Discussion
The main purpose of this research was the effect of HRQoL on symptoms of
Depression, Anxiety and Stress in women with Endometriosis, with
Personality as a mediating factor. The results showed that the HRQoL
significantly affects the symptoms of Stress and Anxiety, but not
Depression. Worse HRQoL predicts increased symptoms of Stress and
Anxiety but not Depression. Thus, the first research hypothesis is
supported except for the symptoms of Depression.
This new finding presents new statistical data for the literature, since
the importance of HRQoL in the symptoms of Stress is shown. This
relationship may be explained by previous research that found that women
with Endometriosis consider their disease to define their lives (12).
Endometriosis diminishes HRQoL (16) and can reduce wellbeing (6), the
predictive relationship found in this research is of great value, since
it links the impact of the disease on the quality of life and the
psychological well-being of women with Endometriosis. Also, the link
found in this study emphasises the importance of psychological support
in women with Endometriosis. As shown by the research of Farshi et
al.21 counselling with self-care as its core can
reduce anxiety symptoms. Thus, since the present research showed that
health-related quality of life is linked to stress and anxiety levels,
it is important in any psychological support given to women with
Endometriosis to explore self-care. These research findings also support
the theory of Facchin et al.8 where the daily life of
women with Endometriosis is disrupted to a great extent, resulting in
Stress and Anxiety. The lack of a significant effect of HRQoL on
symptoms of Depressions could be due to the majority of the participants
reporting low levels of depressive symptoms.
Another noteworthy result of this research was the significant effect of
the subscale Pain on Stress. Research has previously shown that women
with Endometriosis experience pain due to the disease on a daily basis
(5). Therefore, the predictive relationship between the Pain subscale of
HRQoL and Stress levels is a very important finding for the literature,
as it emphasises the power pain has on mental wellbeing. Future research
could investigate in more depth the levels of pain in Endometriosis and
how they affect psychological wellbeing. Moreover, this research showed
a significant effect of the subscale Control and Powerlessness on Stress
levels. This finding supports the relationship between the Control and
Powerlessness scale with subjective well-being shown by the research of
Rush & Misajon15. The unpredictable nature of
Endometriosis and the physical exhaustion it causes, leads to loss of
control and total inability to do various activities, which increases
Stress levels.
Furthermore, it was found that Neuroticism as a mediating factor between
Stress symptoms and HRQoL showed moderate statistical significance. It
was also found that Neuroticism as a mediating factor between HRQoL and
Anxiety symptoms showed significant statistical significance with a
large effect. Meaning, when HRQoL is low and Neuroticism levels are
high, Anxiety and Stress symptoms are reduced. When HRQoL is worse,
levels of Neuroticism are lower and Anxiety and Stress symptoms are
increased. Research has shown that Endometriosis can be a ‘continuous
battle’ as the disease makes it extremely difficult for women to
maintain their everyday life (13). The ”sickness response” from a
biopsychological point of view, involves behavioral changes (10). These
studies can partially support this relationship. Despite this, the
interesting relationship between Neuroticism and Stress and Anxiety
symptoms do not support previous findings that found that high
Neuroticism levels can predict high Anxiety and Stress levels in women
with Endometriosis. The reason for this result in the present research
may be due to the low levels of Anxiety and the high levels of
Neuroticism presented by the participants. People with high levels of
Neuroticism usually present negative feelings and constant worry (30)
and this research presents findings which are very unpredictable. One
theory that could possibly explain this predictive relationship is
Bury’s18 adaptive theory. Although it is quite an
antiquated theory, it may contribute. According to this theory women
with Endometriosis have to adapt and modify their identity in order to
cope with the unpredictability that follows with the start of their
Endometriosis symptoms. Thus, the relation between high levels of
Neuroticism and low levels of symptoms of anxiety and stress may be due
to this adaptation in behavioural patterns to be able to survive the
intense pain that may come with Endometriosis. Endometriosis is a
disease that in the long term can change the sense of personal identity,
since women have to adapt to be able to face the difficulties that the
disease brings (19).
Overall, this research has introduced new information about
Endometriosis and its link with mental health and personality
characteristics. Although the effect of the mediating factor Neuroticism
that was found was unpredictable it is still a noteworthy finding which
can add to the literature. The main outcome of this study is that HRQoL
can predict symptoms of Stress and Anxiety and Neuroticism levels can
affect this relationship. Some of the limitations of this study may have
affected the results. It has to be acknowledged that the sample of 47
women is quite small so the findings need to be generalised with
caution. The many symptoms of Endometriosis could also have affected the
results as the severity of the disease was not investigated in this
study. Despite these limitations, this research is one of the first
studies on mental health in Endometriosis in the Cypriot population.