Associations Between Smoking, Alcohol Consumption, Physical Activity and Depression in Middle-Aged Premenopausal and Postmenopausal Women

Hyewon Kim,Hong Jin Jeon,Kyungdo Han,Mi Jin Park,Juhwan Yoo,Maurizio Fava,David Mischoulon

doi:10.3389/fpsyt.2021.761761

Abstract

Background: Changes in lifestyle factors are known to affect mood. However, there is insufficient evidence supporting the association between smoking, alcohol consumption, physical activity and depression in middle-aged women who are likely to experience rapid hormonal changes.Methods: We used a nationwide database of medical records in South Korea. 901,721 premenopausal and 943,710 postmenopausal women aged 40 years or older included in this study. Information on smoking, alcohol consumption, physical activity was identified from health examination data and followed up for the occurrence of depression using claims data.Results: Compared with never-smokers, ex-smokers and current smokers among premenopausal and postmenopausal women showed an increased risk of depression in a dose-dependent manner (aHR 1.13 for ex-smokers; aHR 1.23 for current smokers). Compared with non-drinkers, mild drinkers showed a decreased risk of depression (aHR 0.98 for premenopausal women; aHR 0.95 for postmenopausal women), and heavy drinkers showed an increased risk of depression both among premenopausal (aHR 1.20) and postmenopausal women (aHR 1.05). The risk of depression due to smoking and heavy alcohol consumption was higher in premenopausal women than in postmenopausal women. Compared with those who had not engaged in regular physical activity, those who had engaged showed a decreased risk of depression both among premenopausal (aHR 0.96) and postmenopausal women (aHR 0.95).Conclusions: Smoking and heavy alcohol consumption increased the risk of depression, and the increased risk was prominent in premenopausal than in postmenopausal women. Regular physical activity decreased the risk of depression both in premenopausal and postmenopausal women.

Highlights

Depression is a common mental illness associated with significant morbidity [1]
We identified the age at menarche, age at menopause, parity, duration of oral contraceptive (OC) use, duration of breast feeding, and duration of hormone replacement therapy (HRT) as female reproductive factors using the self-administered questionnaire data
There were more non-alcohol users in the non-depression group in premenopausal women, and more in the depression group in postmenopausal women. The proportion of those who had engaged in regular physical activity was higher in the non-depression group than in the depression group among postmenopausal women, while there was no significant difference between groups among premenopausal women

Summary

Introduction

Depression is a common mental illness associated with significant morbidity [1]. Depression is characterized by symptoms of depressed mood, decreased interest, motivation and cognition, accompanied by vegetative symptoms including changes in appetite or sleep. Women experience certain forms of depression such as premenstrual dysphoric disorder, and postpartum depression that occur during periods of rapid changes in estrogen levels [8]. Women’s reproductive aging cycle includes the reproductive stage, menopausal transition stage and postmenopausal stage according to changes in the levels of female sex hormones including estrogen [13]. The risk of depression associated with decreased levels of estrogen may occur in middle-aged women in their 40s and later ages considering the average age of menopause in women [15]. There is insufficient evidence supporting the association between smoking, alcohol consumption, physical activity and depression in middle-aged women who are likely to experience rapid hormonal changes

Methods

Results

Conclusion