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Symptom groupings at midlife: cross-cultural variation and association with job, home, and life change

Sievert, Lynnette Leidy PhD1 ; Obermeyer, Carla Makhlouf PhD2; Saliba, Matilda MSc3

doi: 10.1097/gme.0b013e31804f8175
Articles from the Workshop on "Cross-cultural Comparisons of Midlife and Aging"

Objective: To examine how symptoms at midlife grouped together by factor analyses in four different countries and to examine whether life changes were associated with symptom frequencies.

Design: The Decisions at Menopause Study was a multisite study of women aged 45 to 55 drawn from the general population in the United States, Spain, Lebanon, and Morocco. Semistructured questionnaires collected demographic, reproductive, and lifestyle information, along with 4-week recalls of 25 symptoms. Factor analyses were performed using symptom frequency data from each country. Symptoms frequencies were examined by χ2 analysis in relation to job, home, and life changes. Regression scores for individual factors were examined as dependent variables in relation to menopause status and life change while controlling for demographic and reproductive variables.

Results: The intercorrelation among symptoms differed in country-specific ways, eg, hot flashes grouped with vaginal dryness and sexual symptoms in Spain, with general somatic symptoms in Morocco, and did not cluster with other symptoms in the United States or Lebanon. In χ2 analyses, household change, not job change, was associated with increased symptomatology in Spain. Job change was a significant predictor of the first symptom cluster in the United States (mental symptoms) and Spain (emotional symptoms). Home change was a significant predictor of the third (mental) symptom cluster in Spain. Life change was a significant predictor of symptom clusters in Spain and Morocco.

Conclusions: Cross-population comparisons demonstrate variation in symptom clusters. Regression analyses showed how the variables that predict symptom groupings (eg, job change, marital status, menopause status, or level of education) also differed in country-specific ways.

A study of symptom clusters in Morocco, Lebanon, Spain, and the United States demonstrates cross-population variation. Variables that predict symptom groupings (eg, job change, marital status, menopause status, or level of education) also differed in country-specific ways.

From the 1Department of Anthropology, University of Massachusetts Amherst, Amherst, MA; 2Department of Population and International Health, Harvard University, Cambridge, MA; and 3Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon.

Received January 2, 2007; revised and accepted February 16, 2007.

Funding/support: Supported by grant SBR-9600721 from the National Science Foundation and grant S 900 000196 from the National Institutes of Health.

Financial disclosure: None reported.

Address correspondence to: Lynnette Leidy Sievert, PhD, Department of Anthropology, Machmer Hall, UMass Amherst, Amherst, MA 01003-9278. E-mail:

©2007The North American Menopause Society