中年期的抑郁症状：生殖阶段的作用。

Depressive symptoms in midlife: the role of reproductive stage.

作者信息

Almeida Osvaldo P, Marsh Kylie, Flicker Leon, Hickey Martha, Sim Moira, Ford Andrew

机构信息

1Western Australian Centre for Health & Ageing (M573), Centre for Medical Research of the Perkins Institute for Medical Research, University of Western Australia, Crawley, Western Australia, Australia 2School of Psychiatry & Clinical Neurosciences, University of Western Australia, Western Australia, Australia 3Department of Psychiatry, Royal Perth Hospital, Australia 4School of Medicine and Pharmacology, University of Western Australia, Western Australia, Australia 5Department of Geriatric Medicine, Royal Perth Hospital, Australia 6Department of Obstetrics & Gynaecology, University of Melbourne and Royal Women's Hospital, Parkville, Victoria, Australia 7School of Medical Sciences, Edith Cowan University, Joondalup, Western Australia, Australia.

出版信息

Menopause. 2016 Jun;23(6):669-75. doi: 10.1097/GME.0000000000000598.

DOI:10.1097/GME.0000000000000598

PMID:26859342

Abstract

OBJECTIVE

The aim of the study was to determine the prevalence of depression among community-dwelling women in the premenopause, menopausal transition (MT), and postmenopause stage. We also sought to clarify the direct and indirect contribution of menopausal status on the risk of depression.

METHODS

Cross-sectional survey of 1,612 women aged 45 to 55 years living in the Perth metropolitan region, who were recruited using a random sample of the electoral roll (voting is compulsory in Australia), was conducted. Women with clinically significant symptoms of depression had Patient Health Questionnaire (PHQ-9) scores of at least 10, and those with major depression, reported symptoms consistent with Diagnostic and Statistical Manual of Mental Disorders, 5th ed (DSM-5), criteria. We used past and current gynecological and reproductive data to classify women as premenopausal, undergoing the MT, and postmenopausal. Other study measures included age, place of birth, education, marital status, drinking habit, number of children, medical illnesses, and history of premenstrual syndrome, postnatal depression, and past depression or anxiety. We investigated the direct and indirect effect of reproductive status with mediation/modulation analysis.

RESULTS

Among the women included in the survey, 8.2%, 11.5%, and 13.0% of women in premenopause, MT, and postmenopause had PHQ-9 at least 10, whereas major depression was present in 2.2%, 3.4%, and 3.6% of them. Reproductive status did not affect the prevalence of major depression, but more postmenopausal than premenopausal women had PHQ-9 score equal to or greater than 10 (P = 0.013). Compared with premenopausal women, MT was associated with a direct odds ratio (OR) 1.35 (95% confidence interval [CI] = 0.90, 2.01) and indirect OR 1.08 (95% CI = 0.92, 1.26) for PHQ-9 at least 10. Similarly, the direct and indirect effect of the postmenopause on the odds of PHQ-9 at least 10 was OR 1.31 (95% CI = 0.87, 1.98) and OR 1.29 (95% CI = 1.10, 1.52).

CONCLUSIONS

The slight, but not significant, excess of depressive symptoms during MT and early postmenopause cannot be attributed to a direct effect of reproductive status.

摘要

目的

本研究旨在确定社区居住的处于绝经前期、绝经过渡（MT）期和绝经后期的女性中抑郁症的患病率。我们还试图阐明绝经状态对抑郁症风险的直接和间接影响。

方法

对居住在珀斯都会区的1612名45至55岁女性进行横断面调查，这些女性是通过选民名册随机抽样招募的（在澳大利亚投票是强制性的）。有临床显著抑郁症状的女性患者健康问卷（PHQ - 9）得分至少为10分，而患有重度抑郁症的女性，其报告的症状符合《精神疾病诊断与统计手册》第5版（DSM - 5）标准。我们使用过去和当前的妇科及生殖数据将女性分为绝经前期、处于MT期和绝经后期。其他研究指标包括年龄、出生地、教育程度、婚姻状况、饮酒习惯、子女数量、疾病、经前综合征病史、产后抑郁症以及过去的抑郁症或焦虑症病史。我们通过中介/调节分析研究生殖状态的直接和间接影响。

结果

在纳入调查的女性中，绝经前期、MT期和绝经后期的女性分别有8.2%、11.5%和13.0%的PHQ - 9得分至少为10分，而患有重度抑郁症的分别占2.2%、3.4%和3.6%。生殖状态并未影响重度抑郁症的患病率，但绝经后期PHQ - 9得分等于或高于10分的女性比绝经前期更多（P = 0.013）。与绝经前期女性相比，MT期女性PHQ - 9得分至少为10分的直接优势比（OR）为1.35（95%置信区间[CI] = 0.90, 2.01），间接OR为1.08（95% CI = 0.92, 1.26）。同样，绝经后期对PHQ - 9得分至少为10分的优势比的直接和间接影响分别为OR 1.31（95% CI = 0.87, 1.98）和OR 1.29（95% CI = 1.10, 1.52）。