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Symptom clusters at midlife: a four-country comparison of checklist and qualitative responses

Sievert, Lynnette Leidy PhD1; Obermeyer, Carla Makhlouf DSc2

doi: 10.1097/gme.0b013e3182292af3
Original Articles

Objective The purpose of this study was to examine the frequency and clustering of somatic symptoms as reported by women aged 45 to 55 years in four countries, to compare women’s responses to open-ended questions with those derived from structured checklists, and to assess the extent to which bodily symptoms grouped with emotional complaints.

Methods The Decisions at Menopause Study recruited 1,193 women from the general population in Beirut, Lebanon; Rabat, Morocco; Madrid, Spain; and central Massachusetts. Women participated in semistructured interviews on health, menopause, and bodily changes at midlife. The women’s responses to symptom checklists and their statements in response to open-ended questions were analyzed through factor and textual analyses.

Results There was considerable consistency between the frequencies of quantitative and qualitative responses, and analyses of qualitative data illustrate the extent to which women associate somatic and emotional complaints. As shown in their responses to the open-ended questions, the women in Massachusetts and Spain did not often cluster somatic with emotional symptoms. In Morocco, dizziness, fatigue, and headaches were clustered with emotional symptoms. Women in Lebanon explicitly associated shortness of breath, chest pain, palpitations, dizziness, fatigue, gastrointestinal complaints, headaches, and, to a lesser extent, joint pain and numbness with emotional symptoms.

Conclusions The number of volunteered symptom responses was small because the respondents were relatively healthy; however, the extent and pattern of association between somatic and emotional symptoms varied across sites. Certain somatic symptoms may be more likely to communicate psychosocial distress in particular cultures. These results have implications for patterns of healthcare utilization.

The four-country study presented here documents some of the connections that link somatic and emotional symptoms at midlife, as well as variations across cultures in the ways that psychosocial distress may be communicated through certain somatic symptoms.

From the 1Department of Anthropology, UMass Amherst, Amherst, MA; and 2Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon.

Received April 20, 2011; revised and accepted June 13, 2011.

Funding/support: This work was supported by the National Science Foundation grant SBR-9600721 and the National Institutes of Health/National Institute on Aging grant 5R01 AG17578-03.

Financial disclosure/conflicts of interest: None reported.

The results presented here do not represent the views of the World Health Organization.

Address correspondence to: Lynnette Leidy Sievert, PhD, Department of Anthropology, Machmer Hall, 240 Hicks Way, UMass Amherst, Amherst, MA 01003-9278. E-mail:

©2012The North American Menopause Society