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Somatic and affective anxiety symptoms and menopausal hot flashes

Lermer, Miriam A. BSc1; Morra, Angela BSc1; Moineddin, Rahim PhD2; Manson, Judith BScN, RN, NCMP3; Blake, Jennifer MD, MSc4; Tierney, Mary C. PhD1,2

doi: 10.1097/gme.0b013e3181ec58f8
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Objective: Menopausal hot flashes have been associated with increased scores on measures of anxiety. Anxiety measures are typically composed of items measuring somatic and affective symptoms. Because hot flash symptoms are similar to symptoms of somatic anxiety, we wanted to examine the differential contribution of somatic anxiety and affective anxiety to hot flash scores.

Methods: A total of 80 psychologically well-functioning postmenopausal women aged 50 to 64 years were administered the Zung Anxiety Index (ZAI), from which total score, somatic anxiety subscale score, and affective anxiety subscale score were calculated. The outcome measure was a hot flash score that incorporated both frequency and severity based on a 7-day diary. A linear regression analysis examined the association between hot flashes and the two anxiety subscales controlling for age, education, and sleep quality.

Results: Higher score on somatic anxiety was significantly associated with higher hot flash score (P = 0.04), whereas the association with affective anxiety was not significant (P = 0.80). Higher total score on the ZAI was also significantly associated with higher hot flash score (P = 0.02).

Conclusions: These results suggest that the positive association between higher ZAI scores and hot flashes in recently postmenopausal women may be due to the overlap between the somatic manifestation of hot flashes and anxiety symptoms rather than to an affective anxiety disturbance. These results have potential implications for the care and treatment of postmenopausal women, but replication is required in other samples including women at different transition stages of menopause and women with psychiatric comorbidities.

The positive association between higher Zung Anxiety Index (ZAI) scores and hot flashes in recently postmenopausal women may be a result of the overlap between the somatic manifestation of hot flashes and anxiety symptoms rather than of an affective anxiety disturbance. This overlap may have potential implications for the care and treatment of anxiety and hot flashes in postmenopausal women.

From the 1Geriatric Research Unit, Brain Sciences, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada; 2Family & Community Medicine, University of Toronto, Toronto, Ontario, Canada; 3Family & Community Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; and 4Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.

Received April 14, 2010; revised and accepted June 8, 2010.

Funding/support: Funding for this study was provided by the Geriatric Research Unit, Sunnybrook Health Sciences Centre, University of Toronto, and the Women's Health Student Experience, Women's College Hospital, University of Toronto, Toronto, Ontario, Canada.

Financial disclosure/conflicts of interest: None reported.

Address correspondence to: Mary C. Tierney, PhD, Geriatric Research Unit, Brain Sciences, A1-45, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Ave, Toronto, Ontario, Canada M4N 3M5. E-mail: mary.tierney@sunnybrook.ca

©2011The North American Menopause Society