0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Comment & Response |

Estrogen-Based Therapies and Depression in Women Who Naturally Enter Menopause Before Population Average—Reply

Marios K. Georgakis, MD1; Alkistis Skalkidou, MD, PhD2; Eleni Th. Petridou, MD, MPH, PhD1
[+] Author Affiliations
1Department of Hygiene, Epidemiology, and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
2Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
JAMA Psychiatry. 2016;73(8):874-875. doi:10.1001/jamapsychiatry.2016.0953.
Text Size: A A A
Published online

Extract

In Reply The letter by Hengartner raised important issues regarding the significance and interpretation of findings in our recent meta-analysis1 on the association of increasing age at menopause and duration of reproductive period with decreased risk for depression in postmenopausal women. While we value the concerns, the following points should be underlined.

Large sample sizes indeed provide the statistical power to yield practically nonsignificant deviations from the null hypothesis; however, in our study, causality criteria were also met. Specifically, our results followed a biologically plausible hypothesis supported by previous epidemiologic and basic research evidence, whereas the lack of heterogeneity in the analysis implies coherence across different populations and study designs. Interestingly, the findings were also replicated in an equally large study (N = 60 114) of primary data from a Korean population2 published after we completed our systematic review. The magnitude of the association in our meta-analysis (2.3% decrease in depression risk for 2-year increase in age at menopause; exact odds ratio, 0.977) is rather comparable with the 2.9% increased risk for 1-year increment of age at menopause reported for breast cancer3 and the 3% decreased risk for 1-year increment for cardiovascular disease.4 Moreover, the association was amplified for severe depression (decreased by 5.1% depression risk for 2-year increase of age at menopause) and the risk actually doubled for women with age at menopause younger than 40 years, indicating a biological gradient of the effect. Last, regarding the comment by Hengartner on the lack of association in the analysis adjusting for past depression, we clearly showed in the eFigure in the Supplement for our article1 that the association reached nominal statistical significance (exact odds ratio, 0.976; exact 95% CI, 0.957-0.996, with upper limit rounded to 1.00; P = .02). An observation attributed to random fluctuation would not be expected to follow such a pattern; yet, because of inherent limitations, detailed in our publication, cautious interpretation of the findings is suggested.

Topics

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview

Figures

Tables

References

Correspondence

August 1, 2016
Michael Pascal Hengartner, PhD, MSc
1Department of Applied Psychology, Zurich University of Applied Sciences, Zurich, Switzerland
JAMA Psychiatry. 2016;73(8):874. doi:10.1001/jamapsychiatry.2016.0709.
CME
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.

Multimedia

Some tools below are only available to our subscribers or users with an online account.

205 Views
0 Citations
×

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...
Jobs
brightcove.createExperiences();