title: Negative attitudes and affect do not predict elective hysterectomy: a prospective analysis from the Study of Women's Health Across the Nation.
abstract: OBJECTIVE
  Cross-sectional studies suggest an association between hysterectomy and negative affect. Using prospective data, we examined the associations of negative affect, attitudes toward aging and menopause, premenstrual symptoms, and vasomotor symptoms with elective hysterectomy in midlife.
  
  
  METHODS
  Data were from the Study of Women's Health Across the Nation, a multisite, community-based prospective cohort study of the menopausal transition (n = 2,818). Annually reported hysterectomy at visits 2 to 9 was verified with medical records when available (71%). Anxiety, perceived stress, depressive symptoms, attitudes toward aging and menopause, vasomotor symptoms, and premenstrual symptoms were assessed at baseline using standardized questions. Cox proportional hazards models were used to relate these variables to subsequent elective hysterectomy. Covariates included demographic variables, menstrual bleeding problems, body mass index, hormone levels, and self-rated health, also assessed at baseline.
  
  
  RESULTS
  Elective hysterectomy was reported by 6% (n = 168) of participants over an 8-year period. Women with hysterectomy were not higher in negative affect or negative attitudes toward aging and menopause compared with women without hysterectomy. Vasomotor symptoms (hazard ratio [HR], 1.44; 95% CI, 1.03-2.01; P = 0.03) and positive attitudes toward aging and menopause (HR, 1.74; 95% CI, 1.04-2.93) at baseline predicted hysterectomy over the 8-year period, controlling for menstrual bleeding problems, site, race/ethnicity, follicle-stimulating hormone, age, education, body mass index, and self-rated health. Menstrual bleeding problems at baseline were the strongest predictor of hysterectomy (HR, 4.30; 95% CI, 2.05-9.05).
  
  
  CONCLUSIONS
  In this prospective examination, negative affect and attitudes were not associated with subsequent hysterectomy. Menstrual bleeding problems were the major determinant of elective hysterectomy.
authors.affiliation: Department of Psychology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA. gibsoncj@upmc.edu
authors.forename: Carolyn J
authors.initials: CJ
authors.lastname: Gibson
authors.forename: Joyce T
authors.initials: JT
authors.lastname: Bromberger
authors.forename: Gerson E
authors.initials: GE
authors.lastname: Weiss
authors.forename: Rebecca C
authors.initials: RC
authors.lastname: Thurston
authors.forename: MaryFran
authors.initials: M
authors.lastname: Sowers
authors.forename: Karen A
authors.initials: KA
authors.lastname: Matthews
mesh_terms: D000328:Adult; D001290:Attitude; D017558:Elective Surgical Procedures / Q000523:psychology*; D005260:Female; D006306:Health Surveys / Q000706:statistics & numerical data; D019584:Hot Flashes / Q000523:psychology; D006801:Humans; D007044:Hysterectomy / Q000523:psychology*; D008796:Metrorrhagia / Q000453:epidemiology / Q000523:psychology*; D008875:Middle Aged; D047648:Perimenopause / Q000523:psychology; D011446:Prospective Studies; D011795:Surveys and Questionnaires