Mindfulness-Based Stress Reduction (MBSR) Effects on the Worries of Women with Poly Cystic Ovary Syndrome (PCOS)

doi:10.21203/rs.3.rs-2248153/v1

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Mindfulness-Based Stress Reduction (MBSR) Effects on the Worries of Women with Poly Cystic Ovary Syndrome (PCOS)

https://doi.org/10.21203/rs.3.rs-2248153/v1

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published 21 Mar, 2023

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Introduction

Polycystic ovary syndrome is one of the most common endocrine disorders in women that can cause anxiety, psychological distress and reduced quality of life. Therefore, the present study aimed to determine the effect of mindfulness-based stress reduction counseling on the worries of women with polycystic ovary syndrome.

Materials and methods

This quasi experimental was implemented on 60 women with polycystic ovary syndrome, referring to health centers in Kerman, Iran, from April to September 2021. In the intervention group, MBSR was conducted in eight 90-minute sessions twice a week. A researcher-made questionnaire with 34 questions (with six domains includes worries related to mental complications, interpersonal problems, non-pregnancy physical complications, pregnancy complications, sexual complications, and religion issues) on the worries of women with polycystic ovary syndrome were completed by the participants in two intervention and control groups as pre and posttest and one month later. 22 SPSS statistical software was used for analysis.

Results

The mean score of worries in the intervention group(48.18 ± 5.18) compared to the control group(75.73 ± 8.08) was significantly reduced in total and in all six domains immediately after the intervention (P < 0.0001). One month later also the total mean score of worries and subtitles decreased significantly(P < 0.0001), in intervention group (38.27 ± 3.58) in comparision with control group(76.13 ± 7.52).

Conclusion

Results showed that, the method of reducing stress based on mindfulness has caused a significant reduction in worries in the intervention group. Therefore, this method can be used to improve the mental health of this group of patients in health centers.

Polycystic Ovary Syndrome

Mindfulness

Mindfulness Stress Reduction

Concern

Quality of Life

Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders in women of reproductive age, with clinical consequences such as reproductive, metabolic, psychological, and some cancers. The disease affects 5 to 10 percent of women worldwide [1]. The prevalence of this complication in Iran is reported to be 14.6% [2].

Physical issues such as infertility and menstrual irregularities appear to have a significant effect on reducing the quality of life and mental health of patients with this syndrome. But other things, such as changes in a person's appearance, especially obesity and hair loss, acne, changes in sexual behaviour, anxiety and depression, can also significantly reduce the physical and mental quality of life [3.4]. Due to their gender role, poor body image owing to obesity, acne and increased hair growth, which severely leads to a decrease in the quality of life of these women and has negative effects on their mental state and psychological health, so they need special support of health care systems in different dimensions [5,6].

One of the most important clinical consequences of PCOS women is having many physical and psychological worries. Worries as a cognitive process predict risk and threat, including recurring thoughts and images, anxious topics, potentially stressful events, and potentially catastrophic consequences [7]. Treatment of PCOS Worries is divided into complementary medicine and pharmaceutical medicine. Some of the non-pharmacological treatments for worry include relaxation techniques, mindfulness changes, fun activities, and coping with worries [8].

According to the mindfulness approach, all thoughts that come to mind are accepted equally so that one does not judge those thoughts and accepts all of them as one's current thoughts [9].

Given the impact of polycystic ovary syndrome on women's mental and psychological aspects the present study was conducted to determine the effect of MBSR on the worries of women with polycystic ovary syndrome.

Design and setting

This quasi experimental study was implemented on 60 women with polycystic ovary syndrome, referring to health centers in Kerman, Iran, from April to the end of September 2021.

Participants included women with PCOS who referred to health centers in Kerman. Out of 16 health centers, 2 centers in the north and 2 centers in the south of the city were selected by lottery to conduct research.

Sample Size And Sampling

The sample size was calculated for each group by comparing means. 30 people were determined for each group by using the formula below and taking into account the 10% Sample shedding.

Women with PCOS who referred to health care centers were divided into two intervention and control groups by lottery, if they were eligble for entry and consent to participate in the study.

Inclusion criteria included: Diagnosis of PCOS based on Rotterdam method, aged between15 to 45 years old, literate, resident of Kerman, lack of known chronic disease like; Cardiac, pulmonary, diabetes, anemia, immunodeficiency, hemophilia, Malnutrition, lack of drug and other psychotropic substance use, lack of known mental disorders, lack of hyperprolactinemia, lack of special diet, lack of Cushing's syndrome and, Adrenal Hyperplasia.

Exclusion Criteria were adverse psychological events such as the death of a first-degree relative during the study, failure to attend two counseling sessions, reluctance to continue the study, participation in counseling sessions other than the current program and pregnancy during the study [10].

Measures

For pre assessment phase the Demographic Information Questionnaire included questions such as age, level of education, spouse's education, employment status, spouse's job, weight, age of onset of menstruation, time of onset of symptoms, and a researcher-made questionnaire on the worries of women with polycystic ovary syndrome was completed by the participants in both group. The questionnaire on the worries of women with polycystic ovary syndrome was consisted of 34 questions with six subscales which includes worries related to mental complications(8 questions), interpersonal problems (5 questions), non-pregnancy physical complications(7 questions), pregnancy complications(6 questions), sexual complications(5 questions), and religion issues(3 questions). It was sent to 10 professors for narration, which included faculty members of the midwifery and gynecology department and a psychologist. Reliability was determined by calculating Cronbach's alpha coefficient, which was calculated to be 95%. The questionnaire was prepared on a 5-point Likert scale, which “always” got a score of 5 and “never” a score of 1. The lowest score is 34 and the highest score is 170. A lower score was less worry and a higher score was more worry.

Intervention

After obtaining informed written consent and giving the essntial information about the objectives of the study, women with PCOS completed the measures. After selecting the eligible women, they were divided into two groups of intervention and control based on randomized sampling technique.

MBSR was conducted in eight 90-minute sessions twice a week for 30 women in intervention group .The intervention was given by ZS who had previously been trained in this regard and AA was facilitator. Attendance sessions were held in a room in one of health centers with good ventilation, observance of social distance and the use of personal protective equipment such as masks. At the end of each meeting, the date and time of the next meeting was announced in coordination with the participants.Researchers performed the intervention session with discussion methode and using a video projector. In the last session, the results of the sessions were measured by post-test. And again, a month later, the questionnaires were completed for both groups. During the intervention, control group were in waiting list. It should be noted that the next meeting was held at certain times with the agreement of the attendees. The content of counseling sessions is shown in Table 1

Table 1

Summary of sessions of counseling based on MBSR approach for reduction of worry in women with PCOS
session	Content
1	Greeting and declaration of counseling rules, definition of the concepts of mindfulness and the main variables, description of the internal and external flow of the mind, Eating raisins, home works.
2	Reviewing previous home works, mindful thinking, Mindful examination of body and sitting meditation, home works.
3	Reviewing previous home works, focus on being present, practice seeing and hearing consciously in three minutes, focus on five senses in five minutes, home works.
4	Reviewing previous home works, stress and the body's reaction, Practicing thoughts-emotions-body senses-behavior relationships, three minutes of concentration on an unpleasant event, mindful walking, home works.
5	Reviewing previous home works, effective responses to stress, Three-Minute Breathing Space (3MBS), meditation in daily life, home works.
6	Reviewing previous home works, conscious mind interactions, take care of yourself, practicing speaking and listening consciously, practicing consecutive thoughts in an hour, getting feedback from participants from practicing, presenting homework Homemade.
7	Reviewing previous home works, being more careful, Mindful Yoga, making the unpleasant event enjoyable, providing homework
8	Reviewing previous home works, mountain meditation, summarization of all sessions, homework ^[12].

Data analysis

The descriptive statistics were reported as frequency, percent and mean(SD). To analyze the data, independent t-test, paired t-test, Chi- square test were used. The significance level was 0.05. SPSS version 22 of IBM company was used for analysis.

Ethical Considerations

This manuscript was derived from a master counselling in midwifery thesis (project code No. 97001078) and was approved by the Ethics Committee of Kerman University of Medical Sciences, Iran (the code of ethics No. Kmu.ac.ir.1398.163). Written informed consent was obtained to enter the study ,and participants were easy to withdraw the study whenever they were willing. At the request of the ethics committee, the study was conducted in accordance with the Declaration of Helsinki and Ethics Publication on Committee (COPE). Special codes were used for each of the participants to ensure the information confidentiality.

The mean age of the samples in the intervention group was 32.25 ± 4.67 years and in the control group was 31.4 ± 4.37 years. The mean weight of the samples in the intervention group was 70.92 ± 7.75 kg and in the control group was 73.83 ± 8.79 kg.The mean age of onset of the first symptoms in the intervention group was 20.59 ± 1.69 years and in the control group was 20.8 ± 2.32 years.

The mean number of children in the intervention group was 1.4 ± 0.5 and in the control group was 1.06 ± 0.98. There was no statistically significant difference between two groups in terms of quantitative variables. [Tables 2 and 3].

Table 2

Comparing distribution of quantitative variable between of two intervention and control group
Group Variable	Control		Independent T- test	P value
Group Variable	Mean ± SD		Independent T- test	P value
Age	31.4 ± 4.37	32.25 ± 4.67	-0.71	0.47
Weight	73.83 ± 8.79	70.92 ± 7.75	1.38	0.19
Age of Onset of Menstruation	14 ± 0.74	13.25 ± 0.59	4.12	0.001
Age of Onset of Symptoms	20.8 ± 2.32	20.59 ± 1.69	0.38	0.70
Number of Children	1.06 ± 0.98	1.40 ± 0.50	-1.62	1.011

Table 3

Comparing distribution of qualitative variable between of two intervention and control group
Group Variable		Control	Intervention	\({X}^{2}\)	P value
Group Variable		N(%)	N(%)	\({X}^{2}\)	P value
Education Level	Associate Degree	8(26.7)	8(29.6)	2.75	0. 25
	Bachelor	12(40)	15(55.6)
	Masters and PhDs	10(33.3)	4(14.8)
Spouse Education Level	Diploma	4(13.3)	4(14.8)	*	0.13
	Associate Degree	4(13.3)	1(3.7)
	Bachelor	13(43.3)	19(70.4)
	Masters and PhDs	9(30)	3(11.1)
Job	House wife	17(56.7)	12(44.4)	*	0.34
	Employee	10(33.3)	14(51.9)
	Freelance	3(10)	1(3.7)
Husbands job	Employee	17(56.7)	21(77.8)	2.85	0.09
Husbands job	Freelance	13(43.3)	6(22.2)	2.85	0.09
Family history of Polycystic Ovary	Yes	5(16.7)	0	*	0.053
Family history of Polycystic Ovary	No	25(83.3)	27(100)	*	0.053
*Fisher Exact Test

The mean score of pre-intervention worry was 76.21 ± 8.18 in the intervention and 75.89 ± 7.77 in the control group (P = 0.22). Immediately after the intervention, the mean score of the worry was 48.18 ± 5.18 in the intervention and 75.73 ± 8.08 in the control group (P < 0.0001). One month after the intervention, the mean score of worry was 38.27 ± 3.58 in the intervention and 76.13 ± 7.52 in the control group (P < 0.0001) [Table 4].

Table 4

Comparison of the mean score of worry before, after and one month after counselling in both groups
Time	Variable Group	mental complications	Interpersonal problems	non-pregnancy physical complications	pregnancy complications	sexual complications	religion issues	Total
Time	Variable Group	Mean ± SD
Pre test	Intervention	17.93 ± 8.32	11.2 ± 7.59	15.69 ± 8.01	13.44 ± 11.24	11.2 ± 9.71	6.72 ± 4.21	76.21 ± 8.18
Pre test	Control	17.85 ± 8.29	11.16 ± 7.28	15.61 ± 8.43	13.39 ± 10.96	11.16 ± 7.28	6.69 ± 4.41	75.89 ± 7.77
P-value		0. 19	0. 33	0.25	0.27	0.33	0.61	0.22*
Post test	Intervention	11.33 ± 7.21	7.08 ± 4.14	9.91 ± 6.12	8.5 ± 6.25	7.08 ± 4.14	4.25 ± 3.22	48.18 ± 5.18
Post test	Control	17.81 ± 8.26	11.13 ± 7.15	15.59 ± 8.39	13.36 ± 9.87	11.13 ± 7.16	11.13 ± 7.15	75.73 ± 8.08
P-value		< 0.0001**
One month later	Intervention	9 ± 5.02	5.62 ± 3.31	7.87 ± 4.56	6.75 ± 4.11	5.62 ± 3.31	3.37 ± 1.18	38.27 ± 3.58
One month later	Control	17.91 ± 8.53	11.19 ± 7.13	15.67 ± 8.36	13.43 ± 9.48	11.19 ± 7.13	6.71 ± 4.51	76.13 ± 7.52
P-value		< 0.0001**
Independent T-Test * ANCOVA

Therefore, it is clear that during the study in the intervention group, the worries were significantly reduced. There was a statistically significant difference between the two groups in terms of worries during the study. In other words, the mean score of worries was significantly lower in the intervention group than the control group immediately after and one month after the intervention.

All subscales of the worries of women with PCOS were compared between two groups. The decrease in all dimentions score immidiatly after and one month after the counseling in the intervention group was statistically significant (p < 0.0001) [Table 4].

Repeated Measure ANCOVA Shows the difference in the level of worry during the time [Table 5]. Figure 1 also declares it better.

Table 5

Comparing the anxiety in two intervention and control groups (immediately and one month after the intervention) using Repeated Measure ANCOVA
Group Variable	Intervention	Control	F-test	P*
	Mean ± SD
Worry immediately after intervention	48.18 ± 5.18	75.73 ± 8.08	146.09	< 0.0001
Worry one month after intervention	38.27 ± 3.58	76.13 ± 7.52
* ANCOVA adjusted by menstruation age and worry before study

Finding of present study showed that in general, the mean score of worry in women with PCOS in the intervention group has decreased. This means that MBSR has been effective in reducing worry scores.

Since the worry includes different areas, multiple studies have been conducted, each of which has examined one branch. The worry about physical complications related to PCOS was one of the subtitle of concern which the findings showed that MBSR was able to reduce its mean score.

A Study by - Ghazagh et al. also Showed that MBSR leads to improved quality of life and reduced fatigue in patients with multiple sclerosis [11].Results of Mohammed´s study demonstrated that MBSR increased pain tolerance and mindful awareness for injured athletes. Moreover, their findings observed a promising change in positive mood [12].

Stress and anxiety are commonly seen in women with PCOS, which according to the results, MBSR could reduce these mental problems in the samples which is aligned with Jafari and Shahabi who reported that MBSR reduced anxiety in obese women [13]. But Krusche et al., reported that there was no significant difference in the stress levels of pregnant women before and after the mindfulness intervention in both groups, which is contrary to the findings of the present study [14]. Probably it is due to different counseling method. Another study showed that MBSR intervention led to a sustained reduction of negative emotional states as measured by both psychological and electrophysiological metrics, which supports the adoption of MBSR as an effective and sustainable stress-countering approach for students[15].

Worries as a cognitive process predict risk and threat, including recurring thoughts and images, anxiety, potential stressful events, and potentially catastrophic consequences [7]. According to the results of the present study, mindfulness reduces anxiety and then may leads to reduce pessimism.

One interventional study confirms our findings with the results of his study by evaluation of the effectiveness of mindfulness training on increasing optimism in diabetic pregnant women [16].

One of the issues that follows the disease of polycystic ovary syndrome is the change in the appearance of the person in such a way that the person suffers from hair loss, acne, hair growth in parts of the face and obesity.The findings of a study indicated that MBSR influenced the body image of adolescent girls with dysfunctional eating attitudes [17].

How to communicate with others, be it with spouses, colleagues or other members of the society, is problematic due to the decrease in self-confidence and self-esteem in this group of women, and they have a concern to start and continue a relationship.Fortunatlely we saw that MBSR could improve interpersonal problems. Leufke et al.’s findings showed that IBSR intervention significantly reduced a wide range of psychological symptoms, interpersonal sensitivity, hostility, obsession, and paranoid thoughts [18].

Worries about sexual issues may arise from a change in appearance, which is called sexual anxiety. Anxiety and worry about sexual function, destroy the relationship between couples and deprive the parties of the necessary self-confidence [19]. In the present study, participants were worried about sexual issues and thought that the disease might cause sexual dysfunction in them or their spouse, but mindfulness intervention could reduce their worries. Previous studies entitled "Anxiety of Sexual Performance" and "Mindfulness and Sexual Desire" confirm the results of the present study [20,21].

The results determined that despite the completion of the intervention, the effect continued until one after the intervention. Tajnia also declared that IBSR improved mortality awareness and decrease interpersonal problems among intensive care unit nurses and the effect continued until 6 weeks after the intervention[22].

Limitations

The present study, like any other study, had limitations.One of the limitations of the research was that only married women were included in the study and single people did not want to participate in the study, perhaps because married people were more familiar with the problems caused by the disease and had touched it objectively.

Overall, given the theoretical underpinnings discussed, as well as the findings of the present study, it shows that mindfulness-based stress reduction programs have an impact on reducing worries in women with polycystic ovary syndrome. Since MBSR is a non-pharmacological method, health personnel can use it to reduce the problems of patients in health centers.

MBSR

Mindfullness-Based Stress Reduction

PCOS

Poly Cystic Ovary Syndrome

MMA-M

Multidimensional Mortality Awareness Measure.

Ethics approval and consent to participate

Consent for publication

Not applicable

Availability of data and materials

The datasets used during the current study are available from the corresponding author on reasonable request

Competing interests

Authors declare that they do not have competing interests.

Funding

This research did not receive any grant from funding agencies in the public, commercial, or non-profit sectors.

Authors' contributions

All authors planned the study. ZS :Investigation, Writing - Original Draft, Formal analysis, Visualization. KA: Conceptualization, Methodology, Supervision, Writing - Original Draft, Project administration, Visualization. AA: Conceptualization, Methodology, Project administration, Writing - Review & Editing, Visualization. HSH: Writing - Review & Editing. YJ: Formal analysis, Visualization. FNA: Verification, Resources ZS: Verification, Resources. All of the authors have approved the final version of the manuscript for submission

Acknowledgements

Authors would thank the research deputy of Kerman University of Medical Sciences and all health care center staffs. Thanks to all women for participating in this research.

Authors' information

¹ Nursing Research Center, School of Nursing and Midwifery, Kerman University of Medical Sciences, Kerman, Iran

² Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran

³ Infertility and Health Reproductive Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran

⁴ Obstetrics and Gynecology Center, Afzalipour School of Medicine, Kerman University of Medical Sciences, Kerman, Iran

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No competing interests reported.

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You are reading this latest preprint version

Mindfulness-Based Stress Reduction (MBSR) Effects on the Worries of Women with Poly Cystic Ovary Syndrome (PCOS)

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Journal Publication

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Abstract

Introduction

Materials and methods

Results

Conclusion

Figures

Introduction

Materials And Methods

Design and setting

Sample Size And Sampling

Measures

Intervention

Data analysis

Ethical Considerations

Results

Discussion

Limitations

Conclusion

Abbreviations

Declarations

References

Additional Declarations

Status:

Journal Publication

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