Assessment of anxiety—At each visit, women completed a symptom checklistconsisting of 15 items similar to those used in numerous studies of menopause. Womenwere asked if they had experienced each of these symptoms in the previous two weeks and ifso, how frequently: none (0), 1-2 days (1), 3-5 days (2), 6-9 days (3), daily (4). Thequestionnaire includes four symptoms of anxiety: irritability, nervousness or tension, feelingfearful for no reason, and heart pounding or racing. Responses to the anxiety items weresummed. Due to a skewed distribution, the summed scores were dichotomized as high andlow anxiety. Women with the top 20% of scores (i.e., ≥ 4) were identified as having highBromberger et al. Page 3Menopause. Author manuscript; available in PMC 2014 May 01.NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author Manuscriptanxiety. Internal consistency for the four symptoms was good based on the baselineassessment: Cronbach's alpha=.77 and the scores were highly correlated with theGeneralized Anxiety Disorder-7 (GAD-7) (Spearman r=.71), a 7-item measure ofgeneralized anxiety that was completed at the same time (visit 12) as the 4-item measureused in the current analyses. The GAD-7 has been shown to be a reliable and valid measureof anxiety in the general population and in primary care (17; 18). Furthermore, the GAD-7means (sd) in the low and high anxiety groups were statistically different, 2.21 (sd=2.7) and8.69 (sd=5.29), respectively (p < .0001) providing additional support for the validity of thecluster of symptoms.