From the Department of Preventive Medicine, Northwestern University, Chicago, IL.
Institute for Health Policy and Innovation, University of Michigan, Ann Arbor, MI.
Menopause. 2024 Dec 1;31(12):1035-1043. doi: 10.1097/GME.0000000000002447.
The aim of this study was to examine how depressive symptoms change in midlife and across the menopause transition.
We conducted a secondary analysis of data from a prospective population-based cohort, the Coronary Artery Risk Development in Young Adults study. We included women (n = 2,160) with ≥3 responses to the Center for Epidemiologic Studies Depression Scale (CES-D) beginning at examination year 5, at approximately 30 years of age, and again at years 10, 15, 20, 25, 30, and 35 (ages 35 through 60 years). We modeled trajectories of CES-D by chronologic age and compared these to trajectories of depressive symptoms by relation to age at menopause.
We identified three trajectories of depressive symptoms: women with minimal (n = 1,328, 61%, mean CES-D 8.1); intermediate (n = 675, 31%, mean CES-D 15.6); or persistent depressive symptoms (n = 157, 7%, mean CES-D 26.1). Trajectories were stable over time, among women who had undergone natural menopause (n = 1,153), Black race (odds ratio [OR], 1.85; 95% confidence interval [CI], 1.43 to 2.40), less than a high school education (OR, 1.83; 95% CI, 1.38 to 2.41), and low income (OR, 1.60; 95% CI, 1.18 to 2.18), along with tobacco use (OR, 1.35; 95% CI, 1.04 to 1.77), alcohol consumption (OR, 1.01; 95% CI, 1.004 to 1.02), estrogen use for vasomotor symptoms (OR, 1.71; 95% CI, 1.06 to 2.77), and higher body mass index (OR, 1.03; 95% CI, 1.01 to 1.05) that were also associated with persistent depressive symptoms. Hormonal contraceptive use at year 2 was associated with lower odds of persistent depressive symptoms (OR, 0.69; 95% CI, 0.51 to 0.93). Similar patterns were observed among women who underwent surgical menopause.
Depressive symptoms in the premenopause were similar to those in postmenopause, and risk factors could be identified early in reproductive life. Studies with more frequent assessments of depressive symptoms during the menopause transition are needed.
本研究旨在探讨中年期和绝经过渡期间抑郁症状的变化情况。
我们对前瞻性人群队列研究——冠状动脉风险发展在年轻人研究的数据进行了二次分析。我们纳入了至少有 3 次中心流行病学研究抑郁量表（CES-D）应答的女性（n=2160），起始于检测年份 5（约 30 岁），然后在 10、15、20、25、30 和 35 岁（35 至 60 岁）时再次进行应答。我们通过年龄对 CES-D 进行了轨迹建模，并将这些轨迹与绝经年龄相关的抑郁症状轨迹进行了比较。
我们确定了三种抑郁症状轨迹：症状轻微的女性（n=1328，61%，CES-D 平均得分 8.1）；症状中等的女性（n=675，31%，CES-D 平均得分 15.6）；或持续性抑郁症状的女性（n=157，7%，CES-D 平均得分 26.1）。在经历自然绝经的女性中（n=1153），这些轨迹在时间上是稳定的，她们为黑人（比值比[OR]，1.85；95%置信区间[CI]，1.43 至 2.40）、受教育程度较低（OR，1.83；95%CI，1.38 至 2.41）、收入较低（OR，1.60；95%CI，1.18 至 2.18），以及吸烟（OR，1.35；95%CI，1.04 至 1.77）、饮酒（OR，1.01；95%CI，1.004 至 1.02）、激素替代治疗血管舒缩症状（OR，1.71；95%CI，1.06 至 2.77）和更高的体重指数（OR，1.03；95%CI，1.01 至 1.05），这些因素也与持续性抑郁症状相关。在第 2 年使用激素避孕药与较低的持续性抑郁症状几率相关（OR，0.69；95%CI，0.51 至 0.93）。在经历手术绝经的女性中也观察到了类似的模式。
绝经前的抑郁症状与绝经后的抑郁症状相似，并且可以在生殖生命早期识别出风险因素。需要进行更多在绝经过渡期间更频繁评估抑郁症状的研究。
