Table of Contents

2017 Month : December Volume : 3 Issue : 2 Page : 1-3

AN ATTITUDE STUDY AMONG COLLEGE GOING WOMEN RELATED TO MENSTRUAL STRESS.

risha Ray1, Somasree Basu2, Sriya Satuluri3, Rajkumari Basu4, Suddhendu Chakraborty5

1Research Fellow, Department of Psychiatry, Calcutta National Medical College and Hospital.
2Research Fellow, Department of Psychiatry, Calcutta National Medical College and Hospital.
3Research Fellow, Department of Psychiatry, Calcutta National Medical College and Hospital.
4Professor, Department of Psychiatry, Calcutta National Medical College and Hospital.
5Consultant Psychiatrist, Department of Psychiatry, Calcutta National Medical College and Hospital.

Corresponding Author:
Dr. Suddhendu Chakraborty,
30 B, Second Road, East End Park,
Kalikapur, Kolkata-700099.
E-mail: dr.suddhendu.chakraborty@gmail.com

ABSTRACT

BACKGROUND

Menstruation has distinct somatic, physiological and psychologicalaspects distinct to each of its phases. Studies have showed menstruation results in adjustment related insufficiency, irritability and mood disorders, inattentiveness, depression and even suicidality. The study helps to find menstruation as an entity towards psychiatric morbidity and its necessary further implications.

The study aims at clearly identifying the nature and exact time of onset of psychiatric morbidity during the period of menstruation and also the need of undertaking appropriate measure towards cure of the same.

MATERIALS AND METHODS

This is a questionnaire-based case study among thirty-five college-going women through premenstruum, menstruum and postmenstruum.

RESULTS

It is found from this study that attitude does bring about a significant change in the nature of menstrual experience.

CONCLUSION

The present study helps us to find out the exact time of occurrence of psychiatric comorbidity in relation to menstruation and their probable nature and outcome.

KEYWORDS

Attitude, Menstruation, Stress.

How to cite this article

Ray T, Basu S, Satuluri S, et al. An attitude study among college going women related to menstrual stress. Journal of Research in Psychiatry and Behavioural Sciences 2017; Vol. 3, Issue 2, July-December 2017; Page:1-3.

BACKGROUND

In addition to the daily nuances, women have an additional event of menstruation associated with its distress and other social factors.1 Menstruation has distinct somatic,2 physiological3 and psychological4 aspects distinct to each of its phases.5 Studies have showed menstruation results in adjustment related insufficiency,6 irritability and mood disorders,7 inattentiveness,8 depression9 and even suicidality.10 The female role and attitude towards menstruation has been ascribed to internal hormonal changes and its associated physiological factors. The resultant myth and ideas of “irreversible evil” as in Roman civilisation and Hindu mythology are not unknown. The concept of Menstrual etiquette11 has been devised and role of education towards developing a correct attitude towards this physiological phenomenon has also been studied.12 On studying symptomatology “anxiety” is commonly found as the most experienced event,13 more specifically in the premenstruum and postmenstruum phase. The concept of anxiety is sometimes compared with the concept of arousal.14

Aims and Objectives

The positive symptoms experienced during menstruation can be assessed by using questionnaires, as in this study.15 The study aims at clearly identifying the nature and exact time of onset of psychiatric morbidity during the period of menstruation and also the need of undertaking appropriate measure towards cure of the same.

MATERIALS AND METHODS

This is a questionnaire-based case study. Thirty-Five undergraduate students belonging to the age group of 19 - 21 years were selected for this study. The sampling technique used was selective random sampling. They were all unmarried belonging to a nuclear family, mostly living in city and free from any apparent morbidity. The menstrual flow on interviewing was taken to be normal on an average. The subjects were screened for general medical illness by the General Health Questionnaire (GHQ). Thereafter, they were screened for distress by using Menstrual Distress Questionnaire (MDQ)16 and Menstrual Attitude Questionnaire (MAQ).17 Menstrual Distress Questionnaire (MDQ) is a standard method used for measuring the cyclical symptoms related to menstruation. It was developed by RH Moos in 1968 and revised and reprinted in 1991. In this study, the revised version has been used. It is a self-reporting inventory for the purpose of diagnosis and treatment of premenstrual and menstrual symptoms. There are three forms of MDQ. Form C measures symptoms experienced during each of the three phases of a menstrual cycle. Short Form-T consists of the first twenty two items and the first four scales of Form T. Western Psychological Services (WPS) test report computer programs are available for scoring and interpretation of Form-C and Form-T of the MDQ. In the present study, we have used Form-C and the items of the MDQ. GHQ was designed to be self-administered screening test aimed at detecting psychiatric disorders among respondents. There are different versions of GHQ available depending upon the nature of the items. Scoring is done as per instructions laid down by Goldberg and Williams (1988). Threshold for case identification was taken to be 4/5. The Menstruum (M) was taken as the first day of onset of bleeding.18 The Intermenstruum (IM) was taken as any day between 15th and 18th day of cycle.19 The Premenstruum (PM) was taken as one or two days prior to onset of bleeding. Form-C of MDQ was administered to each of the subjects in these three phases separately and assessed. The tests were administered by psychologist under a strict supervision of the psychiatrist having necessary experience in this field. An informed consent was obtained in detail from the subjects along with a clearance of the Ethical Committee.

Sample Size

Thirty-Five undergraduate students belonging to the age group of 19 - 21 years were selected for this study.

Where it was done

The study was undertaken in three city-based college after taking necessary ethical clearance from the college authorities.

Scales

The subjects were screened for distress by using Menstrual Distress Questionnaire (MDQ)16 and Menstrual Attitude Questionnaire (MAQ) 18.

The Inclusion and Exclusion Criteria

In this study, mostly girls belonging to age group of 19 - 21 years were selected. They were undergraduate and college going. Mostly girls belonging to middle class and upper middle-class families were chosen. Only unmarried girls were chosen in this study.

However, in this study girls having any preceding medical or gynaecological comorbidity were excluded. The girls were also screened for any premorbid psychiatric morbidity and if found positive were excluded. Girls taking any medication chronically, which included use of contraceptive pills were also excluded in this study.

RESULTS
Mean, Standard Deviation, Mode and other central tendencies were considered while interpreting the results as a statistical tool in this study. At value was calculated. The following table shows the comparative analysis of the ‘t’ values.

Calculation of the T Value for the Two Groups

The study showed impaired concentration (with a mean of 76.636) as the most commonly perceived symptom during all of the three phases. Autonomic reactions (68.454) and pain (62.818) were the other two commonly attained variables. The symptom of control was found to be positively correlated with majority of the attitudinal factors indicating that the subjects had an increased tendency of reporting symptoms even in their absence in reality. IM was found to be the calmest phase compared to PM and M phase. In this study, the highly distressed subgroup showed a relatively high prevalence of negative attitudinal factors like bothersome effect and denial.

 

DISCUSSION
In this study, Form-C of MDQ was used to assess stress within the studied women. A retrospective study was avoided, as in these studies women tend to overestimate severity of symptoms20 and often underreport cyclical symptoms owing to lack of awareness.21 Some studies have shown age to be positively related to the nature of symptoms reported during menstruation.22 However, in this study the age has been strictly confined to 19 - 21 years. Another factor which usually influences the nature of symptoms is educational qualification. In the present study, all the subjects were college going and educated. Consideration of the exact day of menstruation remains a challenge even to this day as some researchers have taken third or fourth day of menstruation to be the appropriate day of study,23 while some study the period of ovulation.24

In this study, the entire period has been restructured to premenstruum, menstruum and postmenstruum and conducted accordingly. Our study shows predominance of impaired concentration, pain and autonomic reactions in all of the phases. The intermenstruum period appeared “calmest” phase and more distressed individuals reported more negative symptoms during the phase.

 

Implication
Studies related to Attitude among individuals in itself is weak statistically, but nevertheless this study is unique because it was conducted among educated and aware individuals on a subject that is quite often considered and neglected at the same time on discussing psychiatric morbidities. The sample size was small, so also the hormonal level consideration during the phases and comparison with psychological comorbidities could have been considered. This ensures need for further studies in this field and warrants more inputs into this relatively unventured domain.

Limitations

The study has a very small sample with limited variety of the subjects belonging to a specific stratum of the society. It could have been undertaken on a larger platform using more subject attributes. Moreover, more sophisticated statistical tools could have been undertaken while interpreting results. More psychiatric comorbidities could also have been incorporated. These issues warrant a scope for further research into this area

CONCLUSION

The present study helps us to find out the exact time of occurrence of psychiatric comorbidity in relation to menstruation and their probable nature and outcome.

 

REFERENCES

[1]           Bell B. Psychophysiological studies of the menstrual cycle. Unpublished doctoral dissertation. University of Birmingham, England:  1973.

[2]           Coppen A, Kessel N. Menstruation and personality. Brit J Psychiatry 1963;109(463):741.

[3]           Slade P, Jenner FA. Autonomic activity in subjects reporting changes in affect in the menstrual cycle. Brit Journal of Clinical Psychology 1979;18(1):135-6.

[4]           Cockerill IM, Wormington JA, Nevill AM. Menstrual-cycle effects on mood and perceptual-motor performance. Journal of Psychosomatic Res 1994;38(7):763-71.

[5]           Mandell AJ, Mandell MP. Suicide and menstrual cycle. Journal of American Medical Association 1967;200:792-3.

[6]           Siegal SJ. The effect of culture on how women experience, Jewish women. Wright Institute 1983.

[7]           Lee KA, Rittenhouse CA. Prevalence of perimenstrual symptoms in employed women. Journal of Women and Health 1991;17(3):17-32.

[8]           Wilcoxon LA, Schrader SL, Sherif CW. Daily self-reports on activities, life events, moods and somatic changes during the menstrual cycle. Psychosomatic Medicine 1976;38(6):399-417.

[9]           Dalton K. Menstruation and crime. British Medical Journal 1961;2(5269):1752-3.

[10]       Tonks CM, Rack PH, Rose MJ. Attempted suicide and the menstrual cycle. J Psy Res 1968;11(4):319-23.

[11]       Redei E, Freeman EW. Preliminary evidence for plasma adrecorticotropin levels as biological correlates of premenstrual symptoms. Acta Endocrinologica (Copenh) 1993;128(6):536-42.

[12]       Parlee MB. Media Treatment of Premenstrual Syndrome. New York: Plenum Press 1987:189-90.

[13]       Spencer-Gardner C, Dennerstein L, Burrows GD. Premenstrual tension and Female role. Journal of Psychosom Obstet and Gynaecol 1983;2(1):27-34.

[14]       Taylor JW. Psychological factors in the aetiology of pre-menstrual symptoms. Australian and New Zealand Journal of Psychiatry 1979;13(1):35-41.

[15]       Moos RH. The development of a menstrual distress questionnaire. Psychosomatic Medicine 1968;30(6):853-67.

[16]       Moos R. Menstrual distress questionnaire. Revised version. Los Angeles: Western Psychological Services 1991.

[17]       Brooks J, Ruble D, Clarke A. College women’s attitudes and expectations concerning menstrual-related changes. Psychosom Med 1977;39(5):288-98.

[18]       Sampson GA, Jenner FA. Studies of daily recordings from moos menstrual distress questionnaire. Brit J Psychiatry 1977;130:265-71.

[19]       Bell B, Christie MJ, Venables PH. Psychophysiology of menstrual cycle. Chapter 8. In: Venables PH, Christie MJ. eds. Research in psychophysiology. London, New York, Sidney, Toronto: John Wiley and Sons., 1975.

[20]       Woods NF. Recollections of menarchae, current menstrual attitudes and pre-menstrual symptoms. 1983:87-07.

[21]       Golub S. The magnitude of pre-menstrual anxiety and depression. Journal of Psychological Medicine 1976;38(1):4-12.

[22]       Gough HG. Personality factors related to reported severity of menstrual distress. Journal of Abnormal Psychology 1975;84(1):59-65.

[23]       Kopell BS, Lunde DT, Clayton RB, et al. Variations in some measures of arousal during the menstrual cycle. Journal of Neurological and Mental Disease 1969;148(2):180-7.

[24]       Little BC, Zahn TP. Changes in mood and autonomic functioning during menstrual cycle. Journal of Psychophysiology 1974;11(5):579-90.


 

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