Midlife Issues Aging Personal Work Parents/ related Health Teenage - PDF document

9/27/2018 Midlife Issues Aging Personal Work ‐ Parents/ related Health Teenage Pressures Factors Children Menopausal Richa Sood, MD MS FACP NCMP Symptoms Stress Mindfulness Amplification of Menopausal A Stress Management Strategy Symptoms Mindfulness is paying attention De Novo Worsening of On purpose Mood preexisting Problems mood In the present moment High problems Non judgmentally Stress Interference with Work Decreased Mechanism of action and Productivity Relationships Possibly by avoiding emotional reactivity; And by avoiding maladaptive ruminative thinking Overall Decreased Satisfaction with Life 1

9/27/2018 Current Study Design Impact of Mindfulness and Perceived Stress on *Cross ‐ sectional study of 1744 women; 40 ‐ 65 years; Tertiary care setting Menopausal Symptoms *Three scales used: Menopause Rating Scale (MRS); Perceived Stress Scale ‐ 4 (PSS ‐ 4) and Mindfulness Attention Awareness Scale (MAAS) *Statistical analysis: Mean(SD) for continuous variables; Frequency(%); for categorical variables; Linear regression (uni ‐ and multivariate); 2 ‐ sided tests; p<.05 Mindfulness (MF) Menopausal • MRS • PSS ‐ 4 • MAAS Symptoms • 15 ‐ item scale • 11 ‐ item scale • 4 ‐ item scale (MPS) • Measures • Psychological, • Global frequency of Perceived somato ‐ measure of mindful states in vegetative and stress over Stress day ‐ to ‐ day life Urogenital the last 4 • Higher mean domains; weeks (PS) score implies • Score range 0 ‐ • Score range 0 ‐ more 44 16 mindfulness Results Patient demographics 2939 Women seen in the Women’s Health Clinic (Jan 2015 ‐ Dec 2016) Age, mean (SD) 53.4 (6.1) 709 excluded because of age BMI, mean (SD) 26.8 (6.0) 200 excluded due to lack Race of research 93% white authorization Marital Status 286 excluded due 82.7% married to incomplete information Education Status 64.6% educated at 4 year college or beyond 1744 women included in Employment Status the study 65.3% employed 2

9/27/2018 Summary Statistics Results MAAS, PSS ‐ 4, and MRS Mean SD Range MAAS 4.4 0.9 1.0 ‐ 6.0 PSS ‐ 4 5.1 3.5 0.0 ‐ 16.0 MRS (total) 13.9 7.5 0.0 ‐ 44.0 MRS (Psych) 4.5 3.7 0.0 ‐ 16.0 MRS (Som ‐ Veg) 5.3 3.0 0.0 ‐ 16.0 MRP (Urogen) 4.1 2.8 0.0 ‐ 12.0 Multivariable Linear Regression Impact of MAAS on MRS MAAS and PSS ‐ 4 on MRS with changing PSS ‐ 4 values Variable Estimate (95% CI) P value MRS Total PSS ‐ 4 Value Change in MRS (Total) PSS ‐ 4 0.84 (0.46, 1.21) <.001 for 1 ‐ point increase in MAAS ‐ 1.16 ( ‐ 1.75, ‐ 0.56) <.001 MAAS total score PSS ‐ 4*MAAS ‐ 0.09 ( ‐ 0.18, ‐ 0.01) .03 MRS Psychological PSS ‐ 4 0.58 (0.42, 0.74) <.001 0 ‐ 1.16 MAAS ‐ 0.48 ( ‐ 0.73, ‐ 0.23) <.001 4 ‐ 1.53 PSS ‐ 4*MAAS ‐ 0.06 ( ‐ 0.09, ‐ 0.02) .001 8 ‐ 1.90 MRS Urogenital PSS ‐ 4 0.09 (0.03, 0.14) 0.002 12 ‐ 2.27 MAAS ‐ 0.49 ( ‐ 0.67, ‐ 0.31) <0.001 MRS Somato ‐ vegetative 16 ‐ 2.64 PSS ‐ 4 0.02 (0.03, 0.08) 0.44 MAAS ‐ 0.39 ( ‐ 0.56, ‐ 0.20) <0.001 3

9/27/2018 Discussion Discussion What is the possible mechanism of action: What we found: 1. Mindfulness allows for attention training. In this cross ‐ sectional study, mindfulness was associated with Since ‘trained’ attention can be deployed at will, more mindful women may be choosing to shift their attention to more pleasant aspects of life rather than their symptoms lower menopausal symptom burden. In women with higher 2. Mindfulness allows for avoiding emotional reactivity and ruminative thinking stress, the magnitude of association between mindfulness More mindful women may be softening the impact of their symptoms by avoiding and menopausal symptoms appeared more robust. negative emotional response to their symptoms, and by decreasing ruminations about their implications. What is already known: If you allow me to speculate a bit… *Mindfulness is linked to positive mental health outcomes and health behaviors, 1. In our study, the association of higher mindfulness and lower menopausal better quality of life, improved insomnia, and better self care in non ‐ menopausal symptoms was most robust in the psychological domain. What is the possible settings. explanation? *In the menopausal setting, mindfulness based stress reduction (MBSR ) was shown *The underpinnings of psychological symptoms rest in threat focused attention to reduce menopausal symptom bother from 21.6% to 10.5% in 110 peri ‐ and and emotional reactivity. So the mindfulness approach appears to fit very well to postmenopausal women. MBSR participants had significant improvements in QOL, sleep, anxiety and stress (p<.05). impact such a change. *In the somato ‐ vegetative and urogenital domains, those women with higher What is new in this study: emotional reactivity (or perceived stress) may have reaped greater benefit with mindfulness compared to those with less reactivity. *This study cohort was not trained in mindfulness. 2. Total menopausal symptom experience (B) = Physical symptoms (A) + emotional response to symptoms *Thus, trait (or dispositional mindfulness) appears to be protective Mindfulness might be a tool to impact the emotional component of the overall against stress and symptoms in midlife women. experience, thereby decreasing the total suffering (burden) Discussion What are the limitations of this study: •Tertiary care setting •Homogenous population •Cross ‐ sectional design What are the conclusions: • Higher mindfulness in midlife women appears to impact women’s stress and menopausal symptoms positively. Thanks for your attention! • The current study adds to the wealth of data supporting the role of mindfulness in various settings for impacting positive sood.richa@mayo.edu change in health and behaviors. • There is a need to do more research with heterogeneous sample of women using causal study designs. 4