This study adopted a cross-sectional descriptive design to collect information exploring the potential relationships between menopausal symptoms, sleep quality, hot flash, and depressive symptoms in postmenopausal women. This research was additionally approved by the ethics committee of Babol University of Medical Sciences (Ethic ID: IR. MUBABOL.HRI.REC. 1397. 032). The inclusion criteria for the study were as follows: The participants had to be around 45-60 years of age, and they had to have experienced their last menstruation at least one year prior to the study. It is also worth noting that women with a history of surgical menopause, abnormal cervical smear test, chronic diseases, endometrial or ovarian cancer or breast cancer, thyroid dysfunction, anti-psychotic drug use, hormone replacement therapy during the last six months, and smoking habits or alcohol use were excluded from the study. Any interested menopausal women around 45-60 years of age who referred to the menopausal clinic affiliated with Babol University of Medical Sciences over the period between September 2016 and August 2018 were recruited for this study. We totally recruited 189 women (age range 45–60) for this study, out of whom 31 were excluded, and 158 proved to be eligible for the purpose of this study. Before the outset of the research, informed written consents were obtained from all the participants. Then the participants were asked to complete the questionnaires for the study. Eight questionnaires were excluded due to missing information, and the remaining data from the 150 women were used for the final analysis.
The instruments for this study were: The traits data; the Beck Depression Inventory (BDI), used for assessing depressive symptoms [22]; Modified Blatt-Kupperman Menopausal Index (MKMI), measuring the severity of climacteric symptoms [23]; and Five Factor Inventory (NEO-FFI), used for the assessment of personality traits [24].
The participants’ age, education, marital status, parity, working status, monthly family income, and cigarette use were obtained from the questionnaire. The participants’ weight was measured using digital scales with minimal dress and without shoes. The height was recorded with a tape. The BMI was computed using the formula weight (kg)/height2 (m). The waist circumference was measured to the nearest 1 centimeter using a tape measure at the level midway between the lower rib margin and iliac crest.
Beck Depression Inventory (BDI): BDI is a standard tool, widely used in numerous studies measuring physical, behavioral, and cognitive symptoms of depression. This questionnaire comprises 13 items, each substance has 4 options, scaling down from 0 to 3, and it sets various degrees of depression from mild to severe. The maximum score in this test is 63, and the minimum is zero [22]. The reliability and validity of this questionnaire was reported by a study conducted by Rajabi. The questionnaire had been used to screen depression in psychiatric outpatients in Iran [25].
NEO Five-Factor Inventory (NEO-FFI): The NEO-FFI is one of the most widely used instruments to assess personality traits on five dimensions: Neuroticism, Extraversion, Openness, Agreeableness, and Conscientiousness through 60 questions. NEO-FFI is scored based on a 5-point Likert's scale (strongly disagree, disagree, no idea, agree, and strongly agree) , and the questions are scored from 0 to 5. It is worth mentioning that reverse-coding needs to be considered for some questions [24]. The reliability of the NEO-FFI had already been confirmed by Garousi et al. in Iran. They reported Cronbach alpha coefficients of 0.86, 0.73, 0.56, 0.68, and 0.87 for neuroticism, extraversion, openness to experience, agreeableness, and conscientiousness, respectively [26].
Modified Blatt- Kupperman Menopausal Index (MKMI): The Climacteric symptoms were assessed through the 13-item MKMI. It should be mentioned that urinary infection was added to the modified version, and libido was reduced from the original KI. It comprises the following 13 components: hot flash and night sweats, paresthesia, insomnia, nervousness, melancholia, vertigo, fatigue, arthralgia, myalgia, headache, heart palpitation, formication, sexual complaints, and urinary tract infection. Each symptom on the MKMI was rated from 0 to 3 for no, slight, moderate, and severe complaints. To calculate the MKMI, the weighted score for hot flashes/sweating was 4 points; paresthesia, insomnia, mood swings, sexual problems, and urinary tract infection were 2 points each; and the other symptoms were 1 point each. The total scores ranged from 0 to 63. Scores ranging from 0–6, 7–15, 16–30, and 30 were used to rate the degree of severity as none, mild, moderate, and severe, respectively [23]. The validity of MKMI had already been confirmed by Mohammadi et al., in Iran [27].
Statistical analyses
The data were analyzed using statistical package of computer software (SPSS) 20.0. Chi-square test was used to examine the characteristics of the participants: women without depression and those with depression. Logistic regressions were run to assess the relationships between variables, related to depressive symptoms at p = 0.2 in the bivariate analyses. Odds ratios associated with 95% confidence intervals (CIs) were computed using logistic regression. The p-value of 0.05 or less was considered significant in all tests.