UCSF

The Impact of Chronic Perceived Stress on Perceived Health Status and Symptom Experience in Pre- and Post-Menopausal Women

Holly J. Jones

Abstract

Chronic stress has been recognized as a precursor to poor health outcomes and health disparity. The purpose of this dissertation research study was to evaluate the impact of chronic perceived stress on perceived health status and symptom experience in women before and after menopause. The theory of allostasis was used as the framework for this study and proposes that chronic perceived stress will result in symptom expression or illness if a person in unable to adapt effectively to a stressor(s). In an effort to fully explore this phenomenon, this study was comprised of two parts: 1) secondary analyses of retrospective data exploring symptom experience in a cohort of midlife women who participated in the UCSF Midlife Women’s Health Study prior to menopause and, 2) mixed-methods analysis of current data exploring perceived stress and its long-term effects using a smaller sample of the women who participated in the parent study and are now post menopause.

Bladder and sleep symptoms were found to be prevalent in the sample. Reproductive status was a significant contributor to the variance in experiencing nocturia. Sleep quality and sleep hours were associated with several determinants of adverse health outcomes: perceived stress, body mass index, and race. Mixed methods analysis found perceived stress scores to be consistent over time in the subsample of African American women and six stress-related themes were identified.

Finally, multiple physiological, psychosocial, and demographic factors were investigated to determine their unique contributions to the variance in leukocyte telomere length. Telomere length is recognized as a measure of aging and chronic stress. Despite the small sample size, income, age, perceived stress, and diastolic blood pressure were noted to be influential to having shorter telomere length.

The combination of data from a cohort of contemporary women before and after menopause provided a better understanding of the stressors endured over time, symptom experience, coping strategies, and associations with genetic biomarkers. Results from this study should be used to identify vulnerable midlife women and formulate individualized care plans in an effort to decrease morbidity and health disparity.