Psychological Sciences, University of Melbourne and Royal, Women's Hospital, Parkville, Vic 3052, Australia.
J Affect Disord. 2012 Jul;139(2):141-8. doi: 10.1016/j.jad.2011.06.055. Epub 2011 Jul 23.
There have been relatively few studies of the relationship between anxiety and menopause. Despite the paucity of clear evidence, some authors have suggested that the menopausal transition is a time of heightened risk for onset or exacerbation of anxiety symptoms. There is also controversy as to whether anxiety predates or is a consequence of hot flashes. The aim of this paper is to examine the evidence as to the relationship between menopause and anxiety, and between anxiety and hot flushes, one of the core symptoms of menopause.
A systematic review was undertaken based on literature published between 1960 and 2011, using the Medline, Web of Science and PsychINFO databases. The key terms 'anxiety', 'anxiety symptoms', 'anxiety disorder', 'menopause', 'menopausal transition', 'midlife', 'hot flushes or flashes' and 'vasomotor symptoms' were entered into the search. Studies were included if they reported original research using a clearly described measure of anxiety or investigated the relationship between anxiety and vasomotor symptoms.
Nine studies reporting the relationship between menopause and anxiety, two studies reporting the prevalence of panic disorder, and eight studies investigating the relationship between anxiety and vasomotor symptoms were identified. Overall, anxiety symptom levels were low throughout the menopausal transition, but the studies were characterised by poor measurement of both menopausal status and anxiety symptoms and relied heavily on the use of brief, largely nonvalidated measures of anxiety symptoms, which are of unknown clinical significance. In the studies that also measured factors such as attitude to menopause, and dispositional optimism or changes in family life these emerged as important predictors of vasomotor symptom severity.
None of the available studies provides solid data on the prevalence of anxiety disorders that meet diagnostic criteria, and the present state of knowledge does not be no justify the inclusion of "menopausal anxiety" as a reproductive-related disorder. With respect to the relationship between hot flashes and anxiety, studies need to ensure that somatic and psychological symptoms are not confounded by the use of unsuitable anxiety measures, and that psychological variables are given serious consideration.
有关焦虑与绝经期之间关系的研究相对较少。尽管缺乏明确的证据，但一些作者认为，绝经期过渡是焦虑症状发作或加重的高风险时期。关于焦虑是先于热潮还是后于热潮出现，也存在争议。本文旨在研究绝经期与焦虑以及焦虑与热潮之间关系的证据，热潮是绝经期的核心症状之一。
根据 1960 年至 2011 年间发表的文献，采用 Medline、Web of Science 和 PsychINFO 数据库进行了系统评价。搜索关键词为“焦虑”、“焦虑症状”、“焦虑障碍”、“绝经期”、“绝经期过渡”、“中年”、“热潮或热潮发作”和“血管舒缩症状”。如果研究报告了使用明确描述的焦虑测量方法的原始研究，或调查了焦虑与血管舒缩症状之间的关系，则将其纳入研究。
确定了 9 项报告绝经期与焦虑之间关系的研究、2 项报告惊恐障碍患病率的研究以及 8 项调查焦虑与血管舒缩症状之间关系的研究。总体而言，焦虑症状水平在整个绝经期过渡期间均较低，但这些研究的特点是对绝经期状态和焦虑症状的测量均较差，并且严重依赖于使用简短的、基本上未经证实的焦虑症状测量方法，这些方法的临床意义未知。在还测量了对绝经期的态度、性格乐观或家庭生活变化等因素的研究中，这些因素成为血管舒缩症状严重程度的重要预测因素。
目前没有任何可用的研究提供符合诊断标准的焦虑障碍患病率的可靠数据，因此，目前的知识状况并不能证明将“绝经期焦虑”作为生殖相关障碍是合理的。关于热潮与焦虑之间的关系，研究需要确保躯体和心理症状不受使用不适当的焦虑测量方法的影响，并认真考虑心理变量。
