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Emotional Antecedents of Hot Flashes During Daily Life

Thurston, Rebecca C. PhD; Blumenthal, James A. PhD; Babyak, Michael A. PhD; Sherwood, Andrew PhD

doi: 10.1097/01.psy.0000149255.04806.07
Original Articles

Objective: Hot flashes are among the most frequently reported menopausal symptoms. However, little is known about factors associated with their occurrence. Moreover, despite the wide use of self-report hot flash measures, little is known about their concordance with physiological flashes. This study evaluated emotional and behavioral antecedents of subjectively and objectively measured hot flashes during daily life. It also examined individual differences predicting concordance between objective and subjective hot flashes.

Methods: Forty-two perimenopausal or postmenopausal women (mean age = 50.5 ± 4.8 years) reporting daily hot flashes completed 2 days of ambulatory sternal skin conductance monitoring, behavioral diaries 3 times an hour, and psychometric questionnaires. Hot flashes meeting objective physiological criteria and subjectively reported flashes not meeting physiological criteria were assessed. Likelihood of hot flashes following emotions and activities were examined in a case-crossover analysis.

Results: Relative to nonflash control times, objective hot flashes were more likely after increased happiness, relaxation, and feelings of control, and less likely after increased frustration, sadness, and stress. Conversely, subjective hot flashes not meeting physiological criteria were more likely after increased frustration and decreased feelings of control. Questionnaires revealed increased negative mood and negative attitudes were associated with fewer objective flashes and higher false-positive reporting rates.

Conclusion: Increased positive and decreased negative emotions were associated with objective hot flashes, whereas increased negative and decreased positive emotions were associated with subjective flashes not meeting physiological criteria. The anecdotal association between negative emotions and hot flashes may be the result of self-reported flashes lacking physiological corroboration.

HRT = hormone replacement therapy; BDI-II = Beck Depression Inventory, Second Revision; STAI = State Trait Anxiety Inventory; DSI = Daily Stress Inventory; SCL-90-R = Symptom Checklist-90, Revised; RR = rate ratio.

From Duke University Medical Center, Department of Psychiatry and Behavioral Sciences, Durham, North Carolina.

Rebecca Thurston is currently a Robert Wood Johnson Health and Society Scholar at Harvard University.

Address correspondence and reprint requests to Rebecca C. Thurston, PhD, Harvard School of Public Health, 677 Huntington Avenue, 7th Floor, Boston, MA 02115-6096. E-mail:

Received for publication March 23, 2004; revision received July 26, 2004.

This research was conducted in partial fulfillment of requirements for a doctoral degree in clinical health psychology at Duke University. The authors thank Ginger Henshall for help with data preparation/programming and Janet Carpenter for help with reliability coding and sternal skin conductance monitoring.

Copyright © 2005 by American Psychosomatic Society
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