Abstract
IntroductionThe role of the menopausal transition and associated menopausal symptoms in the occurrence of depressive disorders has been discussed and debated for a long time. Most previous clinical studies had limited case samples, and did not control the attributable risk of medical comorbidities.MethodsPatients with a diagnosis of symptomatic menopausal transition and without a psychiatric history were enrolled in 2000 in Taiwan, and compared with age-matched controls (1∶4). These subjects were followed to the end of 2010 to investigate the association between symptomatic menopausal transition and new-onset depressive disorder; the effect of medical comorbidities was also assessed.ResultsA total of 5,837 women with symptomatic menopausal transition were identified, and compared with 23,348 age-matched controls in 2000. The follow-up showed that symptomatic menopausal transition was an independent risk factor for major depression (hazard ratio[HR]: 2.18, 95%CI: 1.79∼2.65) and any depressive disorder (HR: 2.34, 95%CI: 2.08∼2.63) after adjusting age at enrollment, monthly income, residence location, level of urbanization, and comorbid medical diseases. In addition, medical comorbidities, including cerebrovascular disease (HR: 1.77, 95% CI: 1.52∼2.07), cardiovascular diseases (HR: 1.35, 95% CI: 1.15∼1.57), congestive heart failure (HR: 1.35, 95% CI: 1.04∼1.75), and liver diseases (HR: 1.19, 95% CI: 1.03∼1.36) increased the risk of developing any depressive disorder.ConclusionOur population cohort study, with the largest study sample and medical record diagnosis thus far, supports an association between symptomatic menopausal transition and depressive disorder in midlife women, and an increased risk of depressive disorder with medical comorbidities.
Highlights
The role of the menopausal transition and associated menopausal symptoms in the occurrence of depressive disorders has been discussed and debated for a long time
Women with symptomatic menopausal transition had a higher incidence of developing major depression (2.8% vs. 1.2%, p,0.001) and any depressive disorder (7.8% vs. 3.1%, p,0.001) during the follow-up period
Using multivariable Cox regression analysis, the follow-up showed that symptomatic menopausal transition was an independent risk factor for major depression (HR: 2.18, 95% CI: 1.79,2.65) and any depressive disorder (HR: 2.34, 95% CI: 2.08,2.63) after adjusting for age at enrollment, monthly income, residence location, level of urbanization, and comorbid medical diseases (Table 3); this was demonstrated in the Kaplan-Meier survival curves (Figure 1)
Summary
The role of the menopausal transition and associated menopausal symptoms in the occurrence of depressive disorders has been discussed and debated for a long time. In 2005, the US National Institutes of Health claimed that because of the multiple potential causes of mood changes (i.e., history of prior depression, life stress, and general health) and the relatively high proportion of women reporting 1 or more affective symptoms, it is difficult to establish whether menopause causes any increase in the prevalence of mood symptoms during the perimenopausal years [13] They concluded that the data on the association between menopause and depression were mixed, and that there is limited evidence that ovarian changes associated with menopause might be a cause of depression, anxiety, and irritability [13].
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