Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA.
Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC.
Menopause. 2022 Jul 1;29(7):805-815. doi: 10.1097/GME.0000000000001988.
To examine depressive symptoms during postmenopause and the contribution of depressive symptom trajectories before the final menstrual period (FMP) and psychosocial/health factors to postmenopause depressive symptoms.
Longitudinal analysis of depressive symptoms (Center for Epidemiologic Studies-Depression scale) collected every 1 to 2 years from 1996 to 2017 from 1,551 midlife women in the Study of Women's Health Across the Nation for a median follow-up of 19.0 years. Latent class growth analysis identified depression trajectories from baseline to FMP. Multivariable random effects (woman as random effect) linear or logistic regression models were conducted.
Women had higher odds of reporting high depressive symptom score (≥16) during postmenopause than when they were premenopausal (OR = 1.49, 95% CI, 1.09-2.04), but not when perimenopausal. Three pre-FMP trajectories were identified: Group 1 (47.7%), consistently low scores, Group 2 (39.9%), moderate scores below the high depressive symptom threshold, and Group 3 (12.4%), consistently high scores. Both the moderate (OR = 2.62, 95% CI, 1.89-3.66) and high score (OR = 6.88, 95% CI, 4.72-10.02) groups, compared with the consistently low group, had significantly higher postmenopausal depressive symptom scores. Other pre-FMP variables associated with high postmenopausal depressive symptoms were: higher odds of childhood trauma/maltreatment, poor role physical, high anxiety symptoms, sleep problems, high vasomotor symptoms, and lower odds for chronological aging and lower social support.
Compared with premenopause, postmenopause remains a period of increased risk for higher depressive symptoms, especially for women with pre-FMP depressive symptoms. Pre-FMP depressive symptom trajectories are highly predictive of postmenopause depressive symptoms independent of health and psychosocial factors.
探讨绝经后女性的抑郁症状，并分析绝经前的抑郁症状轨迹以及心理社会/健康因素对绝经后抑郁症状的影响。
对 1996 年至 2017 年期间参加全国妇女健康研究的 1551 名中年女性进行了纵向分析，这些女性每隔 1 到 2 年就会使用流行病学研究中心抑郁量表（Center for Epidemiologic Studies-Depression scale）进行抑郁症状评估，平均随访时间为 19.0 年。采用潜在类别增长分析（latent class growth analysis）方法确定从基线到绝经前的抑郁症状轨迹。采用多变量随机效应（以女性为随机效应）线性或逻辑回归模型进行分析。
与绝经前相比，女性在绝经后报告高抑郁症状评分（≥16）的可能性更高（OR=1.49，95%CI，1.09-2.04），但在围绝经期并非如此。在绝经前发现了三种抑郁症状轨迹：第 1 组（47.7%），始终保持低评分；第 2 组（39.9%），评分低于高抑郁症状阈值但处于中度水平；第 3 组（12.4%），始终保持高评分。与始终保持低评分的组相比，中度评分（OR=2.62，95%CI，1.89-3.66）和高评分（OR=6.88，95%CI，4.72-10.02）组的绝经后抑郁症状评分显著更高。其他与绝经后高抑郁症状相关的绝经前变量包括：儿童期创伤/虐待的可能性更高、角色身体功能较差、焦虑症状更高、睡眠问题、血管舒缩症状更高、以及与实际年龄增长相比，衰老速度较慢和社会支持较低。
与绝经前相比，绝经后女性仍处于更高抑郁症状风险增加的时期，尤其是那些在绝经前就存在抑郁症状的女性。绝经前的抑郁症状轨迹对绝经后抑郁症状具有高度预测性，独立于健康和心理社会因素。
