برازش روابط علّی- ساختاری اضطراب و افسردگی با عملکرد جنسی با میانجی¬گری کیفیت خواب در زنان یائسه مبتلا به دیابت نوع دو
محورهای موضوعی : سلامت زنانمریم شجاعیان 1 , ناصر صبحی قراملکی 2 * , حسین ابراهیمی مقدم 3
1 - دانشجوی دکتری روانشناسی عمومی، دانشکده روانشناسی، واحد قم، دانشگاه آزاد اسلامی، قم، ایران.
2 - . (نویسنده مسئول)، دانشیار، گروه رفتار حرکتی و روانشناسی ورزشی، دانشکده تربیت بدنی و علوم ورزشی، دانشگاه علامه طباطبایی، تهران، ایران sobhi@atu.ac.ir Tel: 09141529565
3 - دانشیار، گروه روانشناسی، واحد رودهن، دانشگاه آزاد اسلامی، رودهن، ایران
کلید واژه: اضطراب, افسردگی, دیابت نوع دو, عملکرد جنسی, کیفیت خواب, یائسگی,
چکیده مقاله :
چکیده مقدمه: عملکرد جنسی جزء مهمی از زندگی زنان یائسه مبتلا به دیابت نوع دو است و تغییر در آن به خصوص در یائسگی، می تواند بر سلامت ایشان تاثیرگذار باشد. عملکرد جنسی این زنان می¬تواند تحت تاثیر عوامل مختلفی قرار گیرد. هدف از پژوهش حاضر بررسی برازش روابط علّی- ساختاری اضطراب و افسردگی با عملکرد جنسی با میانجی¬گری کیفیت خواب در زنان یائسه مبتلا به دیابت نوع دو بود. روش¬ پژوهش: مطالعه حاضر از نوع همبستگی بود. جامعه آماری شامل زنان یائسه مبتلا به دبابت نوع 2 ساکن شهر تهران در سال 1402 بودند. حجم نمونه بر اساس مدل Kline و با روش نمونهگیری در دسترس 300 نفر انتخاب شد. ابزار گردآوری دادههای پژوهش شامل پرسشنامه عملکرد جنسی زنان، سیاهه افسردگی، سیاهه اضطراب و پرسشنامه کیفیت خواب پیتزبورگ بود. تحلیل آماری دادهها با استفاده از نرم¬افزار SPSS و AMOS نسخه 28 انجام گرفت. یافته¬ها: یافته¬های پژوهش نشان داد که اثرات مستقیم اضطراب، افسردگی و کیفیت خواب بر عملکرد جنسی معنادار بود. همچنین نتایج نشان داد که کیفیت خواب در رابطه بین اضطراب و افسردگی با عملکرد جنسی نقش میانجی و معنادار دارد. همچنین مدل نهایی پژوهش از برازش مطلوبی برخوردار بود(030/0=RMSEA و 05/0>P-value) و 93 درصد عملکرد جنسی به وسیله اضطراب و افسردگی با نقش میانجی کیفیت خواب تبیین میشود. نتیجه¬گیری: بنابراین عملکرد جنسی زنان یائسه مبتلا به دیابت نوع دو می¬تواند متاثر از اضطراب، افسردگی و کیفیت خواب آنان باشد. لذا نتیجهگیری می¬شود که اضطراب و افسردگی با تاثیرگذاری بر کیفیت خواب موجب نقص در عملکرد جنسی زنان یائسه مبتلا به دیابت نوع دو می-شود که بر این اساس پیشنهاد می¬شود در مداخلات روانشناختی برای این زنان اقدام به کاهش اضطراب و افسردگی آنان کرد.
Abstract Introduction: Sexual function is an important part of the life of menopause women with type 2 diabetes and changes in it, especially in menopause, can affect their health. The sexual function of these women can be affected by various factors. The purpose of the present study was to investigate fittness the causal-structural relationships of anxiety and depression with sexual function with the mediating role of sleep quality in menopause women with type 2 diabetes. Methods: The present research is the correlation. The statistical population in this research included postmenopausal women with type 2 diabetes in Tehran city in year 2023. The sample size was selected based on Kline model and with convenience sampling of 300 people. Data collection tools included the female sexual function index, depression inventory-II, anxiety inventory, Pittsburgh sleep quality index. Statistical analysis of data was performed using SPSS and AMOS-28 software. Results: The findings showed that the direct effect of anxiety, depression and sleep quality were significant on sexual function. Also, the results showed that sleep quality has a mediating role in relationship between anxiety and depression with sexual function. Also, proposed model had an acceptable fitness to the data (RMSEA=0/030, P-value<0/05) and analyses also revealed that %93 of variance of sexual function was explained by anxiety and depression through the mediating role of sleep quality. Conclusion: Therefore, it is concluded that anxiety and depression affect the sleep quality and cause defects in the sexual function of postmenopausal women with type 2 diabetes, so it is suggested to reduce their anxiety and depression in psychological interventions for these women.
1. Lorefice L, D’Alterio MN, Firinu D, Fenu G, Cocco E. Impact of Menopause in Patients with Multiple Sclerosis: Current Perspectives. International Journal of Women's Health, 2023; 1(2): 103-109. https://doi.org/10.2147/IJWH.S334719
2. Mishr P, Davies DA, Albensi BC. The Interaction between NF-κB and Estrogen in Alzheimer’s Disease. Molecular Neurobiology, 2023; 60(3): 1515-1526. https://doi.org/10.1007/s12035-022-03152-3
3. Lekkala S, Sacher SE, Taylor EA, Williams RM, Moseley KF, Donnelly E. Increased advanced glycation endproducts, stiffness, and hardness in iliac crest bone from postmenopausal women with type 2 diabetes mellitus on insulin. Journal of Bone and Mineral Research, 2023; 38(2): 261-277. https://doi.org/10.1002/jbmr.4757
4. Loona DP, Das B, Kaur R, Kumar R, Yadav AK. Free Fatty Acid Receptors (FFARs): Emerging Therapeutic Targets for the Management of Diabetes Mellitus. Current Medicinal Chemistry, 2023; 30(30): 3404-3440. https://doi.org/10.2174/0929867329666220927113614
5. Yang Y, Wang Q, Li G, Guo W, Yang Z, Liu H, Deng X. Cysteine-Derived Chiral Carbon Quantum Dots: A Fibrinolytic Activity Regulator for Plasmin to Target the Human Islet Amyloid Polypeptide for Type 2 Diabetes Mellitus. ACS Applied Materials & Interfaces, 2023; 15(2): 2617-2629. https://doi.org/10.1021/acsami.2c17975
6. Li H, Lu W, Wang A, Jiang H, Lyu J. Changing epidemiology of chronic kidney disease as a result of type 2 diabetes mellitus from 1990 to 2017: Estimates from Global Burden of Disease 2017. Journal of diabetes investigation, 2021; 12(3): 346-356. https://doi.org/10.1111/jdi.13355
7. Feduniw S, Korczyńska L, Górski K, Zgliczyńska M, Bączkowska M, Byrczak M, Kociuba J, Ali M, Ciebiera M. The Effect of Vitamin E Supplementation in Postmenopausal Women—A Systematic Review. Nutrients, 2022; 15(1): 160-170. https://doi.org/10.3390/nu15010160
8. Santoro N, Epperson CN, Mathews SB. Menopausal symptoms and their management. Endocrinology and Metabolism Clinics, 2015; 44(3): 497-515. https://doi.org/10.1016/j.ecl.2015.05.001
9. Lampio L, Polo-Kantola P, Polo O, Kauko T, Aittokallio J, Saaresranta T. Sleep in midlife women: effects of menopause, vasomotor symptoms, and depressive symptoms. Menopause, 2014; 21(11): 1217-1224. https://doi.org/10.1097/GME.0000000000000239
10. Armeni A, Anagnostis P, Armeni E, Mili N, Goulis D, Lambrinoudaki I. Vasomotor symptoms and risk of cardiovascular disease in peri-and postmenopausal women: A systematic review and meta-analysis. Maturitas, 2023; 171(1): 13-20. https://doi.org/10.1016/j.maturitas.2023.02.004
11. Cairoli E, Grassi G, Gaudio A, Palermo A, Vescini F, Falchetti A, Merlotti D, Eller-Vainicher C, Carnevale V, Scillitani A, Rendina D. Validation of the clinical consensus recommendations on the management of fracture risk in postmenopausal women with type 2 diabetes. Nutrition, Metabolism and Cardiovascular Diseases, 2023; 33(1): 158-167. https://doi.org/10.1016/j.numecd.2022.10.004
12. Nazarpour N, Simbar M, Ramezani Tehrani F. Factors affecting sexual function during menopause: a review of the literature. Payesh, 2015; 14 (1): 41-58. http://payeshjournal.ir/article-1-255-fa.html
13. Safaei M, Alirezaei S, Rajabzadeh, S. The relationship between sexual function with depression and anxiety in postmenopausal women referred to health centers of Torbat Heydariyeh in 1395. Navid No, 2018; 21(66): 32-40. (In Persian) https://doi.org/10.22038/nnj.2018.31368.1121
14. Fernandes J, Pedro J, Costa ME, Martins MV. Effect of depression and anxiety on sexual functioning in couples trying to conceive with and without an infertility diagnosis. Psychology & Health, 2023; 38(1): 58-75. https://doi.org/10.1080/08870446.2021.1955115
15. Besharat MA, Farahmand H, Gholamali Lavasani M. The Mediating Role of Procrastination in the Relationship between Perfectionism Pathologies and Depression/Anxiety Symptoms, Journal of Developmental Psychology Iranian Psychologist, 2018; 14(55): 235-247. (In Persian) https://jip.stb.iau.ir/article_541252.html?lang=en
16. Matrov D, Kaart T, Lanfumey L, Maldonado R, Sharp T, Tordera RM, Kelly PA, Deakin B, Harro J. Cerebral oxidative metabolism mapping in four genetic mouse models of anxiety and mood disorders. Behavioural Brain Research, 2019; 356(2): 435-443. https://doi.org/10.1016/j.bbr.2018.05.031
17. Mojtahedzadeh SP, Teimory S, Nayyeri M, Isanazar A. Presenting the model of sexual performance of postmenopausal women based on sexual self-expression with the mediating role of state-attribute anxiety and sexual self-esteem. Journal of Applied Family Therapy, 2023; 4(1): 356-379. https://doi.org/10.22034/aftj.2022.339984.1551
18. Fabre LF, Smith LC. The effect of major depression on sexual function in women. The Journal of Sexual Medicine, 2012; 9(1): 231-239. https://doi.org/10.1111/j.1743-6109.2011.02445.x
19. Moncrieff J, Cooper RE, Stockmann T, Amendola S, Hengartner MP, Horowitz MA. The serotonin theory of depression: a systematic umbrella review of the evidence. Molecular Psychiatry, 2022; 1(2): 1-14. https://doi.org/10.1038/s41380-022-01661-0
20. Monroe SM, Harkness, KL. Major depression and its recurrences: life course matters. Annual Review of Clinical Psychology, 2022; 18(1): 329-357. https://doi.org/10.1146/annurev-clinpsy-072220-021440
21. Yangın HB, Sözer GA, Şengün N, Kukulu K. The relationship between depression and sexual function in menopause period. Maturitas, 2008; 61(3): 233-237. https://doi.org/10.1016/j.maturitas.2008.09.004
22. Damato TM, Tebar WR, Oliveira CB, Saraiva BT, Morelhao PK, Ritti-Dias RM, Christofaro DG. Relationship of sleep quality with screen-based sedentary time and physical activity in adolescents—the moderating effect of body mass index. Sleep and Breathing, 2022; 26(4): 1809-1816. https://doi.org/10.1007/s11325-021-02519-5
23. Di Muzio M, Diella G, Di Simone E, Novelli L, Alfonsi V, Scarpelli S, Annarumma L, Salfi F, Pazzaglia M, Giannini AM, De Gennaro L. Nurses and Night Shifts: Poor sleep quality exacerbates psychomotor performance. Frontiers in Neuroscience, 2020; 14(2): 10-21. https://doi.org/10.3389/fnins.2020.579938
24. Brown C, Beardslee J, Frick PJ, Steinberg LD, Cauffman E. Perceived sleep quality predicts aggressive offending in adolescence and young adulthood. Journal of Child Psychology and Psychiatry, 2023; 64(2): 320-328. https://doi.org/10.1111/jcpp.13712
25. Casagrande M, Forte G, Tambelli R, Favieri F. The coronavirus pandemic: a possible model of the direct and indirect impact of the pandemic on sleep quality in Italians. Nature and Science of Sleep, 2021; 1(2): 191-199. https://doi.org/10.2147/NSS.S285854
26. Ebrahimi F, Barghiirani Z, Ali Akbari M. Comparison of Cognitive-Behavioral Therapy and Acceptance and Commitment Therapy in Reducing Mood Swings, Sleep Quality and Sexual Performance in Postmenopausal Women. Health Psychology, 2023; 11(44): 73-88. (In Persian) https://doi.org/10.30473/hpj.2023.59513.5289
27. Lin MH, Hsiao PR, Hsu HC. Comparing the Effectiveness of Multicomponent Sleep-Promoting Interventions on the Sleep Quality of Menopausal Women: A Quasi-Experimental Study. In Healthcare, 2022; 10, (3): 559-565. https://doi.org/10.3390%2Fhealthcare10030559
28. Li CH, Chung MH, Liao CH, Su CC, Lin YK, Liao YM. Urinary Incontinence and Sleep Quality in Older Women with Type 2 Diabetes: A Cross-Sectional Study. International Journal of Environmental Research and Public Health, 2022; 19(23): 1-10. https://doi.org/10.3390/ijerph192315642
29. Moulton MK, Johnson BR, Lavender DL, Osae SP, Phillips BB, Thomas I, Stone RH. A Scoping Review Evaluating the Effect of SGLT-2 Inhibitors on Insulin Dose Requirements in Insulin-Dependent Patients With Type 2 Diabetes. Annals of Pharmacotherapy, 2022; 1(2): 21-32. https://doi.org/10.1177/10600280211071089
30. Lopez-de-Andres A, Jimenez-Garcia R, Hernandez-Barrera V, de Miguel-Diez J, de Miguel-Yanes JM, Omaña-Palanco R, Carabantes-Alarcon D. Trends of Non-Traumatic Lower-Extremity Amputation and Type 2 Diabetes: Spain, 2001–2019. Journal of Clinical Medicine, 2022; 11(5): 1-10. https://doi.org/10.3390%2Fjcm11051246
31. Wykoff CC, Khurana RN, Nguyen QD, Kelly SP, Lum F, Hall R, Abbass IM, Abolian AM, Stoilov I, To TM, Garmo V. Risk of blindness among patients with diabetes and newly diagnosed diabetic retinopathy. Diabetes Care, 2021; 44(3): 748-756. https://doi.org/10.2337/dc20-0413
32. Filippatos G, Anker SD, Agarwal R, Pitt B, Ruilope LM, Rossing P, Kolkhof P, Schloemer P, Tornus I, Joseph A, Bakris GL. Finerenone and cardiovascular outcomes in patients with chronic kidney disease and type 2 diabetes. Circulation, 2021; 143(6): 540-552. https://doi.org/10.1161/CIRCULATIONAHA.120.051898
33. Kline RB. Principles and practice of structural equation modeling. Guilford publications. 2023. https://books.google.com/books?
34. Isidori AM, Pozza C, Esposito K, Giugliano D, Morano S, Vignozzi L, Corona G, Lenzi A, Jannini EA. Outcomes assessment: Development and validation of a 6-item version of the Female Sexual Function Index (FSFI) as a diagnostic tool for female sexual dysfunction. The journal of sexual medicine, 2010; 7(3): 1139-1146. https://doi.org/10.1111/j.1743-6109.2009.01635.x
35. Rosen, C. Brown, J. Heiman, S. Leiblum, C. Meston, R. Shabsigh, D. Ferguson, R. D'Agostino R. The Female Sexual Function Index (FSFI): a multidimensional self-report instrument for the assessment of female sexual function. Journal of Sex &Marital Therapy, 2000; 26(2): 191-208. https://doi.org/10.1080/009262300278597
36. Ghassami M, Shairi MR, Asghari Moghadam MA, Rahmati N. Investigate the psychometric properties of the 6-Item Version of the Female Sexual Function Index (FSFI-6) amongst a sample of healthy Iranian women. Nursing and Midwifery Journal, 2014; 12 (7): 532-543. (In Persian) http://unmf.umsu.ac.ir/article-1-1619-fa.html
37. Lovibond SH, Lovibond PF. Manual for the depression anxiety stress scales. Psychology Foundation of Australia. 1996. https://psycnet.apa.org/doiLanding?doi=10.1037/t01004-000
38. Beck AT, Steer, RA, Brown GK. Manual for Beck Depression Inventory-II. San Antonio, TX: Psychological Corporation. 1996. https://psycnet.apa.org/doi/10.1037/t00742-000
39. Hamilton M. Development of a rating scale for primary depressive illness. British journal of social and clinical psychology, 1967; 6(4): 278-296. https://doi.org/10.1111/j.2044-8260.1967.tb00530.x
40. Dabson K, Mohammadkhani P, Massah-Choulabi O. Psychometrics Characteristic of Beck Depression Inventory-II in Patients with Magor Depressive Disorder. Archives of Rehabilitation; 2007; 8(1): 82-87. (In Persian) http://rehabilitationj.uswr.ac.ir/article-1-135-fa.html
41. Hamilton M. The assessment of anxiety states by rating. British journal of medical psychology, 1959; 32(1). 50-55. https://doi.org/10.1111/j.2044-8341.1959.tb00467.x
42. Beck AT, Epstein N, Brown G, Steer RA. An inventory for measuring clinical anxiety: Psychometrie properties. Journal of Consulting and Clinical Psychology, 1988; 56(6): 893-897. https://psycnet.apa.org/doi/10.1037/0022-006X.56.6.893
43. Kaviani H, Mousavi AS. Psychometric properties of the Persian version of Beck Anxiety Inventory (BAI). Tehran Univ Med J, 2008; 66 (2): 136-140. (In Persian) http://tumj.tums.ac.ir/article-1-641-fa.html
44. Buysse DJ, Reynolds CF, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Research, 1989; 28(2): 193-213. https://doi.org/10.1016/0165-1781(89)90047-4
45. Farrahi Moghaddam J, Nakhaee N, Sheibani V, Garrusi B, Amirkafi A. Reliability and validity of the Persian version of the Pittsburgh Sleep Quality Index (PSQI-P). Sleep and Breathing, 2012; 16(1): 79-82. https://doi.org/10.1007/s11325-010-0478-5
46. Gharib Bolouk M, Mikaeili N, Basharpoor S. The mediating role of mindfulness in the relationship between dysfunctional attitude and anxiety sensitivity with sleep quality in high school adolescents. Iraning Journal of Psychiatric Nursing, 2022; 10 (2): 61-72. (In Persian) http://dx.doi.org/https://doi.org/10.22034/IJPN.10.2.61
47. Preacher KJ, Hayes, AF. SPSS and SAS procedures for estimating indirect effects in simple mediation models. Behavior Research Methods, Instruments, & Computers, 2004; 36(4): 717-731. https://doi.org/10.3758/BF03206553
48. Schermelleh-Engel K, Moosbrugger H, Müller H. Evaluating the fit of structural equation models: Tests of significance and descriptive goodness-of-fit measures. Methods of psychological research online, 2003; 8(2): 23-74. https://psycnet.apa.org/record/2003-08119-003
49. Bradford A, Meston, CM. The impact of anxiety on sexual arousal in women. Behavior Research and Therapy, 2006; 44(8): 1067-1077. https://doi.org/10.1016/j.brat.2005.08.006
50. Cox RC, Upender, RP, Olatunji BO. Linking inhibition and anxiety symptoms following sleep restriction: The moderating role of prior sleep efficiency. Behaviour Research and Therapy, 2020; 127(1): 1-10. https://doi.org/10.1016/j.brat.2020.103575
51. Isha AS, Naji GM, Saleem MS, Brough P, Alazzani A, Ghaleb EA, Muneer A, Alzoraiki M. Validation of “Depression, Anxiety, and Stress Scales” and “Changes in Psychological Distress during COVID-19” among University Students in Malaysia. Sustainability, 2023; 15(5): 1-10. https://doi.org/10.3390/su15054492
52. Lo CM, Lee PH. Prevalence and impacts of poor sleep on quality of life and associated factors of good sleepers in a sample of older Chinese adults. Health and quality of life outcomes, 2012; 10(1): 1-7. https://doi.org/10.1186/1477-7525-10-72
53. Dregan A, Rayner L, Davis KA, Bakolis I, de la Torre JA, Das-Munshi J, Hatch SL, Stewart R, Hotopf M. Associations between depression, arterial stiffness, and metabolic syndrome among adults in the UK Biobank population study: a mediation analysis. JAMA psychiatry, 2020; 77(6): 598-606. https://doi.org/10.1001/jamapsychiatry.2019.4712
54. Afonso P, Fonseca M, Teodoro T. Evaluation of anxiety, depression and sleep quality in full-time teleworkers. Journal of Public Health, 2022; 44(4): 797-804. https://doi.org/10.1093/pubmed/fdab164
55. Dilixiati D, Kadier K, Laihaiti D, Lu JD, Rezhake R, Azhati B, Rexiati M. The relationship between sleep disorders, quality, and duration and sexual dysfunction: a systematic review and meta-analysis. The Journal of Sexual Medicine, 2023; 20(6): 766-780. https://doi.org/10.1093/jsxmed/qdad054