Symptom Clusters of Midlife Menopausal Women with Metabolic Syndrome
Background: Midlife menopausal women with metabolic syndrome experience co-occurring symptoms that adversely affect their health outcomes. The purposes of this dissertation were to describe the symptom experience and presence of symptom clusters in midlife menopausal women with metabolic syndrome; to identify the number and types of symptom clusters and key symptoms based on symptom occurrence and severity dimension; and to identify the subgroups of midlife menopausal women with metabolic syndrome at high-risk for greater symptom cluster burden over time and their associated characteristics.Methods: A scoping review and two quantitative studies with cross-sectional and longitudinal approach using secondary data analysis were used in this dissertation. The Joanna Briggs Institute (JBI) Scoping Review methodology served as a guide for the scoping review. A total of eight articles were included and systematically evaluated. Network analysis was used to identify symptom clusters and key symptoms. Multi-trajectory analysis using latent class growth analysis was conducted to identify the high-risk subgroup of midlife menopausal women with metabolic syndrome for greater symptom cluster burden over time. Descriptive statistics was used to explain the demographic characteristics of each symptom cluster burden subgroup and bivariate analysis (analysis of variance, chi-square test) was conducted to examine the association between each symptom cluster burden subgroup and demographic characteristics. Results: Midlife menopausal women with metabolic syndrome experienced urogenital symptoms, vasomotor symptoms, psychological symptoms, sleep symptoms, and somatic symptoms. Urogenital symptoms were the most frequently assessed while sleep and somatic symptoms were the least frequently assessed. However, there were no current studies that examined the presence of symptom clusters in this population. The cross-sectional study using network analysis found that midlife menopausal women with metabolic syndrome experienced the psychological/somatic/genital cluster (key symptom: frequent mood change), the sleep/urinary cluster (sleep disturbance), and the vasomotor cluster (cold sweat) in the symptom occurrence dimension. In addition, they experienced the psychological/somatic/sexual cluster (anxiety), the sleep/urinary cluster (sleep disturbance), and the vasomotor/genital cluster (night sweat) in the symptom severity dimension. A total of four classes were identified with Class 1 (low symptom cluster burden), Class 2 and Class 3 (moderate symptom cluster burden), and Class 4 (high symptom cluster burden). Social support was a significant predictor of high symptom cluster burden subgroup. Conclusions and Implications: This dissertation is the first to identify the symptom clusters and key symptoms in midlife menopausal women with metabolic syndrome. In addition, this dissertation identified four subgroups of midlife menopausal women with metabolic syndrome based on their symptom cluster trajectory over time. This has allowed for an understanding of a high-risk subgroup for greater symptom cluster burden. Clinicians need to routinely assess symptom clusters and offer targeted symptom cluster interventions in clinical settings.
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