Recognition of depression among women presenting with menopausal symptoms

Prevalence and risk factors for depressive and anxiety symptoms in middle-aged Chinese women: a community-based cross-sectional study

Background

Depression and anxiety have become main public health concerns globally. However, risk factors for depression and anxiety remain unclear. This study was to examine the prevalence and risk factors of depressive and anxiety symptoms in middle-aged Chinese women.

Methods

This cross-sectional study, conducted in 2018, included 7,727 women aged 40–60 years from the eastern, central and western regions of China. Depressive and anxiety symptoms were determined by the Patient Health Questionnaire-9 and the Generalized Anxiety Disorders-7, respectively. Logistic regression models were used to estimate odds ratios (ORs) for depressive and anxiety symptoms in relation to sociodemographic, lifestyle and menopausal factors.

Results

Among all participants, 19.5% (1 422/7 275) and 14.2% (1 035/7 275) of participants experienced depressive and anxiety symptoms, respectively. The multivariable logistic regression models showed that age, household income, regular physical activity, chronic diseases, menopausal status, vasomotor symptoms, somatic symptoms and urogenital symptoms were associated with depressive symptoms, while place of residence, regular physical activity, chronic diseases, vasomotor, somatic and urogenital symptoms were associated with anxiety symptoms.

Conclusion

Depressive and anxiety symptoms were common among middle-aged Chinese women, and certain sociodemographic, lifestyle and menopausal symptoms have an important impact on the risk of depressive and anxiety symptoms.

The prevalence and associated factors of depression during pre-, peri-, and post-menopausal period among the middle-aged women of Dhaka city

BACKGROUND

Depression is a serious mental health issue and a major concern among middle-aged women, especially during the menopause transition time. This study aimed to determine the prevalence and associated factors of depression among the middle-aged women of the menopause transition in Dhaka.

METHODOLOGY

A cross-sectional study was conducted among 41 to 60 years older women in Dhaka city using a multistage cluster sampling technique and face to face interview.

RESULT

In total 326 middle-aged women participated in the study, and among them, 30.4% had major depression. No statistically significant association was observed between menopause status and major depression. However, peri-(34.2%) and post-menopausal (33.3%) groups were more depressed compared to pre-menopausal (26.8%) groups. Our adjusted analysis indicates, marital status (p = 0.004), having salaried job (p < 0.001), number of offspring (p = 0.003), sedentary hours (p = 0.002), smoking habit (p = 0.012), hypertension (p = 0.012), chronic disease other than diabetes/hypertension (p = 0.006), vasomotor symptoms (p = 0.004) and sleep problem (p = 0.007) were significantly associated with depression status.

CONCLUSION

The study result indicates a high prevalence of major depression among middle-aged Bangladeshi women during the menopause transition. Therefore, depression should be routinely evaluated among middle-aged women for the monitoring and prevention of depression.

Cognitive-behavioral therapy for depression among menopausal woman: A randomized controlled trial

Context

Menopause is associated with high risk of depression among women. Studies have shown that group cognitive behavioral theory (CBT) is safe and effective treatment for depression among menopausal women; however, only limited studies are conducted in India.

Aims

To examine the efficacy of group CBT for depression among menopausal woman.

Settings and Design

A randomized, controlled trial design was adopted with longitudinal measurement of outcomes for 6 months. The study was conducted from January 2017 to November 2017 at selected Primary Health Centre (PHC) area, urban Bengaluru.

Subject and Methods

Participants were 80 women from selected PHC areas, Bengaluru, India. The participants were randomly assigned to either the experimental or control group by computer-generated random numbers. The experimental group received six weekly group CBT sessions. Depression was evaluated for both groups at the baseline and at two follow-up assessments in the 1^st and 6^th month. Treatment effects of the group CBT were analyzed by repeated-measures analysis of variance.

Statistical Analysis Used

Data were analyzed using Statistical Package for the Social Sciences software package (Version 23).

Results

The results showed that comparisons of depression scores between the two groups before initiating group CBT were not significant. Statistically significant reduction in depression scores were seen among experimental group compared to control group over the 6-month period.

Conclusion

This study concluded that group CBT is effective for reducing depression among menopausal woman.

GABA+ levels in postmenopausal women with mild-to-moderate depression: A preliminary study

BACKGROUND

It is increasingly being recognized that alterations of the GABAergic system are implicated in the pathophysiology of depression. This study aimed to explore in vivo gamma-aminobutyric acid (GABA) levels in the anterior cingulate cortex/medial prefrontal cortex (ACC/mPFC) and posterior-cingulate cortex (PCC) of postmenopausal women with depression using magnetic resonance spectroscopy (H-MRS).

METHODS

Nineteen postmenopausal women with depression and thirteen healthy controls were enrolled in the study. All subjects underwent H-MRS of the ACC/mPFC and PCC using the "MEGA Point Resolved Spectroscopy Sequence" (MEGA-PRESS) technique. The severity of depression was assessed by 17-item Hamilton Depression Scale (HAMD). Quantification of MRS data was performed using Gannet program. Differences of GABA+ levels from patients and controls were tested using one-way analysis of variance. Spearman correlation coefficients were used to evaluate the linear associations between GABA+ levels and HAMD scores, as well as estrogen levels.

RESULTS

Significantly lower GABA+ levels were detected in the ACC/mPFC of postmenopausal women with depression compared to healthy controls (P = 0.002). No significant correlations were found between 17-HAMD/14-HAMA and GABA+ levels, either in ACC/mPFC (P = 0.486; r = 0.170/P = 0.814; r = -0.058) or PCC (P = 0.887; r = 0.035/ P = 0.987; r = -0.004) in the patients; there is also no significant correlation between GABA+ levels and estrogen levels in patients group (ACC/mPFC: P = 0.629, r = -0.018; PCC: P = 0.861, r = 0.043).

CONCLUSION

Significantly lower GABA+ levels were found in the ACC/mPFC of postmenopausal women with depression, suggesting that the dysfunction of the GABAergic system may also be involved in the pathogenesis of depression in postmenopausal women.

The association of depression status with menopause symptoms among rural midlife women in China

OBJECTIVE

This study aims to evaluate the association of depression with menopausal status and some menopause symptoms (vasomotor symptoms and poor sleep).

METHODS

A total of 743 participants aged 40-60 years were recruited. Depression status was evaluated by using Self-Rating Depression Scale (SDS). Sleep quality and vasomotor symptoms were evaluated by specific symptoms questionnaire.

RESULTS

The prevalence of depression among participants was 11.4%. Depression was found more likely to occur in participants with poor sleep (OR, 6.02; 95%CI, 3.61, 10.03) or with vasomotor symptoms (VMS) (OR, 2.03; 95%CI, 1.20, 3.44) after controlling for age, education level, marital status, menopause status, monthly family income and chronic diseases. Menopause status was not associated with depression. Stratification analysis showed a significant association between poor sleep and depression across different menopause stages, while VMS were associated with depression only in premenopausal status.

CONCLUSION

The majority of Chinese rural midlife women do not experience depression. The relationship between depression, VMS and sleep disturbances tends to change with menopausal status in Chinese rural midlife women.

Associations between psychological well-being, mental health, and hormone therapy in perimenopausal and postmenopausal women: results of two population-based studies

OBJECTIVE

A proportion of women experience depressive and anxiety symptoms and/or disorders in connection with the menopausal transition. Estrogen-only therapy has been reported to have beneficial effects on mental health, but the effects of combined hormone therapy (HT) on mental health are less clear. We studied the associations between HT use and psychopathology in perimenopausal and postmenopausal women.

METHODS

Data on women who participated in the Health 2000 Survey and the National FINRISK Surveys in Finland were analyzed.

RESULTS

An association between current HT use and psychiatric diagnosis in the previous 12 months was found. In addition, HT use was associated with recent self-reported diagnosis of depression and with depressed mood (FINRISK), as well as with major depressive disorder and anxiety disorder (Health 2000). Associations with the following symptoms were found: nervousness, frightening thoughts, nightmares, and headache (FINRISK), feelings of depression (FINRISK and Health 2000), and unhappiness (Health 2000). No differences between different routes of administration or types of HT emerged.

CONCLUSIONS

Current use of HT in perimenopausal and postmenopausal women is associated with worse psychological well-being and mental health than in women not using HT. It is important to identify women in need of psychiatric support at the time of the menopausal transition.

Do perimenopausal and menopausal symptoms affect the marital relationship?

This study investigated whether women’s perimenopausal/menopausal symptoms had negative effects on marital or long-term relationships, an aspect underrepresented in the literature. A questionnaire distributed to 110 convenience-sampled women, ages 45-60 years and prescreened for inclusion by private practitioners or the author’s colleagues, yielded a 60% return. Symptoms correlated positively with participants’ feelings about the relationship and sexual intimacy with their partner (.353–.783, p = 0.01, and 272–.371, p = 0.05, respectively). Divorced women did not experience the same loss of sexual desire or feel anger or resentment toward their partners as did married women. Clinicians should ask women about perimenopausal/menopausal symptoms, loss of libido, and the marital relationship during annual visits. Education related to this period of life may provide a better understanding to women and the partner may be included in education, as many men do not understand the changes associated with perimenopause and menopause.

Reproductive aging, menopause, and health outcomes

Changes in ovarian hormone production may affect numerous health outcomes including vasomotor symptoms, cardiovascular disease (CVD), osteoporosis, cognition, depression, mood disorders, sexual function, and vaginal atrophy. We will compare age-related changes to those associated with reproductive aging and menopause and the effects of estrogen therapy on selected health outcomes. Hormone therapy (HT) reduces frequency and severity of hot flashes, prevents bone loss and osteoporotic fractures, and relieves vaginal atrophy. Nonhormone therapy trials with antidepressants or gabapentin for hot flash relief are promising. To date, clinical trial data are insufficient to recommend the use of HT for prevention or treatment of CVD, mood disorders, cognition, or sleep disorders. For some disease states, such as CVD and cognition, a "critical time window" has been proposed but not proven, such that estrogen use early in the menopause transition may be beneficial while estrogen use later in life would lead to increased health risks.

The prevalence of depression symptoms and influencing factors among perimenopausal and postmenopausal women

OBJECTIVE

This study was conducted for the purpose of determining the prevalence of depression in perimenopausal and postmenopausal women and the factors that influence the development of depression.

METHODS

A community-based sample of 685 women aged 45 to 59 years who were living in Malatya was recruited in this cross-sectional study. An information form that included questions on descriptive characteristics and lifestyle variables of cases, the Menopause-Specific Quality of Life Questionnaire, and the Beck Depression Inventory were administered to each woman in the sample. The data were collected through personal interviews with women at their home between February and May 2008.

RESULTS

The mean age of the respondents was 50.66 (4.15) years. The prevalence of depression symptoms among the perimenopausal and postmenopausal women was 41.8%. Of all women, 23.2% were premenopausal and 56.9% were postmenopausal. The logistic regression analysis revealed that depression symptom development was 1.8 times higher in the perimenopausal-postmenopausal period than in the premenopausal period, 3.6 times higher among those with an event history affecting life in a negative way than among those without, and 2.0 times higher among those with a body mass index of 25 kg/m or higher than among those with a body mass index of less than 25 kg/m.

CONCLUSIONS

There is a high level of prevalence of depression symptoms in perimenopausal and postmenopausal women.

Effects of sleep disturbance on the quality of life of Turkish menopausal women: a population-based study

OBJECTIVES

The purpose of this study was to investigate sleep disturbances among menopausal women: their prevalence, risk factors for them and the quality of life of women who have them.

DESIGN

A population-based sample of 887 Turkish women aged 45-59 years and living in Malatya was recruited in this cross-sectional descriptive study. The women were administered the Interview Form, which covers sociodemographic, health and lifestyle variables, as well as the Women's Health Initiative Insomnia Rating Scale, the Menopause Specific Quality of Life Questionnaire and the Beck Depression Inventory.

RESULTS

The prevalence of sleep disturbance in this sample of menopausal women was 54%. Logistic regression models revealed that the risk of sleep disturbance was 2.4 times higher in the perimenopausal than in the premenopausal period, 1.7 times higher among those who received hormone therapy than among those who did not, 1.5 times higher among those with a physical disease than among those without, and 3.9 times higher among those with depression than among those without; an increase of one year in age was associated with a 5% increase in the prevalence of sleep disturbance. Average scores on the vasomotor, psychosocial, physical and sexual sub-scales of the Menopause Specific Quality of Life Questionnaire were significantly higher for women with sleep disturbance than for those without (P<0.001).

CONCLUSIONS

The prevalence of sleep disturbance was found to be high among menopausal women. Initiatives aimed at reducing sleep disturbance should be added to menopausal care programmes in order to improve the quality of life of menopausal women.

Depression and Related Disorders during the Female Reproductive Cycle

For some women, times of reproductive transition represent times of high risk for the onset or exacerbation of depressive symptoms. In order to maintain emotional stability, the female brain must adapt to fluctuations in hormones that affect neurotransmitter functioning. Difficulty with this adaptation, along with stresses related to social role transitions, may confer heightened vulnerability to depression. In this review, we summarize data regarding the course, expression and risks of depression and related symptoms during puberty and menarche, the luteal phase of the menstrual cycle, the perinatal period and perimenopause. We note treatment strategies that have been found to be effective for depressive symptoms during specific phases of the female reproductive cycle.