Direct and Indirect Effects of Stress and Self-Esteem on Primary Dysmenorrhea in Korean Adolescent Girls: A Cross-Sectional Survey Study
Abstract
Background: Positive and negative emotions have recently revealed a link with primary dysmenorrhea in adults. Among them, roles of stress and self-esteem have been less studied specially in adolescents and the direction of causality has not been clearly established. Therefore, this study investigated whether stress and self-esteem independently affect primary dysmenorrhea after adjustment for the known risk factors in adolescents. Additionally, indirect effects of stress and self-esteem were determined using mediation analyses.
Methods: This survey was conducted in adolescent girls aged 15-18 yr in metropolitan regions in South Korea in 2021. The survey included general, menstrual, and lifestyle characteristics, menstrual pain and symptom, perceived stress, self-esteem, depression, and state-trait anxiety.
Results: Stress, depression, and anxiety were associated positively with menstrual pain and symptom (all P<0.001) in adolescent girls (n=519). Self-esteem was also associated inversely with negative emotions and dysmenorrhea (all P<0.001). Additionally, stress independently affected frequency and severity of menstrual symptom (both P<0.05), but not pain intensity after adjustment for covariates. Stress also had indirect effect through depression and anxiety on menstrual pain and symptom. Effect of self-esteem vanished after adjustment for covariates, but indirectly reduced menstrual pain and symptom through mediations of stress, depression, and anxiety.
Conclusion: Mental health such as stress and self-esteem are important for managing menstrual pain and symptom in adolescents. It should be considered in managing dysmenorrhea.
2. Ju H, Jones M, Mishra G (2014). The preva-lence and risk factors of dysmenorrhea. Epidemiol Rev, 36:104–113.
3. Pakpour AH, Kazemi F, Alimoradi Z, Grif-fiths MD (2020). Depression, anxiety, stress, and dysmenorrhea: a protocol for a systematic review. Syst Rev, 9(1): 65.
4. Armour M, Parry K, Al-Dabbas MA, et al (2019). Self-care strategies and sources of knowledge on menstruation in 12,526 young women with dysmenorrhea: A systematic review and meta-analysis. PLoS One, 14(7): e0220103.
5. Chen CX, Carpenter JS, LaPradd M, Ofner S, Fortenberry JD (2021). Perceived In-effectiveness of Pharmacological Treatments for Dysmenorrhea. J Womens Health (Larchmt), 30(9): 1334–1343.
6. Armour M, Smith CA, Steel KA, Macmillan F (2019). The effectiveness of self-care and lifestyle interventions in primary dysmenorrhea: a systematic review and meta-analysis. BMC Complement Altern Med, 19(1): 22.
7. Guimarães I, Póvoa AM (2020). Primary Dysmenorrhea: Assessment and Treat-ment. Rev Bras Ginecol Obstet, 42(8): 501–507.
8. Laganà AS, La Rosa VL, Rapisarda A, et al (2017). Anxiety and depression in pa-tients with endometriosis: impact and management challenges. Int J Womens Health, 9:323–330.
9. Bajalan Z, Moafi F, MoradiBaglooei M, Al-imoradi Z (2019). Mental health and primary dysmenorrhea: a systematic re-view. J Psychosom Obstet Gynaecol, 40(3): 185–194.
10. Borjigen A, Huang C, Liu M, et al. (2019). Status and Factors of Menstrual Knowledge, Attitudes, Behaviors and Thheir Correlation with Psychological Stress in Adolescent Girls. J Pediatr Ado-lesc Gynecol, 32(6): 584–589.
11. Jeon GE, Cha NH, Sok SR (2014). Factors Influencing the Dysmenorrhea among Korean Adolescents in Middle School. J Phys Ther Sci, 26(9): 1337–1343.
12. Mou L, Lei W, Chen J, Zhang R, Liu K, Liang X (2019). Mediating effect of in-terpersonal relations on negative emo-tions and dysmenorrhea in female ado-lescents. Gen Psychiatr, 32(1): e100008.
13. Takeda T, Tadakawa M, Koga S, Nagase S, Yaegashi N (2013). Relationship between dysmenorrhea and posttraumatic stress disorder in Japanese high school stu-dents 9 months after the Great East Ja-pan Earthquake. J Pediatr Adolesc Gynecol, 26(6): 355–357.
14. Sharma P, Kaur M, Kumar S, Khetarpal P (2022). A cross-sectional study on preva-lence of menstrual problems, lifestyle, mental health, and PCOS awareness among rural and urban population of Punjab, India. J Psychosom Obstet Gynaecol, 43(3):349-358.
15. Barcikowska Z, Wójcik-Bilkiewicz K, Sobierajska-Rek A, et al (2020). Dysmen-orrhea and Associated Factors among Polish Women: A Cross-Sectional Study. Pain Res Manag, 2020:6161536.
16. Ogihara Y, Kusumi T (2020). The Devel-opmental Trajectory of Self-Esteem Across the Life Span in Japan: Age Dif-ferences in Scores on the Rosenberg Self-Esteem Scale From Adolescence to Old Age. Front Public Health, 8:132.
17. Robins RW, Trzesniewski KH, Tracy JL, Gosling SD, Potter J (2002). Global self-esteem across the life span. Psychol Aging, 17(3): 423–434.
18. Baumeister RF, Campbell JD, Krueger JI, Vohs KD (2003). Does High Self-Esteem Cause Better Performance, Interperson-al Success, Happiness, or Healthier Life-styles? Psychol Sci Public Interest, 4(1): 1–44.
19. Chen CX, Kwekkeboom KL, Ward SE (2015). Self-report pain and symptom measures for primary dysmenorrhoea: a critical review. Eur J Pain, 19(3): 377–391.
20. Jordan CH (2020). Rosenberg Self-Esteem Scale. In: Zeigler-Hill V, Shackelford T.K. (eds). Springer, Cham: Encyclope-dia of Personality and Individual Dif-ferences.
21. Kim S, Seo DG, Park JC, et al (2022). De-velopment and validation of the Self-Harm Screening Inventory (SHSI) for adolescents. PLoS One, 17(2): e0262723.
22. Cohen S, Kamarck T, Mermelstein R (1983). A global measure of perceived stress. J Health Soc Behav, 24(4): 385–396.
23. Park JN. Seo YS (2010). Validation of the Perceived Stress Scale on samples of Korean university students. Korean J Psy-chol: General, 29(3): 611-629 (Korean).
24. Whooley MA, Avins AL, Miranda J, Brown-er WS (1997). Case-finding instruments for depression. Two questions are as good as many. J Gen Intern Med, 12(7): 439–445.
25. Heo EH, Choi KS, Yu JC, Nam JA (2018). Validation of the Center for Epidemio-logical Studies Depression Scale among Korean Adolescents. Psychiatry Investig, 15(2): 124–132.
26. Julian LJ (2011). Measures of anxiety: State-Trait Anxiety Inventory (STAI): Beck Anxiety Inventory (BAI): and Hospital Anxiety and Depression Scale-Anxiety (HADS-A). Arthritis Care Res (Hoboken), 63 Suppl 11(0 11): S467–S472.
27. Hahn DW, Lee CH, Chon KK (1996) Kore-an adaptation of Spielberger’s STAI (K-STAI). Korean J Health Psychol: Health, 1, 1-14 (Korean).
28. Preacher KJ, Hayes AF (2004). SPSS and SAS procedures for estimating indirect effects in simple mediation models. Be-hav Res Methods Instrum Comput, 36(4): 717–731.
29. Romeo RD (2013). The Teenage Brain: The Stress Response and the Adolescent Brain. Curr Dir Psychol Sci, 22(2): 140–145.
30. Michaelides A, Zis P (2019). Depression, anxiety and acute pain: links and man-agement challenges. Postgrad Med, 131(7): 438–444.
31. Kim SY, Shin YC, Oh KS, et al (2020). The association of occupational stress and sleep duration with anxiety symptoms among healthy employees: A cohort study. Stress Health, 36(5): 675–685.
32. Tafet GE, Nemeroff CB (2016). The Links between Stress and Depression: Psycho-neuroendocrinological, Genetic, and Environmental Interactions. J Neuropsy-chiatry Clin Neurosci, 28(2): 77–88.
33. Wang X, Cheng Z (2020). Cross-Sectional Studies: Strengths, Weaknesses, and Rec-ommendations. Chest, 158(1S): S65–S71.
| Files | ||
| Issue | Vol 53 No 1 (2024) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/ijph.v53i1.14688 | |
| Keywords | ||
| Dysmenorrhea Adolescents Self-esteem Stress Anxiety Depression | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
