Effectiveness of Group Cognitive Behavioral Therapy and Group Cognitive Hypnotism on Anxiety and Depression in Women with Premenstrual Syndrome

Abstract Introduction: Reproductive tract infections are recognized as one of the most serious health problems in the world. These infections can be associated with many consequences. Objective: This study aimed to determine the condition of preventive behavior related to genital tract infections and its effective factors. Methods: This is a descriptive analytical study on preventive behaviors related to reproductive tract infections and its risk factors in women admitted to health centers in Tabriz city in 2013. Twenty-two health centers and stations (including 9 centers and 13 stations) out of 27 centers and 38 stations were randomly selected. In the next stage, according to sample size, 25-30 records were randomly selected from all women's records. The sample size was measured according to the pilot study and using the ratio formula for 384 patients and considering coefficient of 1.5, the final sample size equaled 584. Our study included married 15 to 49-year-old women who had referred for health care and had health records, higher than primary education level and willingness to participate in research. Women who were unwilling to participate for complete more than 20% of the questionnaire were excluded. The data collection tool was a researcher-made questionnaire including questions related to behavioral prevention assessment of reproductive tract infections and questions about factors influencing these behaviors as well as demographic characteristics and obstetrical and fertility history, and questions on knowledge of the risk factors. In order to determine the preventive behavior, the scores of 2, 1, 0 were given to items &quot;always&quot;, &quot;sometimes&quot; and &quot;never&quot;, respectively. The sum of scores was calculated. The mean score was considered as the score of study tool. Of all the behavioral prevention questions, the ones with the lowest and highest score were reported. To determine the knowledge about non-sexually transmitted infections, &quot;correct&quot; and &quot;incorrect/I don&rsquo;t Know&quot; answers were given 1 and zero scores, respectively. Then the total scores were calculated. Knowledge score &le;5 was considered poor, 6-10 average and 15-11 good. To determine the level of knowledge about sexually transmitted infections, according to the number of questions and range of scores (0-37), score &le;12 was considered poor, 13-24 average and 25-37 good. The scientific validity of the questionnaire was determined by content validity and reliability using test-retest. The reliability coefficient was 82.0. Descriptive statistics was used to determine the absolute and relative frequency, mean and 95% confidence interval. T-test and ANOVA were used to control the confounding factors and linear regression was used to determine their effects. The variables with P< 0.1 were entered into the model. In this study, p<0.05 was considered as significant. Results: Most women (56.1%) were in age range of 20-29 years old. Most of them were high school graduates (48.3%), homemaker (90.2%) and had sufficient income (59.4%) in their own opinion. A statistically significant relationship was found between behavioral prevention with age, education level, occupation and income (p<0.05). Half of the subjects had a history of RTIs. Anal, oral, and vaginal-anal sex, sex with husband only and replacement or transfusion of blood in husband were significant related to behavioral prevention score (p<0.05). Mean score of behavioral prevention equaled 25.39 &plusmn; 4.6 of possible scores ranging from zero to 34. Mean score of knowledge of genital non-sexually transmitted infections was 9.6&plusmn;3.19 of possible scores ranging from zero to 15. Thus, research subjects had average level of knowledge. Mean score of knowledge on sexually transmitted infections was 17.08 &plusmn; 7.42 of possible scores ranging from zero to 37. Hence, they had average to poor knowledge. A statistical significant relationship was observed between the level of knowledge and behavioral prevention score (p<0.001). In other words, behavioral prevention had a significant increase with increased score of knowledge. After adjusting the possible confounding factors, multivariate analysis showed a statistically significant relationship between preventive behaviors and knowledge score (R2-0.06, P-0.002), family income (R2-0.023, P<0.001), sex only with husband (R2-0.015, P-0.047), anal sex, oral sex (R2-0.054, P-0.003) and blood transfusion history (R2-0.028, P-0.005). A statistical significant association was detected between the level of knowledge and behavioral prevention score (p<0.001) so that increased knowledge significantly raised the score of behavioral prevention. Conclusion: Trainings on these infections especially in school and pre-marital ages seem necessary as well as providing related public services. Health trainers should be consistent with this strategy. Primary prevention of such infections should be prioritized in health training.