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Original Investigation |

Longitudinal Pattern of Depressive Symptoms Around Natural Menopause

Ellen W. Freeman, PhD1,2; Mary D. Sammel, ScD3; David W. Boorman, MS4; Rongmei Zhang, PhD3
[+] Author Affiliations
1Department of Obstetrics/Gynecology, University of Pennsylvania School of Medicine, Philadelphia
2Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia
3Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia
4Center for Research in Reproduction and Women’s Health, University of Pennsylvania School of Medicine, Philadelphia
JAMA Psychiatry. 2014;71(1):36-43. doi:10.1001/jamapsychiatry.2013.2819.
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Importance  An increased risk of depressive symptoms has been associated with the transition to menopause, but the risk of depressive symptoms in the early postmenopausal years has not been well characterized.

Objectives  To identify within-woman changes in depressive symptoms during a 14-year period around menopause, determine associations of a history of depression with the pattern of depressive symptoms, and evaluate the rate of change in reproductive hormones as predictors of depressive symptoms following menopause.

Design, Setting, and Participants  A randomly identified, population-based sample in Philadelphia County, Pennsylvania, of 203 late-reproductive-age women who were premenopausal at baseline and reached natural menopause.

Main Outcomes and Measures  Center for Epidemiologic Studies Depression Scale.

Results  The prevalence of high scores on the Center for Epidemiologic Studies Depression Scale decreased from 10 years before to 8 years after the final menstrual period (FMP), with a decrease of approximately 15% of baseline per year (odds ratio, 0.85; 95% CI, 0.81-0.89; P < .001). Relative to the FMP, the risk of depressive symptoms was higher in the years before and lower in the years after the FMP. Among women with a history of depression, the likelihood of depressive symptoms was more than 13 times greater overall and 8 times greater after menopause compared with women with no depression history. Among women who first experienced depressive symptoms approaching menopause, the risk of depressive symptoms declined after the FMP, with a significantly lower risk the second year after menopause. The risk of depressive symptoms after menopause decreased by 35% for each unit (SD) increase before the FMP in the log rate of change of follicle-stimulating hormone (odds ratio, 0.65; 95% CI, 0.46-0.91; P = .01).

Conclusions and Relevance  The FMP was pivotal in the overall pattern of decreasing depressive symptoms in midlife women, with higher risk before and lower risk after the FMP. A history of depression strongly increased the risk both before and after menopause. Women who had no history of depression before the menopause transition had a low risk of depressive symptoms 2 or more years after the FMP.

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Figure.
Proportion of Women With a Score of 16 or Higher (A) or 25 or Higher (B) on the Center for Epidemiologic Studies Depression Scale (CES-D) in Each Study Year by History of Depression at Study Enrollment

History of depression, n = 90; no history of depression, n = 113. Years at the range ends were combined due to small numbers of observations; the full range is 12 years before to 11 years after the final menstrual period. Results were generated from a multivariable generalized linear mixed model with robust variance (generalized estimating equation model). Comparisons between the 2 groups each year are P < .001.

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