.01: l**/’ < 0.001; NS, non significant.
F values
F values
(5.40) (6.06) (2.98) (8.40) (30.75)
DxP CxDxP CxDxP
Univariate
Multivariate
3.131’ 3.464. 5.029’.
3.445’ 3.074NS 7.338..
160
EVA HERRERAet al. Depress’Ne-Anovuhtory Depressive-OvLllatory Nondepressive-Anovulatory Nondepressive-Ovulatory
Menstrual
Ovulatory
Premenstrual
CYCLE PHASE Fig. 1. MDQ
total scores considering
Depression
and Cycle Condition.
pain were observed in the D group (mean = 18.36, SD = 6.01) and in the ND group (mean = 18.41, SD = 5.39) during the menstrual phase. In addition, a significant Cycle Condition x Depression x Phase interaction was observed in the total scores of the MDQ (see Table 2). It may be seen from Table 1 that multiple comparison tests showed a significant difference between menstrual and premenstrual phases. As seen in Fig. 1, depressive women with SA cycles had higher levels of symptomatology than the remaining groups of women in the menstrual phase, and showed lower levels of symptomatology in the premenstrual phase. DISCUSSION
Significant differences between the menstrual cycle phases in the scales of pain, water retention, and negative affect, and in the total scores of the MDQ were observed. The highest levels of symptomatology were found during the menstrual phase in comparison with both premenstrual and ovulatory phases. In the remaining MDQ scales, and in the STAI and PSQ questionnaires no significant changes associated with the cycle phases were found. These findings are consistent with the results obtained by other researchers which have found significant changes in symptomatology when assessed by MDQ across the cycle phases (Moos, Kopell, Melges, Yalom, Lunde, Clayton & Hamburg, 1969; Silbergeld et al., 1971; Marriot & Faragher, 1986). These authors have reported higher symptomatology levels in the menstrual as well as in the premenstrual phase. These results might be explained by the use of different population samples and a different range of the age samples. Thus, in our study the sample was restricted to young women (19-24 yr), who usually show greater symptomatology in the menstrual phase, with an increased severity of the premenstrual symptoms with age (Dalton, 1964; Moos, 1968). Contrary to our predictions neuroticism had no significant effects on menstrual cycle symptomatology. Such findings contrast with results of other researchers that have found a direct relationship between neuroticism and paramenstrual symptomatology (Coppen & Kessel, 1963; Ladisich, 1977; Taylor, 1979; Van der Ploeg, 1987). On the other hand, women with high neuroticism scores obtained higher trait and state anxiety (STAI) scores than women with mean and low neuroticism scores, regardless of Cycle Condition and Phase factors. Depression had significant effects on the menstrual cycle symptomatology but only for the pain subscale and-in interaction with Cycle Condition-for the total scores of the MDQ. Depressive women showed the highest pain levels during the menstrual phase with a significant drop in the premenstrual period. In the same way, depressive women with SA cycles showed the highest levels of symptomatology during the menstrual phase with a significant drop in the premenstrual phase on the total scores of the MDQ. However, this result is not directly comparable with findings of other researchers (Silbergeld et al., 1971; Rossi & Rossi, 1980) because the anovulatory cycles examined in their studies were not spontaneous but induced by oral contraceptives. In addition,
Personality. psychological and somatic symptoms
461
depressive women had greater trait and state anxiety (STAI) and lower concentration (MDQ) than nondepressive women, regardless of Cycle Condition and Phase factors. Therefore, the results of this study do not support the notion that neuroticism or the presence of depressive states are clearly associated with an increase in the paramenstrual symptomatology in a nonclinical population. It is difficult to explain the discrepancies in the results of different studies aimed at investigating the relationships between personality variables and menstrual cycle symptomatology. However, Maloney et al. (1982) have pointed out the existence of a wide range of methodological considerations on this type of research as a possible cause of these discrepancies. We can conclude that there is not a clear relationship between personality variables and menstrual cycle symptomatology. Only the presence of depression in association with other variables as Cycle Condition (ovulatory and anovulatory) may influence to some degree the paramenstrual symptomatology, but both depression and cycle condition appear insufficient to explain all the changes observed throughout the menstrual cycle phases. The results of our study suggest that the adoption of a multifactorial perspective (Smith, 1975; Clare, 1985) including psychological, social, psychophysiological and hormonal variables, is necessary to improve our understanding of this biological rhythm. REFERENCES Abplanalp, J. M.. Donnelly, A. F. & Rose, R. M. (1979). Psychoendocrinology of the menstrual cycle: 1. Enjoyment of daily activities and moods. Psychosomaric Medicine, 41, 587-604. Beck, A. T., Ward, C. H., Mendelson, M., Mock, J. & Erbaug, J. (1961). An inventory for measuring depression. Archives of General Psychiatry,
4, 561-571.
Glare, A. W. (1985). Premenstrual syndrome: Single or multiple causes? Canadian Journal of Psychiatry, 30, 474-482. Conde, V. & Useros, E. (1975). Adaptation castellana de la escala de evaluation conductual para la depresion de Beck. Rev&a
de Psiquiatria
y Psicologi’a MPdica de Europa y America,
Ii’, 217-236.
Coppen. A. SCKessel, N. (1963). Menstruation and personality. British Journul of Psychiatry, 109, 71 I-721. Dalton, K. (1964). The premenstrual syndrome. Springfield, Ill.: Thomas. Eysenck, H. J. & Eysenck, S. B. G. (1975). Manual of the Eysenck Personality Questionnaire (Junior and Adult). London: Hodder & Stoughton. Gomez-Amor, J. (1987). Indices psicofisiologicos de activation durante las fases del cicio menstrual humano. Unpublished Ph.D. thesis, University of Murcia, Spain. Ladisich, W. (1977). Influence of progesterone on serotonin metabolism: A possible causal factor for mood changes. Psychoneuroendocrinology,
2, 257-266.
Maloney, P., Deitchman, R. & Wagner, E. E. (1982). Consistency of some personality measures as a function of stage of menstruation. Journal of Personality Assessmenr, 46, 597-602. Marriot, A. & Faragher, E. B. (1986). An assessment of psychological state associated with the menstrual cycle in users of oral contraception. Journal of Psychosomatic Research, 30, 4147. Metcalf, M. G. & Mackenzie, J. A. (1980). Incidence of ovulation in young women. Journal of Biosocial Science, I2, 345-352.
Moos, R. H. (1968). The development of a Menstrual Distress Questionnaire. Psychosomatic Medicine, 30, 853-867. Moos, R. H., Kopell, B. S., Melges, F. T., Yalom, I. D., Lunde, D. T., Clayton, R. B. & Hamburg, D. A. (1969). Fluctuations in symptoms and moods during the menstrual cycle. Journal of Psychosomatic Research, 13, 37-44. O’Brien, R. G. & Kaiser, M. K. (1985). MANOVA method for analyzing repeated measures designs: An extensive primer. Psychological
Bulletin, 97, 3 16-333.
Parlee, M. B. (1974). Stereotypic beliefs about menstruation: A methodological note on the Moos Menstrual Distress Questionnaire and some new data. Psychosomatic Medicine, 36, 229-240. Rossi, A. S. & Rossi, P. E. (1980). Body time and social time: Mood patterns by menstrual cycle phase and day of week. In Parsons, J. (Ed.) The psychology of sex dighrences and sex roles. New York: Hemisphere. Siegel, J. P., Meyers, B. & Dineen, M. K. (1986). Comparison of depressed and nondepressed women with severe premenstrual tension syndrome. Psychotherapy Psychosomatic, 45, 113-l 17. Silbergeld, S., Brast, N. & Noble, E. P. (1971). The menstrual cycle: A double-blind study of symptoms, mood and behavior, and biochemical variables using enovid and placebo. Psychosomatic Medicine, 33, 41 l-428. Smith, S. L. (1975). Mood and the menstrual cycle. In Sachar, E. J. (Ed.), Topics in psychoneuroendocrinology. New York: Gnure & Straton. Sommer, B. (1973). The effect of menstruation on cognitive and perceptual-motor behavior: A review. Psychosomatic Medicine, 35, 5 15-534. Spielberger, C. D., Gorsuch, R. L. Jc Lushene, R. E. (1970). Manualfor rhe Sfafe-Trait Anxiety Inventory. Palo Alto, Calif.: Consulting Psychologists’ Press. Taylor, J. W. (1979). Psychological factors in the aetiology of premenstrual symptoms. Ausrraliun and New Zealand Journal of Psychiafry,
13. 3541.
TEA Ediciones, S. A. (1982). STAI Cuestionario de Ansiedad Esrado-Rasgo: adapracibn espatiola. Madrid: Ediciones. TEA Ediciones, S. A. (1986). EPQ-AJ Cuesrionario de Personalidad para nitios y Adulros: adaptacibn espariola. Madrid: Ediciones. Van der Ploeg, H. M. (1987). Emotional states and the premenstrual syndrome. Personality and Indiuidual Dl$erences, 8, 95-100.
Wilkinson, L. (1988). SYSTAT:
The system for srarisrics. Evanston, Ill.: Systat.
1990
0191-8869 90 53.00 + 0.00 Copyright c 1990 Pergamon Press plc
RELATIONSHIP BETWEEN PERSONALITY, PSYCHOLOGICAL AND SOMATIC SYMPTOMS, AND THE MENSTRUAL CYCLE EVA
HERRERA,’J&s
G~MEZ-AMOR,‘* Jo& M. MARTiNEZ-SELVA’ and MANUELATO’
’ Departamento
de Ciencias Metodologia y An&is
Morfologicas, Anatomia Patologica de1 Comportamiento, Universidad (Received
I5 August
y Psicobiogia and 2Departamento de Murcia, 30071, Murcia, Spain
de
1989)
Summary-The relationship between personality variables and menstrual cycle symptomatology was studied in a sample of 40 young women (19-24 yr) with different scores in neuroticism and depression. Subjects were grouped into spontaneous ovulatory and anovulatory cycles according to basal body temperature data. Women were asked to complete Spielberger’s State-Trait Anxiety Inventory, Moos’ Menstrual Distress Questionnaire and a psychosomatic symptoms questionnaire during the menstrual, ovulatory and premenstrual phases. Significant changes in the total scores and in the subscales of pain, water retention and negative affect of the Menstrual Distress Questionnaire throughout the menstrual cycle regardless of neuroticism and depression were observed, with the highest symptomatology levels in the menstrual phase. Depressive women showed higher degrees of pain during the menstrual phase, and those depressive women with spontaneous anovulatory cycles reported the highest symptomatology in the total scores of the Menstrual Distress Questionnaire during the menstrual phase. In conclusion. neuroticism, depression and cycle condition can not explain by themselves all the changes during the menstrual cycle phases found in this research.
INTRODUCTION Menstrual cycle symptomatology has been associated with individual differences in neuroticism and depression, there being a greater intensity of psychological and somatic symptoms in women with the highest neuroticism or depression levels (Coppen & Kessel, 1963; Ladisich, 1977; Taylor, 1979; Siegel, Meyers & Dineen, 1986; Van der Ploeg, 1987). In addition, psychological changes during the menstrual cycle appear to be minimal in healthy populations (Abplanalp, Donnelly & Rose, 1979). Therefore, a consideration of the influence of personality variables in menstrual cycle symptomatology is needed. On the other hand, significant differences in menstrual cycle symptomatology have been found between women taking and not taking oral contraceptives with some relief of menstrual symptoms among pill users (Silbergeld, Brast & Noble, 1971). Also, menstrual fluctuations in mood are reported not to be present in pilltaking women (Rossi & Rossi, 1980). However, differences in symptomatology between spontaneous ovulatory (SO) and spontaneous anovulatory (SA) cycles have not been studied, in spite of the fact that there is an important proportion of SA cycles among young women (Metcalf & Mackenzie, 1980). In the present study changes in cycle-related psychological and somatic symptoms were examined in a sample of young women with different scores in neuroticism and depression. It was expected that women with higher scores in neuroticism and/or depression would show higher levels of symptomatology related to the menstrual cycle, and that women with SO cycles would present a higher degree of symptomatology than women with SA cycles. To minimize the effects of social expectations on menstrual symptomatology (Sommer, 1973; Parlee, 1974), the method of assessment of women’s symptomatology was concurrent and the purpose of the study was disguised. METHOD Subjects
Forty volunteers, psychology female undergraduates at the University of Murcia, constituted the sample of the present study. All were unmarried, nulliparous, aged between 19-24 yr (mean *To whom
all correspondence
should
be addressed. 457
EVA HERRERAer al.
458
age = 21.9, SD = 1.36). Ss were not taking oral contraceptives and drugs that could affect their neuroendocrine system. All women reported regular cycles (mean length = 28.7, SD = 2.1) in the previous 3 months and no history of gynaecological disorders. The aim of this study was disguised. Once the experiment was finished the Ss were informed about the actual aim of the research. Questionnaires
Depression was assessed by the Beck Depression Inventory (Beck, Ward, Mendelson, Mock & Erbaug, 1961; Conde & Useros, 1975) and neuroticism was measured by the Eysenck Personality Questionnaire (EPQ-Eysenck & Eysenck, 1975; TEA, 1986). Psychological and somatic symptoms related to the menstrual cycle were assessed by the Menstrual Distress Questionnaire (MDQ-Moos, 1968), the State-Trait Anxiety Inventory (STAI-Spielberger, Gorsuch & Luschene, 1970; TEA, 1982), and a Psychosomatic Symptoms Questionnarie (PSQGomez-Amor, 1987). Procedure
Three groups were formed from neuroticism scores on the EPQ: High Neuroticism (HN; per centile scores 99-75; n = 11; mean = 87.18, SD = 6.29), Mean Neuroticism (MN; per centile scores 70-30; n = 14; mean = 45.35, SD = 13.81), and Low Neuroticism (LN; per centile scores 25-l; n = 15; mean = 18.66, SD = 7.40). Two groups were formed according to depression scores on the Beck Depression Inventory: Depressive (D; direct scores > 11; mean = 15.00, SD = 4.67) and Nondepressive (ND; direct scores < 11; mean = 4.24, SD = 2.78). Thus, each S was included in two groups, one of neuroticism and one of depression. Menstrual cycles were divided in three phases: menstrual (l-4 days), ovulatory (12-16 days), and premenstrual (24-28 days). The Ss were instructed to record on a graph, before getting out of bed, their morning sublingual temperature during a complete menstrual cycle to estimate the ovulation point. This point was defined as a drop in Basal Body Temperature (BBT) between 0.2 and 0.4’C, followed by a steady temperature rise for two or three consecutive days of, at least, O.l”C above the normal BBT prior to the temperature drop. In our study, 23 women (57.5%) showed SO cycles, and 17 women (42.5%) SA cycles. The proportion of SA and SO cycles found in our sample of young women are similar to those found in previous reports (Metcalf & Mackenzie, 1980). All Ss were asked to complete MDQ, STAI, and PSQ questionnaires during the menstrual, ovulatory, and premenstrual phases. Data analysis
Neuroticism was analysed by a 2 x 3 x 3 mixed design with Cycle Condition (spontaneous ovulatory; spontaneous anovulatory) and Neuroticism (high neuroticism; mean neuroticism; low neuroticism) as between-Ss factors, and Phase (menstrual; ovulatory; premenstrual) as within-Ss factor. Depression was analysed by a 2 x 2 x 3 mixed design with Cycle Condition and Depression (depressive; nondepressive) as between Ss factors, and Phase as within-Ss factor. An univariate analysis of variance (ANOVA) was performed for each dependent variable, and multivariate analysis of variance (MANOVA) on the within-Ss portion (O’Brien & Kaiser, 1985). A variable of the within-Ss portion was considered significant only when the Pilai’s trace multivariate statistic showed it (Wilkinson, 1988). Multiple comparison tests were performed according to the Bonferroni procedure. All multivariate analysis of variance and multiple comparison tests were analysed with the 4.0 version of the SYSTAT statistical package (Wilkinson, 1988). RESULTS State-Trait
Anxiety Incentory
Significant differences were found between the neuroticism groups on state [F(2,34) = 3.934, P < 0.051 and trait anxiety [F(2,34) = 13.628, P < O.OOl]. Means were on state anxiety 63.96 (SD = 24.86), 53.57 (SD = 24.43), and 39.68 (SD = 29.46) for the HN, MN, and LN groups respectively. The HN, MN, and LN groups had mean trait anxiety scores of 72.63 (SD = 20.51),
Personality.
psychological
and somatic
459
symptoms
Table I. F values for multiple comparisons with Bonferroni’s procedure Measure
Variable
STAI State-Anxiety Trait-Anxiety
MDQ Pain
N N
High vs Low High vs Low High vs Mean
P
Menstrual Menstrual Ovulatory Menstrual Menstrual Menstrual Menstrual Menstrual Menstrual Menstrual Menstrual
Water retention
DxP P
Negative affect
P
Total scores
P
F values
Comparison
CxDxP
f(1.34)=7.277* F(l.34) =23&X?*‘* F(1.34) = 1&x531***
vs Premenstrual VI (Ovulatory + vs Premenstrual YS Premenstrual vs Ovulatory vs (Ovulatory + vs Premenstrual vs (Ovulatory + vs Premenstrual vs (Ovulatory + vs Premenstrual
Premenstrual)
Premenstrual) Premenstrual) Premenstrual)
F(l.34) F‘(1.34) F(l,36) P(l.34) F(l.34) P(1.34) P(1.34) F(l.34) P(1.34) F(l.34) F(l.36)
= 13.441*** = 10.810” = 7.071. 16.729’ = 22.122*** = 16.749’** = 9.641.. = 8.702** = 15.321*** = 10.920** = 12.867***
N = Neuroticism; D = Depression; C = Cycle condition; P = Phase. * = P < 0.05; l * = P < 0.01; l ** = P < 0.001.
41.47 (SD = 21.08), and 26.93 (SD = 22.11) respectively. F values for comparisons between the neuroticism groups are shown in Table 1. Pearson product moment correlations showed significant correlations between neuroticism and state anxiety (r = 0.437, P < O.Ol), and neuroticism and trait anxiety (r = 0.718, P < 0.01). In addition, there were significant differences between the two groups of depression on state [F(1,36) = 6.079, P < 0.051 and trait anxiety [F(1,36) = 26.404, P < O.OOl]. State anxiety was greater in the D group (mean = 65.18, SD = 24.17) than the ND (mean = 45.93, SD = 27.95), and trait anxiety was also greater in the D -group (mean = 72.81, SD = 19.98) than the ND (mean = 33.88, SD = 22.87). Pearson product moment correlations showed significant correlations between depression and state anxiety (r = 0.417, P < 0.02), and depression and trait anxiety (r = 0.727, P < 0.01). Psychosomatic Symptoms Questionnaire
Symptomatology scores did not show significant differences between the menstrual cycle phases. Significant effects due to neuroticism, depression, or cycle condition were not observed. Menstrual Distress Questionnaire
There were significant cycle-related changes on the total scores of the MDQ and on the subscales of pain, water retention, and negative affect, with the highest symptomatology levels in the menstrual phase (see Table 2). Table 1 shows F values for comparisons between phases. Significant differences were obtained between the two depression groups on concentration [F(1,36) = 4.178, P < 0.051. Mean for the D group was 14.57 (SD = 5.79) and 11.81 (SD = 4.83) for the ND group. A significant Depression x Phase interaction was observed on the pain subscale (see Table 2). Significant differences were observed between ovulatory and premenstrual phases (see Table 1). Pain was greater in the D group (mean = 17.72, SD = 5.46) than the ND group (mean = 15.24, SD = 4.34) in the ovulatory phase. Mean pain scores in the D group were 13.81 (SD = 4.64) and 15.72 (SD = 5.58) in the ND group during the premenstrual phase. However, the highest levels of Table 2. Means, standard deviations and F values of ANOVA and MANOVA for the significant MDQ scales Significant interaction
Phase Means (SD in parentheses)
MDQ Pain Behavioral change Water retention Negative affect Total scores
Menstrual 18.40 14.05 8.07 21.60 103.10
(5.57) (6.09) (3.46) (8.03) (27.21)
Ovulatory 15.92 12.25 5.85 19.62 94.05
(4.80) (5.68) (2.53) (8.10) (27.62)
Premenstrual
Univariate
Multivariate
IS.20 12.65 7.20 18.75 94.45
6.883* 2.229NS 10.743*** 3.259. 4.372’
7.112’* 2.04ONS 9.49v** 3.465’ 5.832”
P = Phase; D = Depression; C = Cycle condition. Univariate d.f. = 2.72: Multivariate d.f. = 2.35. ‘P -z 0.05; l*f < 0.01: l**/’ < 0.001; NS, non significant.
F values
F values
(5.40) (6.06) (2.98) (8.40) (30.75)
DxP CxDxP CxDxP
Univariate
Multivariate
3.131’ 3.464. 5.029’.
3.445’ 3.074NS 7.338..
160
EVA HERRERAet al. Depress’Ne-Anovuhtory Depressive-OvLllatory Nondepressive-Anovulatory Nondepressive-Ovulatory
Menstrual
Ovulatory
Premenstrual
CYCLE PHASE Fig. 1. MDQ
total scores considering
Depression
and Cycle Condition.
pain were observed in the D group (mean = 18.36, SD = 6.01) and in the ND group (mean = 18.41, SD = 5.39) during the menstrual phase. In addition, a significant Cycle Condition x Depression x Phase interaction was observed in the total scores of the MDQ (see Table 2). It may be seen from Table 1 that multiple comparison tests showed a significant difference between menstrual and premenstrual phases. As seen in Fig. 1, depressive women with SA cycles had higher levels of symptomatology than the remaining groups of women in the menstrual phase, and showed lower levels of symptomatology in the premenstrual phase. DISCUSSION
Significant differences between the menstrual cycle phases in the scales of pain, water retention, and negative affect, and in the total scores of the MDQ were observed. The highest levels of symptomatology were found during the menstrual phase in comparison with both premenstrual and ovulatory phases. In the remaining MDQ scales, and in the STAI and PSQ questionnaires no significant changes associated with the cycle phases were found. These findings are consistent with the results obtained by other researchers which have found significant changes in symptomatology when assessed by MDQ across the cycle phases (Moos, Kopell, Melges, Yalom, Lunde, Clayton & Hamburg, 1969; Silbergeld et al., 1971; Marriot & Faragher, 1986). These authors have reported higher symptomatology levels in the menstrual as well as in the premenstrual phase. These results might be explained by the use of different population samples and a different range of the age samples. Thus, in our study the sample was restricted to young women (19-24 yr), who usually show greater symptomatology in the menstrual phase, with an increased severity of the premenstrual symptoms with age (Dalton, 1964; Moos, 1968). Contrary to our predictions neuroticism had no significant effects on menstrual cycle symptomatology. Such findings contrast with results of other researchers that have found a direct relationship between neuroticism and paramenstrual symptomatology (Coppen & Kessel, 1963; Ladisich, 1977; Taylor, 1979; Van der Ploeg, 1987). On the other hand, women with high neuroticism scores obtained higher trait and state anxiety (STAI) scores than women with mean and low neuroticism scores, regardless of Cycle Condition and Phase factors. Depression had significant effects on the menstrual cycle symptomatology but only for the pain subscale and-in interaction with Cycle Condition-for the total scores of the MDQ. Depressive women showed the highest pain levels during the menstrual phase with a significant drop in the premenstrual period. In the same way, depressive women with SA cycles showed the highest levels of symptomatology during the menstrual phase with a significant drop in the premenstrual phase on the total scores of the MDQ. However, this result is not directly comparable with findings of other researchers (Silbergeld et al., 1971; Rossi & Rossi, 1980) because the anovulatory cycles examined in their studies were not spontaneous but induced by oral contraceptives. In addition,
Personality. psychological and somatic symptoms
461
depressive women had greater trait and state anxiety (STAI) and lower concentration (MDQ) than nondepressive women, regardless of Cycle Condition and Phase factors. Therefore, the results of this study do not support the notion that neuroticism or the presence of depressive states are clearly associated with an increase in the paramenstrual symptomatology in a nonclinical population. It is difficult to explain the discrepancies in the results of different studies aimed at investigating the relationships between personality variables and menstrual cycle symptomatology. However, Maloney et al. (1982) have pointed out the existence of a wide range of methodological considerations on this type of research as a possible cause of these discrepancies. We can conclude that there is not a clear relationship between personality variables and menstrual cycle symptomatology. Only the presence of depression in association with other variables as Cycle Condition (ovulatory and anovulatory) may influence to some degree the paramenstrual symptomatology, but both depression and cycle condition appear insufficient to explain all the changes observed throughout the menstrual cycle phases. The results of our study suggest that the adoption of a multifactorial perspective (Smith, 1975; Clare, 1985) including psychological, social, psychophysiological and hormonal variables, is necessary to improve our understanding of this biological rhythm. REFERENCES Abplanalp, J. M.. Donnelly, A. F. & Rose, R. M. (1979). Psychoendocrinology of the menstrual cycle: 1. Enjoyment of daily activities and moods. Psychosomaric Medicine, 41, 587-604. Beck, A. T., Ward, C. H., Mendelson, M., Mock, J. & Erbaug, J. (1961). An inventory for measuring depression. Archives of General Psychiatry,
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