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Article

The Influence of Illness Perception on Emotional Disorders in Perimenopausal Women in Macau: The Serial Mediating Effect of Self-Esteem and Psychological Resilience

by
Jiaqi Li
1,
Tulips Yiwen Wang
1,*,
Jenny C. Lok
2 and
Ruiting Shi
3
1
Institute of Analytical Psychology, Faculty of Health and Wellness, City University of Macau, Macau SAR, China
2
Department of Innovative Social Work, Faculty of Health and Wellness, City University of Macau, Macau SAR, China
3
Faculty of Humanities and Social Sciences, City University of Macau, Macau SAR, China
*
Author to whom correspondence should be addressed.
Soc. Sci. 2025, 14(3), 186; https://doi.org/10.3390/socsci14030186
Submission received: 25 January 2025 / Revised: 28 February 2025 / Accepted: 17 March 2025 / Published: 19 March 2025
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Abstract

:
Studying the emotional disorders of perimenopausal women and their influencing factors from a psychological perspective is essential for developing targeted psychological interventions and support strategies. Such efforts can help middle-aged and elderly women better cope with the challenges of perimenopause and improve their overall quality of life. This study aimed to explore the chain mediating effect of self-esteem and psychological resilience on the relationship between illness perception and emotional disorders in perimenopausal women in Macau. A total of 617 postmenopausal women completed the Brief Illness Perception Questionnaire, Psychological Resilience Scale, Self-Esteem Scale, and Hospital Anxiety and Depression Scale. Results revealed a significant positive correlation between illness perception and emotional disorders. Illness perception was found to have a significant direct effect on emotional disorders and an indirect effect through the mediating roles of self-esteem and psychological resilience, both independently and sequentially. These findings indicate that illness perception directly influences emotional disorders in postmenopausal women in Macau and indirectly impacts them through self-esteem and psychological resilience, offering valuable insights for psychological intervention strategies.

1. Introduction

Perimenopause is a life course that every woman must go through, referring to the period from the onset of ovarian function decline until one year after menopause (Kong et al. 2024). During this stage, due to the decrease in estrogen levels, women face both psychological and physiological challenges, such as mood swings triggered by hormonal changes, as well as many physiological problems such as hot flushes, night sweats, and insomnia, which seriously affect their quality of life. Studies have shown that the chance of depression, anxiety, and other emotional problems increases two to three times during this period (Almeida et al. 2016), and the incidence of perimenopausal emotional disorders is as high as 30% to 40% (Bromberger et al. 2007), which jeopardizes the physical and mental health of middle-aged and elderly women to a great extent. Nowadays, research on perimenopausal emotional disorders focuses more on the direction of biomedical or clinical medical treatment (Priya Prakash and Selvi Kumbamoorthy 2024; Wang et al. 2024), with less research in the humanities and social sciences. Therefore, studying perimenopausal women’s emotional disorders and their influencing factors through a psychological perspective can facilitate the development of relevant psychological interventions and support strategies to help middle-aged and elderly women better cope with the challenges posed by perimenopause and improve their overall quality of life. The current study aims to investigate how illness perception influences emotional disorders in perimenopausal women in Macau, with a specific focus on the mediating roles of self-esteem and psychological resilience. Specifically, we employed a cross-sectional design to examine the relationship of illness perception and anxiety/depression symptoms, testing a chain mediation model with self-esteem and psychological resilience as mediators. By exploring these psychological factors, the study seeks to provide a deeper understanding of the emotional challenges faced by women during this stage of life. The findings will contribute to the development of targeted psychological interventions and support strategies that can help improve the emotional well-being and overall quality of life of perimenopausal women.
Illness perception, also known as illness cognition, is the process by which an individual analyzes and interprets current symptoms and develops an understanding of the illness and an emotional response to the illness, using existing knowledge and experience, in the event of a disease state or a threat to health (Hopman and Rijken 2015). The Common-Sense Model (CSM) of illness self-regulation states that illness perceptions (including the expected course of the illness, impact on life, and personal perceptions of the illness) underlie ongoing emotional distress (Leventhal et al. 1992). Patients’ level of illness perception is an important predictor of their choice of coping strategies, and also affects their mental health, which ultimately has a direct or indirect impact on their recovery and prognosis (Hagger and Orbell 2003). A variety of studies related to chronic diseases have confirmed this view (Borge et al. 2014; Gao et al. 2019; Jin et al. 2015; Xie et al. 2022), the higher the patient’s negative perception of the disease, the more likely they are to have symptoms of anxiety and depression. Therefore, this study proposes Hypothesis 1: Illness perception is positively correlated with perimenopausal emotional disorders.
Self-esteem refers to the cognitive appraisal and affective attitudes towards the self as a whole developed by individuals during social interactions (Mruk 2013), which can play a positive role in protecting the mental health and social adjustment of individuals in the face of adversity (Hao and Cui 2014). The Self-Esteem Theories of Depression suggests that low self-esteem is one of the most important vulnerability qualities of depression (Metalsky et al. 1993). Numerous studies have shown that an individual’s self-esteem level is significantly and negatively correlated with his or her anxiety and depression (Bajaj et al. 2016; Qin et al. 2018; Xu et al. 2021). As a core component of an individual’s self-concept, self-esteem not only directly affects an individual’s mental health, but also plays an important role in an individual’s cognitive, motivational, affective, and social behaviors as a mediating personality variable (Wilkinson 2004; Xia 2014). Studies have shown that patients’ illness perception has a significant negative predictive effect on their self-esteem level (Tian et al. 2021; Timkova et al. 2021), and the higher the illness perception score, the more negatively the patient perceives the illness and the lower their self-esteem level. Therefore, this study proposes Hypothesis 2: Self-esteem mediates the relationship between illness perception and perimenopausal emotional disorders.
Psychological resilience refers to the process by which an individual is able to cope effectively and adapt when facing adversity, trauma, threats or other significant stress (Wei et al. 2012). Psychological resilience has a significant negative predictive effect on emotional problems such as anxiety and depression (He 2022; Liang et al. 2021; Mackay Brown 2013), and higher levels of psychological resilience can enhance people’s ability to resist stress, improve their psychological health, and guide them to adopt positive coping strategies to tide over difficulties and solve problems (Steinhardt et al. 2009). Studies have shown a significant negative correlation between illness perception and psychological resilience (Wang and Qin 2017), i.e., the higher the score of illness perception, the worse the level of psychological resilience of the patient, the more negative the view of the disease, and the more threatening the disease is perceived. Therefore, this study proposes Hypothesis 3: Psychological resilience mediates the relationship between illness perception and perimenopausal emotional disorders.
Self-esteem is a significant positive predictor of psychological resilience (He 2015; Wright et al. 2012), and an important protective factor of psychological resilience (Liu et al. 2013). Individuals with higher levels of self-esteem have a more positive evaluation of their own abilities and values, and when facing stress and challenges, they are able to call on more psychological resources and adopt more positive coping strategies, and thus have higher levels of psychological resilience. Therefore, this study proposes Hypothesis 4: Self-esteem and psychological resilience play a chain-mediated role in the relationship between illness perception and perimenopausal emotional disorders.
Macau, as a special administrative region where Eastern and Western cultures are deeply integrated, exhibits unique social and cultural traits that distinctly shape the mental health of perimenopausal women. Previous studies on perimenopausal emotional disorders have often overlooked the influence of cultural background, which affects women’s perceptions of perimenopausal symptoms, coping strategies, mood swings, and approaches to seeking medical care. The special historical and social context of Macau, characterized by its cultural diversity, high level of socioeconomic development, and small city environment, further accentuates the need to consider local cultural factors. From a cultural perspective, the long coexistence of Catholicism and Confucianism in Macau has created a dual-gender norm system. On the one hand, religious communities establish emotional support networks through collective rituals (such as the Christmas parade), with research showing a significant positive correlation between religious belief and life satisfaction, as well as overall health among Macau residents (Chen et al. 2022). On the other hand, the teachings of “humility and restraint” in Catholicism, combined with Confucian ideals of the “virtuous wife and mother”, may heighten perimenopausal women’s feelings of disease stigma, resulting in greater social role conflicts as they deal with their symptoms. This cultural tension may increase the risk of emotional disorders. Additionally, the economic structure of Macau, heavily reliant on the gaming industry (which accounts for nearly 50% of its GDP), along with the high labor intensity of the service industry, amplifies the psychological burden faced by women as they navigate professional pressures alongside the physical challenges of aging.
Perimenopausal women living in Macau may also face some unique challenges during this life stage. For instance, the hot and humid climate exacerbates their physiological discomfort, the high cost of living adds economic pressure, and the competitive work environment and extended working years create additional life stress. Therefore, this study specifically focuses on perimenopausal women in Macau, examining their physical health status and mental health levels. It verifies the correlation between illness perception, self-esteem, psychological resilience, and perimenopausal emotional disorders, building on previous studies. The research also explores the influencing factors of perimenopausal mood disorders within this localized context. The study’s findings are valuable in their local relevance and can provide insights for the Macau government to improve women’s healthcare services, psychological support systems, and social welfare infrastructure.

2. Methods

2.1. Participants

In this study, perimenopausal women aged 40 to 60 years old in Macau were recruited by convenient sampling method (Jia et al. 2023). The inclusion criteria were as follows: (1) Women aged 40 to 60 years old and currently living in Macau. (2) Individuals with normal cognitive function, basic reading and writing ability, and the capacity to complete the questionnaire independently or with assistance from on-site researchers. (3) Women who had not menstruated for 12 consecutive months. (4) Informed consent and voluntary participation in this study. The present study received approval under the ethical review number FHSS24008 issued by the Ethics Committee of Faculty of Humanity and Social Science in the City University of Macau. A total of 670 questionnaires were distributed and 653 were returned. After excluding invalid questionnaires, 617 valid questionnaires remained, with an effective return rate of 92.1%. The mean age of the subjects was 51.50 ± 6.60 years. Detailed information about the participants is provided in Table 1.

2.2. Measurements

Illness perception. The Brief Illness Perception Questionnaire (BIPQ; Broadbent et al. 2006) was used to measure perceptions of illness among perimenopausal women in Macau. The BIPQ consists of eight items and one open-ended question, which are categorized into three dimensions: cognitive symptoms of illness, emotional symptoms, and understanding of illness. Responses are rated on a 0–10 scale. Higher scores indicate more negative perceptions of the illness. The Cronbach’s alpha coefficient for the BIPQ scale in this study was 0.837.
Self-esteem. The scale developed by Rosenberg (Rosenberg 1965) was used to measure the level of self-esteem of perimenopausal women in Macau. The scale consists of 10 items, with a 4-point scale ranging from “1-Strongly disagree” to “4-Strongly agree”. The total score is from 10 to 40 points, and a higher score indicates a higher level of self-esteem. The Cronbach’s α coefficient of SES scale in this study was 0.829.
Psychological resilience. The Connor–Davidson Resilience Scale (CD-RISC) translated in Chinese (Yu and Zhang 2007) was used to measure the psychological resilience of perimenopausal women in Macau. The questionnaire contains 25 items, with a 5-point scale ranging from “0-not true at all” to “4-true nearly all of the time”. The total score ranges from 0 to 100, with higher scores reflecting greater resilience. The Cronbach’s α coefficient of the CD-RISC scale in this study was 0.944.
Perimenopausal emotional disorders. The Hospital Anxiety and Depression Scale (HADS; Zigmond and Snaith 1983) was used to measure anxiety and depression among perimenopausal women in Macau. The HADS consists of 14 items, with 7 items assessing anxiety and 7 items assessing depression. All items are rated on a 4-point scale from 0 to 3. Higher scores indicate higher levels of anxiety and depression. The two subscales of anxiety and depression are categorized based on total scores as follows: asymptomatic (0~7), suspected anxiety/depressive symptoms (8~10), and presence of anxiety/depressive symptoms (11~21). The Cronbach’s alpha coefficient of the HADS scale in this study was 0.813.

3. Results

Data were analyzed using SPSS 23.0 for common method bias tests, descriptive statistics and correlation analysis. Serial mediation effect tests were performed using model 6 of the Process macro program.

3.1. Common Method Bias Test

Harman’s one-factor method was used for the test and the results showed that there were 10 factors with eigenvalues greater than 1 and the variance contribution of the first factor was 24.67%, which is less than the critical value of 40%. There is no significant common method bias in the data of this study.

3.2. Prevalence of Perimenopausal Emotional Disorders

The data revealed that 32.6% of the participants exhibited suspected or confirmed anxiety symptoms, while 29.8% exhibited suspected or confirmed depressive symptoms. The detailed results are shown in Table 2.

3.3. Descriptive Statistics and Correlation Analysis

The correlation analysis results showed a significant positive correlation between illness perception and perimenopausal emotional disorders (including both anxiety and depression dimensions). Both illness perception and emotional disorders were significantly negatively correlated with self-esteem and psychological resilience. Self-esteem was significantly positively correlated with psychological resilience. See Table 3.

3.4. Serial Mediation Models Test

The mediating effects of self-esteem and psychological resilience on the relationship between illness perception and perimenopausal emotional disorders were tested using model 6 of the RPOCESS macro program in SPSS Hayes (Hayes 2017), controlling for age, occupation, marital status, education and illness. The results are shown in Figure 1 and Figure 2, with all paths in the mediation model reaching the level of significance.
The detailed information of the mediation effects test results are shown in Table 4, and the Bootstrap 95% confidence intervals for all three indirect paths did not contain 0. The results indicate that the mediation effect of self-esteem between illness perception and perimenopausal emotional disorders was significant, the mediation effect of psychological resilience between illness perception and perimenopausal emotional disorders was significant, and the serial mediation effect of self-esteem and psychological resilience between illness perception and perimenopausal emotional disorders was significant.

4. Discussion

Among the 617 perimenopausal women in Macau selected for this study, about 30% of them reached the level of suspected or confirmed anxiety and depressive symptoms, which suggests that perimenopausal emotional disorders have a greater impact on the physical and mental health of middle-aged and elderly women, and we must pay extensive attention to them. In this study, we took perimenopausal emotional disorders as the outcome variables, and disease perception, self-esteem, and mental resilience as the predictors to explore the relationship between the four. The results showed that self-esteem and psychological resilience played a chain mediating role between illness perception and perimenopausal emotional disorders. Illness perception, self-esteem and psychological resilience are all important factors affecting perimenopausal emotional disorders, which have a non-negligible role in the physical and mental health of middle-aged and elderly women.
Illness perception is a significant positive predictor of perimenopausal emotional disorders, a result that is consistent with the findings of several other studies related to chronic diseases (Borge et al. 2014; Gao et al. 2019; Jin et al. 2015; Xie et al. 2022), i.e., the higher the level of illness perception and the more negatively the patients perceive the disease, the poorer their mental health will be. The Common-Sense Model (CSM) of illness self-regulation states that illness perceptions (including the expected course of the illness, its impact on life, and the individual’s perception of the illness), underlie ongoing emotional distress (Leventhal et al. 1992). These negative perceptions of the disease tend to induce a sense of insecurity in individuals, which not only leads them to worry excessively about their physical health status, which in turn causes the emergence of emotional problems such as anxiety and depression, but may also lead individuals to choose to avoid interacting with others or participating in social activities, and this independence from the outside world can lead to feelings of loneliness and loss, which in turn can lead to anxiety and depressive symptoms. Perimenopausal women, as a specific group facing psychological challenges, are emotionally vulnerable due to significant physiological changes and family responsibilities, making them more prone to emotional disorders (He et al. 2007). These emotional issues can be further exacerbated by strong negative perceptions of perimenopausal symptoms or other underlying health concerns. Additionally, the cultural context in which these women live, including the Catholic doctrine of “humility and restraint” and the Confucian ideal of the “virtuous wife and mother”, may reinforce negative illness perceptions and contribute to lower self-esteem, further intensifying their psychological vulnerability during this life stage.
Self-esteem acted as an independent partial mediator between illness perception and perimenopausal emotional disorders, with illness perception being a significant negative predictor of self-esteem, and self-esteem also being a significant negative predictor of perimenopausal emotional disorders. This is consistent with the findings of many Chinese studies related to chronic diseases (Qin et al. 2018; Tian et al. 2021; Xu et al. 2021). When an individual’s level of illness perception is high, there is often an overestimation of the severity of the disease and an excessive fear of impaired physical health status. Such overly negative perceptions can lead to individuals feeling dissatisfied with their body image and gradually begin to question their own value and abilities, developing a negative view of the self, which in turn leads to a decline in self-esteem. And, The Self-Esteem Theories of Depression suggests that low self-esteem is one of the most important susceptibility qualities for depression (Metalsky et al. 1993). This low evaluation and expectation of self often leads individuals to focus excessively on their own shortcomings and failures, making them pessimistic about future expectations, believing that they are unable to overcome the disease, unable to overcome the shadow of the disease, unable to return to the right track of life, and unable to integrate themselves into society. If such a pessimistic and negative state persists for a long time, negative emotions such as shame, guilt, loneliness, and helplessness may gradually develop and eventually evolve into anxiety and/or depressive symptoms. Traditional cultural values, which emphasize the familial responsibilities of mothers and wives, may further exacerbate perimenopausal women’s feelings of illness stigma, contributing to a sense of guilt and isolation. This is particularly evident in Macau, where the small family structure means that, when key family members—such as spouses and children—fail to provide adequate support, it could negatively impact their emotional well-being.
Psychological resilience plays an independent partial mediating role between illness perception and perimenopausal emotional disorders. The present study showed that illness perception had a significant negative predictive effect on psychological resilience, which is consistent with the findings of Wang Lei et al. regarding patients with interstitial lung disease (Wang and Qin 2017). Specifically, patients with higher negative illness perceptions tend to be overly concerned about their health status and overestimate the severity of the disease and its consequences, which leads to more negative emotions such as fear and worry, and make it difficult for them to cope positively with the major stresses and challenges posed by the disease, with lower levels of psychological resilience. The results of this study show that psychological resilience has a significant negative predictive effect on perimenopausal emotional disorders, which is consistent with the results of many previous studies (He 2022; Liang et al. 2021; Mackay Brown 2013; Wu et al. 2018), that is, the higher the level of psychological resilience, the better the mental health, and the lower the degree of anxiety and/or depression. Higher levels of psychological resilience can enhance people’s resilience to stress and lead them to adopt positive coping strategies to overcome difficulties and solve problems (Steinhardt et al. 2009).
Self-esteem and psychological resilience were chain-mediated between illness perception and perimenopausal emotional disorders, and self-esteem significantly and positively predicted psychological resilience. This result is consistent with previous studies that self-esteem has a significant positive correlation with psychological resilience (He 2015; Lee et al. 2013; Wright et al. 2012) and is an important protective factor for psychological resilience (Liu et al. 2013). High levels of self-esteem can increase people’s ability to cope with adversity, and in the face of serious threats and challenges, they believe that they are capable of coping and overcoming them, and thus they are able to call upon more psychological resources and adopt more positive coping strategies, which in turn contributes to the development of psychological resilience (Chai et al. 2018).
This study had some limitations. First, it is a cross-sectional correlational study, which means it cannot establish causal relationships between illness perception and emotional disorders. Longitudinal research is needed to explore the directionality and potential causal mechanisms. Second, the reliance on self-report questionnaires may have introduced response biases, such as social desirability or inaccuracies in reporting. Future studies could benefit from using objective measures or a multi-method approach to improve the reliability of the findings. Additionally, while this study highlights the relationship between illness perception and emotional disorders, the influence of cultural and social characteristics was primarily addressed from a theoretical perspective. Given that cultural and societal factors play a significant role in shaping individuals’ psychological health, future research should more explicitly explore the cultural and social impacts on perimenopausal women’s emotional well-being. This could include examining the specific cultural norms, values, and family structures that may further moderate the relationship between illness perception and emotional disorders.
Despite these limitations, this study contributes to a better understanding of how illness perception affects emotional disorders like anxiety and depression in perimenopausal women. It highlights the mediating roles of self-esteem and psychological resilience, providing valuable insights for future psychological interventions. The findings also highlight the complex interplay between cognitive and emotional factors, showing that a woman’s perception of her health plays a critical role in her mental well-being. This contributes to a more nuanced understanding of how psychological factors, beyond biological symptoms, impact emotional health during menopause. Interestingly, despite Macau being one of the wealthiest regions in Asia, perimenopausal women there still face significant mental health challenges, underscoring the importance of addressing emotional well-being in this population. These findings suggest a need for more targeted psychological support, even in economically advanced regions.

5. Conclusions

In summary, the present study explored three pathways of illness perceptions on emotional disorders among perimenopausal women in Macau. The results showed that illness perception can directly affect the emotional disorders of perimenopausal women in Macau and can also indirectly affect perimenopausal emotional disorders through the mediating effects of self-esteem and psychological resilience, as well as the chain mediating effect of self-esteem and psychological resilience.

Author Contributions

Conceptualization, T.Y.W., J.C.L. and R.S.; methodology, T.Y.W.; validation, T.Y.W.; formal analysis, J.L.; investigation, J.L.; resources, J.C.L. and T.Y.W.; data curation, J.L.; writing—original draft preparation, J.L. and T.Y.W.; writing—review and editing, J.C.L. and R.S.; supervision, T.Y.W.; project administration, T.Y.W. and J.C.L.; funding acquisition, T.Y.W. All authors have read and agreed to the published version of the manuscript.

Funding

This research was funded by The Science and Technology Development Fund of Macau, grant number 0016/2022/ITP.

Institutional Review Board Statement

The study was conducted in accordance with the Declaration of Helsinki, and approved by the Ethics Committee of City University of Macau (protocol code FHSS24008 and date of approval: 19 April 2024).

Informed Consent Statement

Informed consent was obtained from all subjects involved in the study.

Data Availability Statement

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

Acknowledgments

Special thanks to the Associação Geral das Mulheres de Macau for their strong support of this research.

Conflicts of Interest

The authors declare no conflicts of interest.

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Socsci 14 00186 g001
Figure 1. Serial mediation model on perimenopausal anxiety. All path coefficients are standardized coefficients. * p < 0.05, *** p < 0.001.
Figure 1. Serial mediation model on perimenopausal anxiety. All path coefficients are standardized coefficients. * p < 0.05, *** p < 0.001.
Socsci 14 00186 g001
Socsci 14 00186 g002
Figure 2. Serial mediation model on perimenopausal depression. All path coefficients are standardized coefficients. * p < 0.05, *** p < 0.001.
Figure 2. Serial mediation model on perimenopausal depression. All path coefficients are standardized coefficients. * p < 0.05, *** p < 0.001.
Socsci 14 00186 g002
Table 1. Detailed information about the participants.
Table 1. Detailed information about the participants.
Basic InformationFormNumber of PeopleProportion (%)
Age40–45 years15224.6
46–50 years12319.9
51–55 years12019.4
56–60 years22236.0
CareersEmployed full time38462.2
Employed part-time548.8
Self-employment304.9
Out of work14924.1
Marital statusUnmarried538.6
Married49079.4
Divorcee457.3
Bereaved of one’s spouse (literary)294.7
Education attainmentBelow university level48378.3
College10316.7
Master’s degree or above315.0
Illness conditionHigh blood pressure14423.3
Diabetes497.9
Osteoporosis13121.2
High blood fat disease548.8
Cervical spondylosis13722.2
Fibroid tumor of the uterus7111.5
Other cardiovascular or urological diseases193.1
Table 2. Prevalence of perimenopausal emotional disorders.
Table 2. Prevalence of perimenopausal emotional disorders.
Basic InformationFormNumber of PeopleProportion (%)
Perimenopausal anxietyAsymptomatic41667.4
Suspected anxiety symptoms14423.3
Presence of anxiety symptoms579.3
Perimenopausal depressionAsymptomatic43370.2
Suspected depressive symptoms12319.9
Presence of depressive symptoms619.9
Table 3. Descriptive statistics and correlation analysis for each study variable (n = 617).
Table 3. Descriptive statistics and correlation analysis for each study variable (n = 617).
MSD12345
1 Illness perception4.661.20-
2 Self-esteem2.980.37−0.14 ***-
3 Psychological resilience2.290.65−0.14 **0.45 ***-
4 Emotional disorders0.840.450.26 ***−0.46 ***−0.38 ***-
5 Anxiety0.880.470.27 ***−0.35 ***−0.25 ***0.87 ***-
6 Depression0.800.520.20 ***−0.46 ***−0.41 ***0.90 ***0.57 ***
** p < 0.01, *** p < 0.001.
Table 4. Bootstrap test for mediating effects.
Table 4. Bootstrap test for mediating effects.
TrailsEffect ValuesBoot SE95% CLRelative Mediation Effect Size
[Boot LLCI, Boot ULCI]
X →M1 → Y10.0280.008[0.0142, 0.0441]19.51%
X → M2 → Y10.0030.002[0.0001, 0.0077]2.16%
X → M1 → M2 → Y10.0040.002[0.0004, 0.0085]2.79%
Total indirect effect0.0350.008[0.0200, 0.0520]24.46%
X → M1 → Y20.0360.008[0.0204, 0.0531]28.16%
X → M2 → Y20.0090.004[0.0022, 0.0180]7.28%
X → M1 → M2 → Y20.0120.003[0.0059, 0.0187]9.18%
Total indirect effect0.0560.011[0.0356, 0.0776]44.54%
Note. X: Illness perception, M1: Self-esteem, M2: Psychological resilience, Y1: Perimenopausal anxiety, Y2: Perimenopausal depression.
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Li, J.; Wang, T.Y.; Lok, J.C.; Shi, R. The Influence of Illness Perception on Emotional Disorders in Perimenopausal Women in Macau: The Serial Mediating Effect of Self-Esteem and Psychological Resilience. Soc. Sci. 2025, 14, 186. https://doi.org/10.3390/socsci14030186

AMA Style

Li J, Wang TY, Lok JC, Shi R. The Influence of Illness Perception on Emotional Disorders in Perimenopausal Women in Macau: The Serial Mediating Effect of Self-Esteem and Psychological Resilience. Social Sciences. 2025; 14(3):186. https://doi.org/10.3390/socsci14030186

Chicago/Turabian Style

Li, Jiaqi, Tulips Yiwen Wang, Jenny C. Lok, and Ruiting Shi. 2025. "The Influence of Illness Perception on Emotional Disorders in Perimenopausal Women in Macau: The Serial Mediating Effect of Self-Esteem and Psychological Resilience" Social Sciences 14, no. 3: 186. https://doi.org/10.3390/socsci14030186

APA Style

Li, J., Wang, T. Y., Lok, J. C., & Shi, R. (2025). The Influence of Illness Perception on Emotional Disorders in Perimenopausal Women in Macau: The Serial Mediating Effect of Self-Esteem and Psychological Resilience. Social Sciences, 14(3), 186. https://doi.org/10.3390/socsci14030186

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