Social determinants of health and menopausal symptoms: the mediating role of menopausal attitudes
Abstract
Background: Menopause is a multidimensional period affecting physical, mental, and social well-being. This study aimed to evaluate the direct and indirect (mediating: menopausal attitudes) effects of social determinants of health on menopausal symptoms in women aged 45-64 years.
Methods: This cross-sectional study was conducted with 495 women who applied to a university hospital. The questionnaire used in the study included questions on sociodemographic characteristics, factors related to menopausal symptoms, questions about domestic violence, the Menopausal Rating Scale (MRS), the Menopause Attitude Assessment Scale (MAAS), the Financial Well-being Scale (FWBS), the Turkish Health Literacy Scale–Short Form (THLS-SF), the Perceived Neighborhood Disorder Scale (PNDS), and the Perceived Social Support Questionnaire (F-SozU K-3). General linear model (GLM) mediation analysis was performed to determine the mediating role of menopausal attitudes in the relationship between social determinants of health and menopausal symptoms.
Results: The mean age of the women was 53.3±6.2 years. Women’s scores on the MRS and MAAS ranged from 0 to 44 and 5 to 52, with a mean score of 20.1±6.6 and 30.2±7.5. GLM mediation analysis identified direct effects on menopausal symptoms from educational level, FWBS, and the history of domestic violence (β=-0.087, p = 0.031; β=-0.158, p < 0.001; β = 0.192, p < 0.001, respectively). Indirect effects were observed for educational level and PNDS (β = 0.019, p = 0.031; β = 0.021, p = 0.024).
Conclusions: Menopausal symptoms should be addressed holistically, considering the social determinants of health, and social risk screenings should be made routine in primary care. Multidisciplinary interventions for domestic violence and economic support should be strengthened. Health education programs and social support policies that improve women’s attitudes towards menopause and health literacy should be widespread.
Key messages: • Menopausal symptoms are directly related to social determinants of health, such as educational level, financial well-being, and domestic violence.
• Attitudes toward menopause influence menopausal symptoms, particularly through the mediating effect of determinants such as education level and neighborhood disorder.
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BibTeX
@article{salıs2026social,
title = {{Social determinants of health and menopausal symptoms: the mediating role of menopausal attitudes}},
author = {E Salış and E Kavlu and D Arslantaş and A Ünsal},
journal = {The European Journal of Public Health},
year = {2026},
month = oct,
doi = {10.1093/eurpub/ckag169.2029},
url = {https://doi.org/10.1093/eurpub/ckag169.2029},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Social determinants of health and menopausal symptoms: the mediating role of menopausal attitudes
AU - E Salış
AU - E Kavlu
AU - D Arslantaş
AU - A Ünsal
PY - 2026
DA - 2026/10/01
JO - The European Journal of Public Health
DO - 10.1093/eurpub/ckag169.2029
UR - https://doi.org/10.1093/eurpub/ckag169.2029
AB - Background: Menopause is a multidimensional period affecting physical, mental, and social well-being. This study aimed to evaluate the direct and indirect (mediating: menopausal attitudes) effects of social determinants of health on menopausal symptoms in women aged 45-64 years. Methods: This cross-sectional study was conducted with 495 women who applied to a university hospital. The questionnaire used in the study included questions on sociodemographic characteristics, factors related to menopausal symptoms, questions about domestic violence, the Menopausal Rating Scale (MRS), the Menopause Attitude Assessment Scale (MAAS), the Financial Well-being Scale (FWBS), the Turkish Health Literacy Scale–Short Form (THLS-SF), the Perceived Neighborhood Disorder Scale (PNDS), and the Perceived Social Support Questionnaire (F-SozU K-3). General linear model (GLM) mediation analysis was performed to determine the mediating role of menopausal attitudes in the relationship between social determinants of health and menopausal symptoms. Results: The mean age of the women was 53.3±6.2 years. Women’s scores on the MRS and MAAS ranged from 0 to 44 and 5 to 52, with a mean score of 20.1±6.6 and 30.2±7.5. GLM mediation analysis identified direct effects on menopausal symptoms from educational level, FWBS, and the history of domestic violence (β=-0.087, p = 0.031; β=-0.158, p < 0.001; β = 0.192, p < 0.001, respectively). Indirect effects were observed for educational level and PNDS (β = 0.019, p = 0.031; β = 0.021, p = 0.024). Conclusions: Menopausal symptoms should be addressed holistically, considering the social determinants of health, and social risk screenings should be made routine in primary care. Multidisciplinary interventions for domestic violence and economic support should be strengthened. Health education programs and social support policies that improve women’s attitudes towards menopause and health literacy should be widespread. Key messages: • Menopausal symptoms are directly related to social determinants of health, such as educational level, financial well-being, and domestic violence. • Attitudes toward menopause influence menopausal symptoms, particularly through the mediating effect of determinants such as education level and neighborhood disorder.
SN - 1101-1262
SN - 1464-360X
ER -