A Study to Assess the Psychosocial problems and coping strategies among Postmenopausal women in selected rural area of Panipat

 

Neha Rana¹, Sathish Rajamani²

¹Senior Nursing Tutor, Happy Child College of Nursing, Sonipat.

²Professor, Ved Nursing College, Panipat.

 

ABSTRACT:

Background and objectives: The present study aims to assess the psychosocial problems and coping strategies adopted by the post-menopausal women in selected rural area of Panipat. Material and methods: The methodology of the present study was descriptive co relational research design. Sample size of the study was (100) samples were selected by means of non– probability sampling technique. Interview method was used to collect data. Psychosocial problems were assessed by using 5 – point likert scale. Coping strategies adopted by the samples were measured through checklist. Result: The study findings revealed that majority of the samples were having moderate level of fear and anxiety 84(84.00%), with mean value was 18.67; S.D was 3.811 and variance level 14.526. Little more than one – half of the samples 52(52.00%) having ineffective coping strategies and 48(48.00%) of the samples were having effective coping strategies. There was a moderate negative correlation (‘r’ = - 0.040) between self– concept and coping strategies adopted by post-menopausal women. There was a statistically significance association between level of depression and occupation. (𝞆2 =28.476, ‘p’ value.

 

 

 

INTRODUCTION:

Menopause characterizes the end of the female reproductive period. During the menopausal transition period, there is a progressive and irreversible decline of ovarian function, which causes an array of symptoms.¹ Postmenopausal woman is mainly affected by the hormonal factors. It is believed that a cause of depression is a change in estrogen levels, which occur during menopause. Menopause has been considered a major transition point in women's reproductive and emotional life. While its reproductive significance is clear, its emotional implications have been confused.²

 

Alterations in menstrual bleeding manner indicate the near of menopause in mid-life women, and several women describe hot flashes, inadequate sleep, depressed mood, anxiety, and additional symptoms along with these menstrual variations.³ Menopause is not a disease but a natural transition in a women’s life that results from a decrease in the ovarian production of sex hormones such as oestrogen, progesterone and testosterone. By loss of reproductive potential and transition into later life she may become a victim of both physically and psychologically problems. Physical complaints in order of frequency are as follows: hot flashes, night sweats or chills, disrupted sleep, vaginal dryness, loss of libido, loss of energy, mood swings, increased irritability, loss of skin tone, and urinary leakage.⁴

 

Menopause is connected with ceasing of ovulation, and it usually happens in 47–53 year olds. Oestrogen deficiency causes hot flashes, sleep disturbance, atrophy, vaginal dryness, and cognitive-emotional disorders. Osteoporosis, dementia, and cardiovascular disease risks are consequently elevated in postmenopausal women. The depression throughout the menopause is related to empty nest syndrome.²

 

Indian women are ignorant about the changes taking place in their reproductive system. Religion and culture of our society also inhibits to express these changes. So awareness programs need to be conducted to overcome these issues. But there is lack of awareness of the causes, effects, and management pertaining to it.⁵ Hence there is a growing need to have counseling and training program by the professionals to improve women’s health, reducing problems and enhancing QOL in menopause period.⁵

 

Various coping strategies are adopted by post-menopausal women’s. Yoga is, instead, an adaptive discipline that can support the body through the myriad of biological changes it is making. Importantly, it can also support our minds and emotions, and allow us to come to a perspective on the inner processes that are happening. Many Perimenopausal women have found both the physical and less tangible benefits of yoga helpful at this time. There are some general points about asanas (poses), however. Back bends can be great for improving one's mood and lifting energy levels, and forward bends are good for anxiety and stress.⁶

 

The coping strategies to overcome these problem is exercise this is one crucial way to control these conditions. Exercise keeps bones, joints and cartilage healthy, guarding against osteoporosis as well as arthritis. It reduces the risk of heart disease by stimulating circulation, controls weight, and enhances emotional well being.  Similarly such study conducted by Ahn S, (2007) on,’ Effects of walking on cardiovascular risk factors and psychosocial outcomes in postmenopausal obese women,’ Suggest that 3 months of moderate-intensity exercise training can improve psychosocial outcomes but further studies are needed to replicate walking exercise on physiologic variables among postmenopausal obese women. These findings are of public health relevance and add a new facet to the growing literature on the health benefits of moderate, exercise^.7

 

From the above cited resources and from the researchers own family members experience with regard to the symptoms of postmenopausal women and their coping strategies used to encounter it, the special attention stimulated the researcher to take this study as her requirement towards the partial fulfilment of M. Sc (N) degree.

 

OBJECTIVES OF THE STUDY:

1.     To assess the psychosocial problems and coping strategies among post-menopausal women.

2.     To correlate psychosocial problems and coping skills of post-menopausal women.

3.     To determine the association between psychosocial problem and selected demographic variables.

4.     To determine the association between coping strategies and selected demographic variables.

 

HYPOTHESIS:

All hypotheses will be tested at 0.05 level of significance

H₁ There will be a significant correlation between psychosocial problems and coping strategies adopted by post-menopausal women.

H₂ There will be a association between psychosocial problems and selected demographic variables.

H₃ There will be a association between coping strategies and selected demographic variables.

 

OPERATIONAL DEFINITIONS:

Assess:

To determine the psychosocial problems and coping strategies adopted by postmenopausal women.

 

Psychosocial Problems:

The term psychosocial refers to the post- menopausal women‘s psychological and social problems which they have in their daily life such as depression, anxiety and fear, anger, suspiciousness, self-concept and other social symptoms as measured by using rating scale.

 

Coping Strategies:

Coping strategies includes the measures such as Self calming skills, Diet and Weight Control, Maintain sense of Achievements, Natural Methods and Medical Methods adopted by post-menopausal women to cope with psychosocial problems.

 

Postmenopausal Women:

It refers to the women those who have attained permanent stop of menstruation within the age group of 40-60 years and they are no longer able to bear a child.

 

Assumptions:

1.     Postmenopausal women experience some psychological and social problems after menopause.

2.     Postmenopausal women will follow some coping strategies to relieve psychosocial problems.

3.     There will be a relation between psychosocial problem and coping strategies adopted by postmenopausal women.

 

Conceptual Framework:

The conceptual framework for the present study based on Transactional stress model. Transactional stress model may be consider as specialization of ―Theory of cognitive Appraisal was proposed by Lazarus andFolkman in 1984 and explained the mental process which influence of the stressors.

 

METHODOLOGY:

Research Approach – Quantitative approach

 

Research Design - Non–experimental research descriptive co- relational design.

 

Settings of the Study: The researcher conducted the study in Baroli village of district Panipat. It is located in Panipat, 5 kms away from Ved Nursing College.

 

Population: Postmenopausal women.

 

Sample Size: 100 Postmenopausal women.

 

Sampling Technique: Purposive sampling technique.

 

Criteria’s for Sample SelectionL:

Inclusion Criteria:

·       The women whose age group between 40yrs - 60 years and those who attained menopause naturally

·       The women’s were residents of the Baroli Village of Panipat

·       Those post-menopausal women who were interested to participated in this study.

 

Exclusion Criteria:

·       Postmenopausal women who were having any contagious disease such as HIV/AIDS T.B etc.

·       Menopausal women who are not willing to participate

·       Women who had undergone hysterectomy

 

Description of the Tool:

Tool for collecting data consists of 3 sections.

 

Section A: Socio-demographic Variable- Demographic perform will consist of 7 items for obtaining information regarding (age, marital status, educational status, occupation, income of the family, religion, type of family)

 

Section B: Rating Scale on Psychosocial Problem among Post-menopausal Women.

 

The 5 point likert scale were used to assessed psychosocial problems among post- menopausal women had 30 items and rating are given according to the severity of the problem like (1 = Much less, 2 = Somewhat less, 3=Fine as is, 4 = Somewhat more, 5 = Much More).

 

The components measured under psychosocial problems are as follows:

·       Depression

·       Anxiety and fear

·       Anger

·       Suspiciousness

·       Self-concept

·       Sexual symptoms

 

Section C: Rating Scale on Coping Strategies among Post-menopausal women:

Checklist on coping strategies among postmenopausal women had 30 items. Each item consist of (yes =1 and No = 0) mark according to coping methods.

The components measured coping strategies among post-menopausal women are as follows

·       Self-calming skills

·       Diet and Weight Control

·       Maintain sense of Achievements

·       Natural Methods

·       Medical Methods

 

Validity and Reliability of the Tool:

The validity of the study tool was obtained from the five experts in the field of psychiatric nursing and two from psychiatric medicine.

 

Reliability of the research tool had obtained by means of test –retest methods.  The internal consistency of the tool was established by using Cronbach‟s alpha co-efficient value r‟ value was estimated as 0.82 for Rating scale and 0.80 for checklist which indicate both tool was highly reliable.

 

Pilot Study:

Pilot study was conducted for determining the reliability of tool and feasibility of the study. The study was conducted in village Ganjanbud rural area of district Panipat. One tenth of the sample size was taken for the pilot study (n=10). The data was collected from 6-03-2019 to 9-03-2019, 4 samples are collected each day and 30 min was taken to collect data from each sample.

 

Data Collection Procedure:

Every day the researcher collected data from four subjects through interview method. It tooks around 25 minutes to collect data from one subjects

 

Data Analysis and Interpretation:

Descriptive and inferential statistics were used to analyse the collected data.

 

Table – I: Frequency and Percentage Distribution of Samples according to socio – demographic variables                       (N = 100)

S. No	Demographic Variables	Frequency	%
1.	Age (Years) a.     40 – 45 b.     46 – 50 c.     51 – 55 d.     56 - 60	12 20 33 35	12.00 20.00 33.00 35.00
2.	Marital Status a.     Married b.     Widow c.     Separated d.     Divorced	83 14 1 2	83.00 1.00 1.00 2.00
3.	Educational Status a.     No formal education b.     Primary education c.     Secondary education d.     Diploma / Graduate e.     Post - Graduate	43 32 14 10 1	43.00 32.00 14.00 10.00 1.00
4.	Occupational Status a.     Home maker b.     Daily wages c.     Private employee d.     Govt employee e.     Business	70 9 13 7 1	70.00 9.00 13.00 7.00 1.00
5.	Monthly Income (Rs) a.     < than 5000 b.     5001 – 10000 c.     10001 – 15000 d.     15001 – 20000 e.     > than 20000	20 42 17 15 6	20.00 42.00 17.00 15.00 6.00
6.	Religion a.     Hindu b.     Sikh c.     Muslim d.     Christian	93 5 1 1	93.00 5.00 1.00 1.00
7.	Type of family a.     Nuclear b.     Joint	72 28	72.00 28.00
8.	Number of children’s a.     One b.     Two c.     More than two	13 20 67	13.00 20.00 67.00
9.	Any morbidities before menopause a.     Hypertension b.     Diabetes mellitus c.     Cancer d.     None	5 7 2 86	5.00 7.00 2.00 86.00
10.	Age at which menopause obtained a.     40 – 45 years b.     46 – 50 years c.     More than 50 years	47 49 4	47.00 49.00 4.00

 

The table – I describes the frequency and percentage distribution of subjects according to selected socio – demographic variables.

 

Age of the sample shows that majority of the samples 35 (35.00%) were in age group 56 – 60 years. Marital status of the samples depicts an overwhelming majority of the samples are married 83(83.00%). Educational status of the samples shows majority of them had no formal education 43(43.00%). With regard to the samples occupation, majority of them 70(70.00%) were home maker. Income of family of the samples shows that majority 42(42.00%) of them were having income between 5001 – 10000 Rs. An overwhelming majority of the samples 93(93.00%) belongs to Hindu by religion. Little less than three fourth of the samples 72(72.00%) were from nuclear type of family. With regard to the number of children majority of the samples 67(67.00%) had more than two children an overwhelming majority of the samples 86(86.00%) had no disease before menopause. Little less than one – half of the samples attained menopause between 46 – 50 years 49(49.00%).

 

 

Figure 1: Percentage distribution of subjects according to postmenopausal psychosocial problems

 

From Figure – 2 it was understood that overwhelming majority of the samples 85 (85.00%) had moderate depression and few samples had severe depression 8 (8.00%) and only 7 (7.00%) of the samples were having mild depression. An overwhelming majority of the samples 84 (84.00%) had moderate fear and anxiety. Samples with mild and severe fear and anxiety were 8 (8.00%) in each category. Samples with anger show majority 61 (61.00 %) had mild anger. Samples with moderate anger were 38 (38.00%). Only one sample had severe anger. Little more than one – half of the samples 53 (53.00%) had moderate suspiciousness. Samples with mild suspiciousness were 46 (46.00%). Only one sample was with severe suspiciousness. Majority of the samples 59 (59.00%) had mild sexual problems. Moderate sexual problems were present in 41 (41.00%). None of the samples had severe sexual problems.

 

Figure – 2: Pie Diagram shows the percentage distribution of subjects according to self - concept

Self – concept of the samples reveals little more than one – half of the samples 53(53.00%) had low self – concept and 47 (47.00%) of the samples had high self – concept.

 

Table II:  Mean, Standard Deviation and Variance of Psychosocial problems

(N = 100)

S. No	Variables	Mean	SD	Variance
1.	Depression	17.89	4.280	18.231
2.	Fear and Anxiety	18.67	3.811	14.526
3.	Anger	12.44	4.021	16.168
4.	Suspiciousness	13.61	4.479	20.058
5.	Self-Concept	17.99	4.931	34.313
6.	Sexual symptoms	11.86	4.247	18.041

 

Table- III shows the mean, standard deviation, variance of psycho – social problems. With regard to depression, the mean value was 17.89, standard deviation was 4.280 and the variance level was 18.321. Regarding fear and anxiety, the mean value was 18.67, standard deviation was 3.811 and the variance level was 14.526. Related to anger, the mean value was 12.44, standard deviation was 4.021 and the variance level was 16.168 regarding suspiciousness, the mean value was 13.61, standard deviation was 4.479 and the variance level was 20.058. Regarding self -concept, the mean value was 17.99, standard deviation was 4.931 and the variance level was 24.311 regarding depression, the mean value was 11.86, standard deviation was 4.247 and the variance level was 18.041.

 

Figure 3: Percentage Distribution of Samples According to Coping Strategies

 

Figure – 3: depicts the percentage distribution of subjects according to level of coping. Little more than one – half of the samples 52 (52.00%) are having ineffective coping strategies. Whereas 48 (48.00%) of the samples were having effective coping strategies.

 

 

Table – I11: Level of Correlation between Psycho – Social Problems and Coping Strategies                                                            (N = 100)

S. No	Variables	Mean	Standard Deviation	Karl Pearson Correlation Co-efficient	Type of correlation
1	Depression and Coping Strategies	2.01 1.48	0.389 0.502	0.27	Mild positive correlation
2	Fear / Anxiety and Coping Strategies	2.00 1.48	0.402 0.502	-0.150	Mild negative correlation
3	Anger and Coping Strategies	1.40 1.48	0.512 0.502	-0.047	Mild negative correlation
4	Suspiciousness and Coping Strategies	1.55 1.48	0.520 0.502	0.062	Mild positive correlation
5	Self – Concept and Coping Strategies	1.50 1.48	0.503 0.502	- 0.40	Moderate negative correlation
6	Sexual Symptoms and Coping Strategies	1.41 1.48	0.495 0.502	0.46	Moderate positive correlation

 

Table – III: shows the level of correlation between psychosocial problems and coping strategies. There was a mild positive correlation (‘r’ = 0.27) between depression and coping strategies adopted by post-menopausal women. There was a mild negative correlation (‘r’ = - 0.150) between fear and anxiety and coping strategies adopted by post-menopausal women. There was a mild negative correlation (‘r’ = -0.047) between anger and coping strategies adopted by post-menopausal women. There was a mild positive correlation (‘r’ = 0.062) between suspiciousness and coping strategies adopted by post-menopausal women. There was a moderate negative correlation (‘r’ = - 0.040) between self – concept and coping strategies adopted by post-menopausal women. There was a moderate positive correlation (‘r’ = 0.46) between sexual symptoms and coping strategies adopted by post-menopausal women.

In the present study the researcher found statistically significance was present between the following psychosocial variable and selected demographic variable.

 

There was a statistically significance association between level of depression and occupation. (𝞆2 =28.476, ‘p’ value <0.001).

 

There was a statistically significance association between level of anger and any disease condition before menopause. (𝞆2 =22.568, ‘p’ value <0.001).

 

DISCUSSION:

Findings of the present study were discussed based on the supportive studies done in the past.

 

To assess the psychosocial problems and coping strategies among post-menopausal women:

According to Table – II With regards to the depression majority of sample were with moderate level of depression 85(85.00%), With regards to the fear and anxiety majority of sample were with moderate level of fear and anxiety 84(84.00%), With regards to the anger majority of sample were with mild level of anger 61(61.00%), With regards to the suspiciousness little more than one – half of the samples 53(53.00%) had moderate suspiciousness. With regards to the self-concept majority of sample were with moderate level of self- concept 53(53.00%) and with regards to the sexual symptoms majority of sample were with mild level of sexual symptoms 59(59.00%).

 

The findings were supported by similar studies done in the past.

 

Olugbemiga I.A et al, (2017) in this study the challenges and coping strategies adopted by menopausal women was assessed. All the respondents were aware of menopause and have experienced one or more out of the twenty one pre-stated symptomatic challenges among which are vaginal dryness (40.40%), decreased sexual libido (41.1%), decreased sexual response (43.7%), joint pain/stiffness (35.95%).⁸

 

Yucel and Eroglu (2013) in this study 309 samples were enrolled the result revealed that 80% of them experienced a decrease in frequency of sexual intercourse, 68% felt changes in sexual desire. It was found that 87.4% of the sample experienced problems in their sexual relationships. During sexual intercourse 42.4% of the women experienced vaginal dryness, 30.1% pain, 24.9% burning and 4.5% bleeding problems.⁹

 

Figure – 3 depicts the Percentage Distribution of Samples According to Coping Strategies. Majority of the sample 52(52.00%) were having ineffective coping strategies regarding psychosocial problems of post menopause. These findings were supported by the following research studies which have been done in the past.

 

Shukla R, Ganjiwale J and Patel R (2018) this study aimed to find the prevalence of postmenopausal symptoms, its severity, and effect on QOL of rural women and the couples' coping mechanisms. A cross-sectional survey was conducted by approaching 250 families from two villages of Gujarat, India. The husbands of women with menopausal symptoms were aware of their condition; however, neither of them exhibited use of the active coping mechanism. The avoidant emotional coping strategy appeared to be followed by most.¹⁰

 

The second objective of the present study was: to correlate the psychosocial problems and coping skills of post-menopausal women.

Table – III shows the Level of Correlation between Psycho – Social Problems and Coping Strategies There was a moderate negative correlation (‘r’ = - 0.040) between self – concept and coping strategies adopted by post-menopausal women. There was a moderate positive correlation (‘r’ = 0.46) between sexual symptoms and coping strategies adopted by post-menopausal women.

 

The above present study findings were supported by similar studies done in the past:

 

Agarwal A K, Kiron N, Gupta R, Sengar A and Gupta P. (2018) done a study to determine the commonly reported menopausal symptoms among middle age women and to correlate identified menopausal problems with coping strategies The mean age of menopause was 49.8 years (±4.9) (range 43 - 57 years). There is a strong significant association between the menopausal symptoms and coping strategies adopted by the menopausal women.

 

CONCLUSION:

The following conclusions can be drawn from the findings of the present study.

1.     The application of various coping methods, including the establishment of social support networks, is warranted to enhance postmenopausal women’s behaviours in different aspects.

2.     Many samples felt embarrassment to share their feelings and problems due to cultural restrictions in the rural communities of Haryana.

3.     Researcher has felt that this association between depression and occupation were due to the cultural practices of rural regions of Haryana.

4.     Self-concept is an important factor for mid-life women to adjust to their menopause.

 

REFERENCES:

1.     Santoro N, Randolph JF. Reproductive Hormones and the Menopause Transition. Obstet Gynecol Clin North Am. 2011 Sep; 38(3): 455–66.

2.     Dalal PK, Agarwal M. Postmenopausal syndrome. Indian J Psychiatry. 2015 Jul; 57(Suppl 2): S222–32.

3.     Mahmoud. Effect of menopausal symptoms on psychological problems among middle-aged women [Internet]. [cited 2020 Oct 7].

4.     Agarwal A, Kiron N, Gupta R, Sengar A, Gupta P. A study of assessment menopausal symptoms and coping strategies among middle age women of North Central India. International Journal of Community Medicine and Public Health. 2018 Oct 1;5.

5.     Quality of Life of Postmenopausal Women in Urban and Rural Communities [Internet]. [cited 2020 Oct 7].

6.     Shinde DM. Psychological Problems and Coping Strategies Adopted by Post Menopausal Women. International Journal of Science and Research (IJSR) [Internet]. [cited 2020 Oct 7];

7.     Ahn S. Effects of Walking on Cardiovascular Risk Factors and Psychosocial Outcomes in Postmenopausal Obese Women. Taehan Kanho Hakhoe chi. 2007 Jul 1; 37: 519–28.

8.     EJPMR | ABSTRACT [Internet]. [cited 2020 Oct 7]. Available from: https://www.ejpmr.com/home/abstract_id/2795

9.     Yücel C, Eroglu K. Sexual Problems in Postmenopausal Women and Coping Methods. Sexuality and Disability. 2013 Sep 1;31.

10.  Prevalence of Postmenopausal Symptoms, Its Effect on Quality of Life and Coping in Rural Couple [Internet]. [cited 2020 Oct 7]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5879841/

11.  Agarwal AK, Kiron N, Gupta R, Sengar A, Gupta P. A study of assessment menopausal symptoms and coping strategies among middle age women of North Central India. International Journal OF Community Medicine and Public Health. 2018 Sep 24;5(10): 4470–7.

 

 

 

Received on 07.10.2020          Modified on 17.01.2021

Accepted on 06.03.2021     ©AandV Publications All right reserved