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Recently Hashiguchi et al. [1] published a short report aimed at determining the most relevant explanatory variable for female mid-aged health: mindfulness, self-compassion, or acceptance. For this purpose, a total of 200 Japanese women aged 40 to 60 years completed self-reported measures of symptoms (depressive and menopausal), quality of life (physical and mental), and well-being. After performing correlation analysis, they determined that mindfulness, self-compassion, and acceptance were significantly associated with all variables of psychological distress and adjustment. Multiple regression analysis revealed that acceptance significantly explained the most variance of symptoms (depressive and menopausal) and also mental quality of life. On the other hand, self-compassion significantly explained the greatest variance in well-being. The authors of this study suggest that, for middle-aged women, “acceptance” is an important explanatory variable of psychological distress and “self-compassion” is an important variable of psychological adjustment.


The progressive decrease of estrogen secretion observed during the female menopausal transition increases the frequency of symptoms (menopausal and psychological), which in turn have a negative impact on their quality of life [2]. Nevertheless, there are also other psycho-  and social aspects that affect women, some directly, and others indirectly, related to their quality of health. Emotion regulation processes, such as mindfulness (“paying attention in a particular way”), self-compassion (“being compassionate toward oneself”), and acceptance (“process of actively embracing private events”), have been discussed as modifiable psychological factors related to psychological distress and adjustment among mid-aged women [3]. Despite the fact that these emotional regulating factors have been discussed separately [3], as the authors indicate the question remains of which of these factors reflect the most variance in female mid-aged health, or how these factors correlate with psychological distress and adjustment. Interestingly, although the authors found that there were significant associations between mindfulness, self-compassion, and acceptance; only self-compassion and acceptance significantly explained depressive and menopausal symptoms, and acceptance had a stronger effect than self-compassion. For mental quality of life, only self-compassion and acceptance were statistically significant and acceptance had a stronger effect than self-compassion. Emotion regulation is a process involved in psychological experiences that is: what psychological experiences people have, when they have them, how they experience them, and how they express them [3].

Despite these interesting findings, the authors recognize several limitations to their study such as study design (cross-sectional), small sample size, or not accounting for the effect of medication use; hence, claiming that the observed results could have been influenced by random fluctuations. Personally I agree with the authors that acceptance may be responsible for more variance in psychological distress than mindfulness or self-compassion; and that self-compassion may be more closely related to psychological adjustment than mindfulness or acceptance. There is a need for more research in this field and psychological interventions aimed at improving the health of female’s mid-life should focus on modifiable factors of acceptance and self-compassion.

Peter Chedraui, MD, PhD
Instituto de Investigación e Innovación en Salud Integral
Universidad Católica de Santiago de Guayaquil, Guayaquil, Ecuador


  1. Hashiguchi K, Yoshikawa S, Muto T. Emotion regulation processes and middle-aged Japanese women’s health. Climacteric. 2021;24(2):200-205.
  2. Chedraui P, Blümel JE, Baron G, et al. Impaired quality of life among middle aged women: a multicentre Latin American study. Maturitas. 2008;61(4):323-9.
  3. Gross JJ. The emerging field of emotion regulation: an integrative review. Rev Gen Psychol 1998;2(3):271–99.

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