INTRODUCTION:

Introduction

“When we are no longer able to change a situation, we are challenged to change ourselves.” ̴ Victor Frank

The menopause, also known as the ’change of life,’ is the end of menstruation. This means a woman’s ovaries stop producing an egg every four weeks. It is a unique stage in female reproductive cycle, a transition from reproductive to non-reproductive stage characterized by cessation of menstruation and implies loss of child bearing capacity and aging. The average age of final menstrual period is 51 years. ¹

Menopausal women undergo various changes in their body and hormonal levels causing unpredictable and wide fluctuations in mood and psychological functions. Various problems that women experience are depression, anxiety, irritability, low self esteem, lack of confidence, memory changes, difficulty in concentration, fatigue, and inferiority feeling.²

Menopause should be recognized as a challenge for identification, prediction and prevention of organic diseases in women during climacteric and postmenopausal years.

Background of the study:

Menopausal health demands priority in the Indian scenario due to the increased life expectancy and growing population of menopausal women who live one third of their life in hormone deficit stage.³

Oestrogen seems to have a mental tonic effect, and lowered levels of hormone during and after menopause can lead to whole range of psychosocial problems such as less energy and drive, irritability, mood changes, headaches, feeling of unworthiness, loss of self-esteem, loss of self-confidence, feeling unable to cope, difficulty in concentrating, feeling of aggressiveness, depression, anxiety, forgetfulness, fear of loneliness, usually prone to tears, and loss of libido (sex drive).⁴

In 1990, there were 467 million postmenopausal women in the world. It is postulated that by the year 2030, the world population of menopausal and postmenopausal women will be1.2 billion¹⁶. Most women stop menstruating around the age of 50, and the average age in the developed world is 51.4 years.

Data from 26 different countries, both rich and poor, calculated a lower average age of 49.24 years. According to Indian menopause society, India has a large population which has already crossed the one billion mark with 71 million people over 60 years of age and the number of menopausal women about 43 million. It is estimated that in the year 2026, the population in India will be 1.4 billion, people over 60 years will be 173 million and the menopausal population will be 103 million. The average age of Indian menopausal women is 47.5years.⁵

Statement of Problem:

“Assessment of psychosocial problems and coping strategies among postmenopausal women in selected communities of Mangalore.”

Objectives:

1. To determine the level psychosocial problems among postmenopausal women.

2. To find out the coping strategies among postmenopausal women.

3. To find out the relationship between psychosocial problems and coping strategies among postmenopausal women.

4. To find out the association of psychosocial problems and coping strategies with the demographic variables.

Assumptions:

The study assumes that:

1. Postmenopausal women experience some physiological, psychological and social problems during menopause.

2. Coping strategies help to overcome problems in postmenopausal age.

Delimitation:

The study is delimited to the women who:

1. have attained menopause naturally.

2. are willing to participate in the study.

Hypothesis:

The hypotheses will be tested at 0.05 level of significance

H₁:There will be significant relationship betweenpsychosocial problems and coping strategies adapted by postmenopausal women.

H₂:There will be significant association of psychosocial problems with the demographic variables.

H₃:There will be significant association of coping strategies with the demographic variables.

RESEARCH METHODOLOGY:

Research Approach:

The investigator utilized a descriptive survey approach in order to assess the psychosocial problems and coping strategies in postmenopausal women.

Research Design:

The research design adopted for the present study is the descriptive co relational study design

Research setting:

This study was conducted in Kavoor, Devinagar and Kunjathbail which are under A. J. Urban Health Centre.

Population:

The target population included for the present study was postmenopausal women residing at Kavoor, Devinagar and Kunjathbail, Mangalore

Sample:

The sample for the present study was 100 postmenopausal women from the urban areas of Mangalore based on those who met the inclusion criteria.

Sampling technique:

Using the purposive sampling technique, a sample of 100 postmenopausal women was selected.

Data collection method:

Sampling criteria:

Inclusion criteria:

· Women who are in menopause for more than a year.

· Menopausal women who can understand Kannada or English.

· Menopausal women who are available at the time of study.

· Menopausal women who are residents of Kavoor, Devinagar and Kunjathbail

Exclusion criteria:

1. Menopausal women who are unwilling to participate in the study.

2. Women who have undergone hysterectomy with bilateral oopherectomy

3. Menopausal women who have history of medical illness (including psychiatric problems).

Description of the tool:

Section 1: Demographic proforma consisted of 10 items regarding age of the woman, marital status, educational status, occupation, income of family, religion, type of family, are you a member of social groups, most supportive member in the family, and obstetric history.

Section 2: Structured psychosocial problems rating scale had 33 items. The items were subdivided into sections which included depression, anxiety and fear, anger, suspiciousness, self concept and sexual. The highest possible score was 66. It was arbitrarily classified into three levels: [1-22-mild psychosocial problems, 23-44-moderate psychosocial problems, 45-66-severe psychosocial problems]

Section 3: ‘Structured Coping Rating Scale’ had 20 items and was subdivided into activity focussed and emotion focussed. The highest possible score was 40. It was arbitrarily classified into two levels: [1-20-inadequate coping, 21-40-adequte coping].

RESULT:

The analyses of the data from the study are presented under the following headings:

Section A:Description of the samples according to their demographic variable.

Section B:Description of the level of psychosocial problems among postmenopausal women

Section C:Description of the coping strategies among postmenopausal women

Section D:Correlation between the psychosocial problems and coping strategies.

Section E:Association of the psychosocial problems with the demographic variables.

Section F:Association of the coping strategies with the demographic variables.

Section A: Description of samples according to their demographic variable.

Table 1: Frequency and percentage distribution of postmenopausal women according to their demographic variables N=100

Sl. No.	Demographic variable	Frequency (f)	Percentage (%)
1.	Age (Years)
	a. 46- 50	18	18
	b. 51-55	46	46
	c. 56-60	36	36
2.	Marital status
	a. Unmarried	-	-
	b. Married	70	70
	c. Widow	28	28
	d. Divorced	2	2
	e. Separated	-	-
3.	Educational Status
	a. No formal education	34	34
	b. Primary education	58	58
	c. Secondary education	8	8
	d. PUC	-	-
	e. Graduate	-	-
	f. Post graduate	-	-
4.	Occupation
	a. Daily wages	-	-
	b. Unemployed	86	86
	c. Private employee	14	14
	d. Government employee	-	-
	e. Any other(specify)	-	-
5.	Income of family(In rupees)
	a. <5000	-	-
	b. 5001-6000	15	15
	c. 6001-7000	10	10
	d. 7001-8000	62	62
	e. >8001	13	13
6.	Religion
	a. Hindu	71	71
	b. Muslim	26	26
	c. Christian	3	3
	d. Any other	-	-
7.	Type of family
	a. Joint	36	36
	b. Nuclear	64	64
	c. Extended	-	-
8.	Are you a member of any social group?
	a. Yes	31	31
	b. No	69	69
9.	Most supportive person in the family
	a. Husband	67	67
	b. In-laws	-	-
	c. Children	33	33
	d. Cousins	-	-
	e. Others	-	-
10(i)	Parity
	a. Nullipara	-	-
	b. Para 1	-	-
	c. Para 2	32	32
	d. Para 3	60	60
	e. Para 4 and above	8	8
10(ii)	Menopause was achieved at the age of (in years)
	a. 40-44	40	40
	b. 45-49	54	54
	c. 50-54	6	6
10 (iii)	Duration of menopause (in years)
	a. 1-2	-	-
	b. 2-3	6	6
	c. 3-4	20	20
	d. >4	74	74

The data presented in table 1 showed the following findings:

Maximum percentage (46% ) of postmenopausal women were in the age group 51-55 years whereas 36% were in the age group 56-60 yrs. Least (18%) were in the age group 46-50 years. The majority percentage (70%) of postmenopausal women were married, 28% were widow and least (2%) were divorced. The highest percentage (58%) of postmenopausal women had primary education and majority (86%) of the postmenopausal women were unemployed. Majority (62%) of postmenopausal women had a family income of Rs. 7,001-8,000 and maximum percentage (71%) of postmenopausal belonged to Hindu religion. Majority (64%) of women belonged to nuclear families and highest percentage (69%) of the women were not members of any social group. The highest (67%) percentage of postmenopausal women considered their husband to be the most supportive person in the family and majority (60%) of postmenopausal women were para 3. Majority (54%) of postmenopausal women had attained menopause at 45-49 years and highest percentage (74%) had attained menopause 4 or more years before the study.

Section B: Description of level of psychosocial problems among postmenopausal women

Figure 2: Cone diagram representing the percentage distribution of the level of psychosocial problems according to their scores

The data presented in Figure 2 shows that 27% of the postmenopausal women had mild level of psychosocial problems, 65% had moderate level of psychosocial problems and 8% had severe psychosocial problems.

Data in Table 2 shows that 52.27% of the sample had psychosocial problems in the areas of depression, anxiety and fear (17.56%), anger (47%), suspiciousness (47.50), self concept (45%), and sexual (6.75%) respectively.

Section C: Description of coping strategies among postmenopausal women

Figure 3: Bar diagram representing the percentage distribution of coping strategy according to their coping scores

The data presented in Figure 3 shows that majority (76%) of the sample had inadequate coping whereas (24%) had adequate coping for menopausal problems.

Table 3: Area-wise maximum possible score, range, mean, mean percentage and standard deviation of coping strategy score among postmenopausal women. N=100

Aspect	Maximum possible score	Range	Mean	Standard Deviation	Mean %
Activity focussed	24	3 – 19	10.00	3.58	41.66
Emotion focussed	18	1 – 11	5.63	2.15	11.94

Data in Table 3 show that the 41.66% of the sample used activity focussed coping and 11.94% of the sample used emotion focussed coping.

Section D: Correlation between the psychosocial problems and coping strategies.

H₀₁: There is no significant relationship between the psychosocial problems and coping strategies at 0.05 level of significance.

Table 4: Correlation between the psychosocial problems and coping strategies among postmenopausal women N=100

	Range	Mean	Standard Deviation	Correlation
Psychosocial problem	10-48	31.01	9.727	-0.06
Coping strategy	5-29	15.66	5.303	-0.06

Karl Pearson’s correlation coefficient was computed in order to find the correlation between the psychosocial problem and coping strategy among postmenopausal women. The data presented in Table 4 shows that there is a low negative correlation between the psychosocial problem and coping strategy. Thus null hypothesis H₀₁was rejected at 0.05 level of significance.

Section E: Association of the psychosocial problems with the selected demographic variables among postmenopausal women

The following hypothesis was stated to find the association:

H₀₂: There is no significant association of the psychosocial problems with the demographic variables.

The data depicted in Table 5 shows that there was a significant association of psychosocial problems with education (χ²=6.8040) at 0.05 level of significance. Thus the null hypothesis was rejected.

There was no significant association of psychosocial problems with age (χ²=2.59), marital status (χ²=0.81), occupation (χ²=0.63), income (0.11), religion (χ²=0.34), type of family (χ²=0.13), member of social group (χ²=0.011), supportive member (χ²=1.13), parity (χ²=2.80), age of menopause (χ²=0.52), and duration of menopause (χ²=0.29) at 0.05 level of significance. Thus the null hypothesis was accepted.

Section F: Association of the coping strategies with the demographic variables among postmenopausal women

H₀₃ There is no significant association of coping strategies with the demographic variables.

Table 5: Chi square test showing association between the psychosocial problems with the demographic variables among postmenopausal women N=100

Sl. No.	Demographic characteristics	χ² value	df	Table value	Inference
1.	Age	2.5900	2	5.991	Not Significant
2.	Marital status	0.8100	1	3.841	Not Significant
3.	Education	6.8040	1	3.841	Significant*
4.	Occupation	0.6300	1	3.841	Not Significant
5.	Income	0.1100	1	3.841	Not Significant
6.	Religion	0.3400	1	3.841	Not Significant
7.	Type of family	0.1300	1	3.841	Not Significant
8.	Member of social group	0.0110	1	3.841	Not Significant
9.	Supportive member	1.1300	1	3.841	Not Significant
10(i)	Parity	2.8000	1	3.841	Not Significant
10(ii)	Age at menopause	0.5200	1	3.841	Not Significant
10(iii)	Duration of menopause	0.2900	1	3.841	Not Significant

p<0.05

Table 6: Chi square test showing association between the coping strategies with demographic variables N=100

Sl. No.	Demographic characteristics	χ² value	df	Table value	Inference
1.	Age	5.4000	2	5.991	Not Significant
2.	Marital status	2.3800	1	3.841	Not Significant
3.	Education	1.9800	1	3.841	Not Significant
4.	Occupation	0.4100	1	3.841	Not Significant
5.	Income	5.1000	2	5.991	Not Significant
6.	Religion	0.3400	1	3.841	Not Significant
7.	Type of family	1.4000	1	3.841	Not Significant
8.	Member of social group	4.0300	1	3.841	Significant*
9.	Supportive member	5.1000	1	3.841	Significant*
10(i)	Parity	0.1400	1	3.841	Not Significant
10(ii)	Age at menopause	0.4500	1	3.841	Not Significant
10(iii)	Duration of menopause	0.0540	1	3.841	Not Significant

p<0.05

The data depicted in Table 6 shows that there was a significant association of coping strategies with member of social group (χ²=4.03) and supportive member (χ²=5.11) at 0.05 level of significance. Thus the null hypothesis H₀₃was rejected.

There was no significant association of coping strategies with age (χ²=5.40), marital status (χ²=2.38), education (χ²=1.98), occupation (χ²=0.41), income (5.10), religion (χ²=0.34), type of family (χ²=1.40), parity (χ²=2.80), age of menopause (χ²=0.52), and duration of menopause (χ²=0.29) at 0.05 level of significance. Thus the null hypothesis was accepted.

DISCUSSION:

Section A: Discussion of demographic characteristics of postmenopausal women.

The study findings were similar to the study conducted to assess the health problems among menopausal women in Udupi district (Karnataka) which showed that majority of women (42%) belonged to age group of 51-55 years, highest percentage (78%) were married, and majority (40%) of them had three or more than three children.⁶

Section B: Discussion of level of psychosocial problems

The study findings were similar to a study conducted in Udupi to assess the health problems of menopausal women that showed majority (50%) of the subjects had moderate symptoms which included forgetfulness (74%), difficulty in concentration, nervousness, anger, loneliness, mood disturbance, irritability (72%) and worthlessness (70%) in urban women and forgetfulness (86%), difficulty in concentration, nervousness, anger, loneliness, mood disturbance, irritability (84%) and worthlessness (74%) in rural women.⁶

Section C: Discussion of coping strategy of postmenopausal women

The study findings was supported by the study conducted in New Delhi to assess the knowledge of perception and coping strategies of menopausal women through self instructional module. The coping strategy score results before intervention was no coping (35%), average coping (2%), and good coping (1%).⁷

Section D: Discussion of correlation between the level of psychological problems and coping strategy scores

Results of this study can be compared with a study conducted on perceived bio-psychosocial problems and coping strategies showed that there was a significant but low negative (r=-0.21) relationship found between the perceived bio psychosocial problems and coping strategies adopted by the postmenopausal women.⁸

Section E: Discussion on the association of psychosocial problem scores with the demographic variables .
The finding of the current study supports the study conducted on menopausal problems among rural women from eastern India, Calcutta, which showed statistically significant association of psychosocial problems with education (χ²⁼13.46, p<0.05).⁹

Section F: Discussion on the association of coping strategy scores with the demographic variables

The findings are supported by a study conducted in Jammu and Kashmir to assess the bio-psychosocial wellbeing and family support revealed that there is statistically significant association of social participation (χ²=5.57, p<0.05) and family support (χ²=7.48, p<0.05) in coping with the menopausal problems.¹⁰

Another study was conducted to assess the effect of support group method on quality of life , Iran revealed that with the help of social group there was significant reduction in psychosocial problem scores before (38.7±10.91) and after (28.63±10.21) thus improving the quality of life of postmenopausal women.¹¹

CONCLUSION:

This study was conducted with the objective to assess the psychosocial problems and coping strategy among postmenopausal women in selected communities at Mangalore.

LIMITATIONS:

· As the study was conducted only in selected communities in Mangalore which imposed limits in generalisation of findings.

· The study was restricted to 100 postmenopausal women in selected urban area.

· Use of the structured knowledge interview schedule restricts the amount of information that can be collected from the respondents.

RECOMMENDATIONS:

Based on the study findings, the following recommendations are stated:

· A comparative study can be conducted to assess the effectiveness of hormone replacement therapy and natural methods on problems of menopause.

· A similar study can be done on a larger sample to generalise the findings.

· Replication of the study can be done in a rural setting.

· A self-instructional module can be developed regarding the coping strategies of postmenopausal problems.

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7. Aisha P, Paras W. Evaluation of knowledge of perception and coping strategies of postmenopausal women. International Journal of Scientific and Technology Research;1(7):42-5.

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Received on 04.05.2014 Modified on 25.05.2014

Int. J. Nur. Edu. and Research 2(2): April- June 2014; Page 173-179

Aspect	Maximum score	Range	Mean	Standard deviation	Mean %
Depression	22	4 -12	11.50	3.34	52.27
Anxiety and fear	16	3 – 7	8.24	2.81	17.56
Anger	8	0 – 2	3.76	1.79	47.00
Suspiciousness	4	0 – 2	1.90	1.24	47.50
Self concept	12	1 – 8	5.40	2.67	45.00
Sexual	4	0 – 4	0.27	0.75	6.75