Presenting a Causal Model of Premenstrual Syndrome in Adolescent Girls

Premenstrual Syndrome (PMS) is a combination of biopsychological and behavioral symptoms that occur in the luteal phase of the menstrual cycle, in some individuals. These symptoms are very debilitating and interfere with social functioning, education, and family relationships. The prevalence of PMS in adolescent girls and its associated physical symptoms and psychological stress indicate a research gap respecting the relationship between PMS and social support; anxiety; academic stress; the duration of menstruation, and especially the role of attitudes toward menstruation. Thus, studies are required to explain the relationship between these characteristics. Considering the above–mentioned issues and the lack of integrated research concerning the aforementioned variables, the present study evaluated this process in the framework of a causal model; therefore, the current study aimed to present a causal model of PMS in adolescent girls.

This correlational study used structural equation modeling. The statistical population of this study included all adolescent girls (aged 13–18 y) in Kermanshah City, Iran, in 2020. The study sample consisted of 381 subjects who were selected by the convenience sampling method. Some responses were discarded due to incomplete data or incomplete questionnaires, and a total of 372 responses were eventually analyzed. The inclusion criteria of the study included having completed at least one year from the onset of menstruation and consent to complete the research questionnaires. Moreover, the exclusion criteria of the study were over 18 years of age, not providing a consent form, and not completing research questionnaires. The study participants were requested to complete the following questionnaires: the Stiner Premenstrual Symptom Screening Tool (Steiner et al, 2003), Menstrual Attitude Questionnaire (Brooks–Gunn & Ruble, 1980), Social Support Appraisals Scale (Vaux et al, 1986), Beck Anxiety Inventory (Beck & Steer, 1990), and Student–Life Stress Inventory (Gadzella, 1991). The obtained data were analyzed in SPSS and AMOS by the structural modeling method at p<0.05.

The current research results suggested a significant relationship between the research variables. Therefore, due to the high volume of the correlation matrix between the research variables among the 23 observed variables, there was a greater correlation between anxiety and menstrual duration (r=0.534, p=0.001); mood symptoms and daily functioning (r=0.512, p=0.001); physical symptoms and menstruation, as a disturbing event (r=0.501, p=0.000); family support and menstruation, as a natural occurrence (r=0.497, p=0.000); daily performance and failures (r=–0.418, p=0.001self–imposed stress and the duration of menstruation (r=0.399, p=0.001), as well as peer support and cognitive assessment (r=0.384, p=0.000). The collected results indicated that among the research variables, anxiety had a greater overall effect on PMS (β=0.404) and the standardized direct effect was equal to 0.367 (p<0.001). The variable of menstrual attitude could determine the relationship between PMS and social support (β=–0.055, p<0.001); anxiety (β=0.037, p<0.001); academic stress (β=0.044, p<0.001), and the duration of menstruation (β=–0.050, p<0.001). The calculated goodness of fit indices of the relationships between the research variables demonstrated that attitude towards menstruation could mediate the relationship between PMS and social support, anxiety, academic stress, and the duration of menstruation (RMSEA=0.027, AGFI=0.914).

Based on the present study findings, social support, anxiety, academic stress, and the duration of menstruation, with the mediating role of PMS, can be a desirable model for explaining premenstrual syndrome.