绝经后妇女终身内源性生殖因素与重度抑郁症状：E3N 队列研究的结果。

Lifetime endogenous reproductive factors and severe depressive symptoms in postmenopausal women: findings from the E3N cohort.

机构信息

From the 1U1018, Institut National de la Santé et de la Recherche Médicale, Center for Research in Epidemiology and Population Health, Villejuif Cedex, France; 2U1018, Université Paris-Sud, Villejuif Cedex, France; 3Gustave Roussy, Villejuif Cedex, France; 4U1061, Institut National de la Santé et de la Recherche Médicale, Université Montpellier, Montpellier, France; and 5Cancer and Disease Epigenetics, Murdoch Children's Research Institute, Parkville, Australia.

出版信息

Menopause. 2013 Nov;20(11):1154-63. doi: 10.1097/GME.0000000000000098.

DOI:10.1097/GME.0000000000000098

PMID:24149927

Abstract

OBJECTIVE

This study aims to identify reproductive factors associated with severe depressive symptoms (SDS) in postmenopausal women and to determine whether a past psychological disorder (PPD) and the timing of first-onset PPD in relation to menopause modify associations.

METHODS

Lifetime reproductive characteristics and PPD were obtained from 51,088 postmenopausal women of the E3N cohort study. The Center for Epidemiologic Studies--Depression Scale (CES-D) was used to assess SDS. Multivariate logistic regression models were performed to estimate the risk of SDS overall and according to the presence and timing of first-onset PPD (before the final menstrual period, in early postmenopause, or in late postmenopause).

RESULTS

Women with irregular cycles were at increased risk for SDS (odds ratio [OR], 1.35; 95% CI, 1.19-1.53), except when PPD occurred in early postmenopause (OR, 1.08; 95% CI, 0.74-1.57). Parity was inversely associated with the risk of SDS (P < 0.001), whereas decreasing age at first full-term pregnancy increased the risk of SDS with PPD (P < 0.001) and increasing age at last full-term pregnancy increased the risk of SDS without PPD (P = 0.012). Age at final menstrual period (per 2-y increment) was associated with a decreased risk of SDS with postmenopausal (especially late postmenopausal) PPD (OR, 0.82; 95% CI, 0.80-0.85) but with an increased risk of SDS when PPD occurred before the final menstrual period (OR, 1.15; 95% CI, 1.12-1.19). Artificial menopause increased the risk of SDS with PPD before the final menstrual period (OR, 1.40; 95% CI, 1.18-1.66), whereas menopausal symptoms were associated with SDS across all categories.

CONCLUSIONS

Associations between endogenous reproductive factors and SDS may vary according to the presence of PPD and the timing of first-onset PPD. Further studies are warranted.

摘要

目的

本研究旨在确定与绝经后妇女重度抑郁症状（SDS）相关的生殖因素，并确定既往心理障碍（PPD）以及 PPD 首次发作与绝经的时间关系是否会改变这些关联。

方法

从 E3N 队列研究的 51088 名绝经后妇女中获得了终生生殖特征和 PPD 数据。采用流行病学研究中心抑郁量表（CES-D）评估 SDS。采用多变量逻辑回归模型来估计 SDS 的总体风险以及是否存在和首次 PPD 发作时间（绝经前、绝经早期或绝经晚期）的风险。

结果

除了 PPD 发生在绝经早期时（OR，1.08；95%CI，0.74-1.57），月经周期不规律的女性 SDS 风险增加（OR，1.35；95%CI，1.19-1.53）。生育次数与 SDS 风险呈负相关（P < 0.001），而首次足月妊娠年龄越小，伴有 PPD 的 SDS 风险增加（P < 0.001），末次足月妊娠年龄越大，不伴有 PPD 的 SDS 风险增加（P = 0.012）。末次月经年龄（每增加 2 年）与绝经后（尤其是绝经晚期）伴有 PPD 的 SDS 风险降低相关（OR，0.82；95%CI，0.80-0.85），但与绝经前发生 PPD 的 SDS 风险增加相关（OR，1.15；95%CI，1.12-1.19）。人工绝经增加了绝经前伴有 PPD 的 SDS 风险（OR，1.40；95%CI，1.18-1.66），而绝经症状与所有类别中的 SDS 相关。