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Klusmann H, Kapp C, Engel S, Schumacher T, Bücklein E, Knaevelsrud C, Schumacher S. Higher Depressive Symptoms in Irregular Menstrual Cycles: Converging Evidence from Cross-Sectional and Prospective Assessments. Psychopathology 2024:1-8. [PMID: 38194941 DOI: 10.1159/000535565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 11/15/2023] [Indexed: 01/11/2024]
Abstract
BACKGROUND Menstrual cycle regularity is an important marker of reproductive health and associated with physiological and psychological illnesses, as well as experiencing stress. We hypothesized that individuals with irregular menstrual cycles report higher depressive symptom severity, after controlling for stress occurrence. METHODS The hypothesis was examined through two measurement approaches: a cross-sectional and a prospective, longitudinal study. In the cross-sectional study, participants (n = 394) reported depressive symptoms and their overall menstrual cycle regularity. In the longitudinal study, participants (n = 77) completed questionnaires on depressive symptoms and stress during the mid-follicular and periovulatory phase of one menstrual cycle. Depressive symptoms were compared between participants with regular and irregular cycles through a Welch t test and an ANCOVA. RESULTS Participants with irregular menstrual cycles reported more depressive symptoms in the cross-sectional analysis. Similarly, in the longitudinal analysis, the group with a current irregular menstrual cycle reported more depressive symptoms after controlling for stress occurrence. When including only complete data sets without multiple imputation (n = 52), the direction of the effects remained but did not reach statistical significance. CONCLUSIONS The results indicate an association between depressive symptoms and menstrual cycle irregularity. Limitations were that although we investigated the menstrual cycle prospectively, it would have been more precise to include two or more cycles and daily sex hormone measurements. Further limitations were the suboptimal statistical power and the data collection during the COVID pandemic. We give recommendations on how to incorporate the association of depressive symptoms and cycle irregularity in future study designs on women's mental health.
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Affiliation(s)
- Hannah Klusmann
- Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | - Claudia Kapp
- Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | - Sinha Engel
- Department of Experimental Psychopathology, Institute for Psychology, University of Hildesheim, Hildesheim, Germany
| | - Tabea Schumacher
- Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
- Clinical Psychology and Psychotherapy, Department of Psychology, Faculty of Health, HMU Health and Medical University, Potsdam, Germany
| | - Elise Bücklein
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Universität Ulm, Ulm, Germany
| | - Christine Knaevelsrud
- Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | - Sarah Schumacher
- Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
- Clinical Psychology and Psychotherapy, Department of Psychology, Faculty of Health, HMU Health and Medical University, Potsdam, Germany
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Klusmann H, Schulze L, Engel S, Bücklein E, Daehn D, Lozza-Fiacco S, Geiling A, Meyer C, Andersen E, Knaevelsrud C, Schumacher S. HPA axis activity across the menstrual cycle - a systematic review and meta-analysis of longitudinal studies. Front Neuroendocrinol 2022; 66:100998. [PMID: 35597328 DOI: 10.1016/j.yfrne.2022.100998] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 04/09/2022] [Accepted: 05/07/2022] [Indexed: 12/29/2022]
Abstract
Differential HPA axis function has been proposed to underlie sex-differences in mental disorders; however, the impact of fluctuating sex hormones across the menstrual cycle on HPA axis activity is still unclear. This meta-analysis investigated basal cortisol concentrations as a marker for HPA axis activity across the menstrual cycle. Through a systematic literature search of five databases, 121 longitudinal studies were included, summarizing data of 2641 healthy, cycling participants between the ages of 18 and 45. The meta-analysis showed higher cortisol concentrations in the follicular vs. luteal phase (dSMC = 0.12, p =.004, [0.04 - 0.20]). Comparisons between more precise cycle phases were mostly insignificant, aside from higher concentrations in the menstrual vs. premenstrual phase (dSMC = 0.17, [0.02 - 0.33], p =.03). In all included studies, nine samples used established cortisol parameters to indicate HPA axis function, specifically diurnal profiles (k = 4) and the cortisol awakening response (CAR) (k = 5). Therefore, the meta-analysis highlights the need for more rigorous investigation of HPA axis activity and menstrual cycle phase.
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Affiliation(s)
- Hannah Klusmann
- Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Schwendenerstraße 27, 14195 Berlin, Germany.
| | - Lars Schulze
- Clinical Psychology and Psychotherapy, Department of Education and Psychology, Freie Universität Berlin, Habelschwerdter Allee 45, 14195 Berlin, Germany.
| | - Sinha Engel
- Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Schwendenerstraße 27, 14195 Berlin, Germany.
| | - Elise Bücklein
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Universität Ulm, Lise-Meitner-Str. 16, 89081 Ulm, Germany.
| | - Daria Daehn
- Clinical Psychology and Psychotherapy, Department of Education and Psychology, Freie Universität Berlin, Habelschwerdter Allee 45, 14195 Berlin, Germany.
| | - Serena Lozza-Fiacco
- School of Medicine, Department of Psychiatry, University of North Carolina at Chapel Hill, Carolina Crossings Building B, 2218 Nelson Highway, 27517 Chapel Hill, USA.
| | - Angelika Geiling
- Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Schwendenerstraße 27, 14195 Berlin, Germany.
| | - Caroline Meyer
- Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Schwendenerstraße 27, 14195 Berlin, Germany.
| | - Elizabeth Andersen
- School of Medicine, Department of Psychiatry, University of North Carolina at Chapel Hill, Carolina Crossings Building B, 2218 Nelson Highway, 27517 Chapel Hill, USA.
| | - Christine Knaevelsrud
- Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Schwendenerstraße 27, 14195 Berlin, Germany.
| | - Sarah Schumacher
- Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Schwendenerstraße 27, 14195 Berlin, Germany; Clinical Psychology and Psychotherapy, Department of Psychology, Faculty of Health, HMU Health and Medical University, Olympischer Weg 1, 14471 Potsdam, Germany.
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