Depressive Symptoms In Midlife Women Research Articles

Sleep–wake changes and incident depressive symptoms in midlife women

Our study aimed to investigate the relationship between sleep–wake changes and depressive symptoms events among midlife women. We enrolled 1579 women aged 44–56 years who had no clinically relevant depressive symptoms at baseline. Depressive symptoms were assessed at each visit using the Center for Epidemiologic Studies Depression scale. At the third and fourth follow-up visits, women reported their sleep habits. The sleep midpoint was defined as the time to fall asleep plus one-half of the sleep duration. Sleep–wake changes were determined by the difference in the midpoint of sleep between the third and fourth visits, which were 1 year apart. The median follow-up time was 7 years (range 1–7 years). Cox proportional hazard models were fitted to calculate hazard ratios and 95% confidence intervals for the incidence of depressive symptoms associated with sleep–wake changes. After adjusting for potential confounding factors, the hazard ratio (95% confidence interval) of depressive symptoms for severe sleep midpoint changes was 1.51 (1.12, 2.05) compared with mild sleep midpoint changes. This relationship remained statistically significant and changed little when additionally controlling for sleep duration, sleep quality, insomnia symptoms, use of sleep medications, use of nervous medications, glucose, insulin, lipids, dietary energy intake, and C-reactive protein. Our findings indicate that exposure to long-term severe sleep–wake changes increases the risk of depressive symptoms in midlife women.

Longitudinal relationships between self-compassion and depressive symptoms in midlife women

Objective Women in midlife face a range of biopsychosocial stressors that increase the risk of depression, with potential negative consequences in older adulthood. Lower self-compassion is known to predict subsequent depressive symptoms, but little is known about whether depressive symptoms predict subsequent levels of self-compassion. This study examined the longitudinal and reciprocal relationships between self-compassion and depressive symptoms over a 5-year period in midlife. Method This longitudinal study used data from 272 women aged 40–60 years at baseline. Cross-lagged panel analysis was used to investigate reciprocal relationships between depressive symptoms and self-compassion at baseline and 5-year follow-up. Results After controlling for autoregressive effects, self-compassion at baseline explained 4% of unique variance in depressive symptoms 5 years later. Baseline depressive symptoms also predicted subsequent levels of self-compassion, with 2% of unique variance explained. Conclusion This is the first study to report a bidirectional longitudinal relationship between self-compassion and depressive symptoms. Midlife women may experience a negative cycle whereby low self-compassion and depressive symptoms reinforce each other through midlife and into older adulthood. Clinical trials examining self-compassion interventions in midlife are indicated.

Associations of dietary Provitamin A carotenoid intake with depressive symptoms in midlife women: Results from the study of Women's Health Across the Nation

BackgroundTo study the association of Provitamin A (pro-A) carotenoid intake from diet with depressive symptoms in midlife women. MethodsData for this cross-sectional study were retrieved from baseline assessment of the Study of Women's Health Across the Nation (SWAN). Logistic regression and restricted cubic spline models were performed to examine the association pro-A carotenoid intake with depressive symptoms. ResultsA total of 3054 midlife women aged 42–52 years were included in the present study. In overall midlife women, pro-A carotenoid intake was inversely associated with depressive symptoms (CES-D score ≥16). In premenopausal women, pro-A carotenoid intake was inversely associated with depressive symptoms after adjustment for age, race/ethnicity, total family income, education, physical activity, BMI, use of antidepressant, dietary total caloric, protein, carbohydrate, fat, vitamin C, vitamin E and pro-A carotenes in model 1. In fully adjusted model, after additional adjustment for day of cycle, FSH and SHBG, this association remained statistically significant. The fully adjusted odds ratios (ORs) with 95 % CI of depressive symptoms were 0.685 (0.450–1.043) in quartile 4 compared with quartile 1 for pro-A carotenoid intake. However, in early perimenopausal women, no statistically significant difference was observed between pro-A carotenoid intake and depressive symptoms after adjustment for confounders. LimitationsThis was a cross-sectional study, limiting causal inferences. Assessment of CES-D was based on a self-report scale. ConclusionPro-A carotenoid intake may be inversely associated with depression symptoms in premenopausal women, but not in early perimenopausal women.

Ascorbic acid intake is inversely associated with prevalence of depressive symptoms in US midlife women: A cross-sectional study

BackgroundWith the endocrine changes in menopausal transition period, associations between dietary ascorbic acid intake and depressive symptoms may be different. This investigation examined cross-sectional relations between dietary ascorbic acid intake of women and prevalence of depressive symptoms. MethodsThis is a secondary analysis performed on a subsample of the Study of Women's Health Across the Nation (SWAN). Women enrolled had measures of CES-D depression scores and ascorbic acid intake. Regression models were used to study cross-sectional associations between ascorbic acid intake and depressive symptoms. ResultsA total of 3088 women aged 42–52 years at baseline were included in the present study. Dietary ascorbic acid intake was inversely associated with depressive symptoms. The adjusted OR and 95% CI of depressive symptoms was 0.699 (0.524 – 0.934) in quartile 4 (the highest) versus quartile 1 (the lowest) of the ascorbic acid intake. Restricted cubic spline analyze showed a suggestion of L-shaped associations between ascorbic acid intake and depressive symptoms. ConclusionsAscorbic acid intake is inversely associated with prevalence of depressive symptoms in midlife women. Future prospective cohort studies are needed to confirm these findings.

Dietary manganese intake is inversely associated with depressive symptoms in midlife women: A cross-sectional study

BackgroundTo study the association of manganese intake from diet with depressive symptoms in midlife women. MethodsData for this cross-sectional study were retrieved from baseline assessment of the Study of Women's Health Across the Nation (SWAN). Linear regression, logistic regression and restricted cubic spline models were performed to examine the association of manganese intake with depressive symptoms. ResultsA total of 2993 midlife women aged 42–52 years were included in the present study. In premenopausal women, manganese intake was inversely associated with CES-D score and after adjustment for total caloric intake, age, race/ethnicity, education, income, financial strain, physical activity, BMI, vasomotor symptoms, chronic stress and use of antidepressant, estradiol, testosterone and sex hormone binding globulin using linear regression. The fully adjusted regression coefficient 95% confidence intervals (CIs) were −0.533 (−0.993, −0.074). Similarly, manganese intake was inversely associated with depressive symptoms (CES-D scores≥16) using logistic regression adjusted same confounders. The fully adjusted odds ratios (ORs) with 95% CI of depressive symptoms were 0.512 (0.287–0.913) in quartile 4 compared with quartile 1 for manganese intake. However, in early perimenopausal women, no statistically significant difference was observed between manganese intake and depressive symptoms after adjustment for same confounders that adjusted in premenopausal women. LimitationsThis was a cross-sectional study, limiting causal inferences. Assessment of CES-D was based on a self-report scale. ConclusionManganese intake may be inversely associated with depression symptoms in premenopausal women, but not in early perimenopausal women.

Association between saturated fatty acid intake and depressive symptoms in midlife women: A prospective study

BackgroundThis prospective investigation examined relations between baseline dietary saturated fatty acid (SFA) intake of women at midlife and prevalence of depressive symptoms 4 years later. MethodsWomen enrolled in the Study of Women's Health Across the Nation (SWAN) had measures of CES-D depression scores 4 years later and SFA intake at baseline. Logistic regression models were used to study prospective associations between SFA intake and depressive symptoms. ResultsA total of 2400 women aged 42–52 years were included in the present study. The ORs of depressive symptoms in model 1 adjustment for baseline CES-D score indicated that baseline SFA intake was positively associated with depressive symptoms. After additional adjustment for age, race/ethnicity, education, financial strain, physical activity, smoking currently, BMI, menopausal status, VMS, chronic stress and use of antidepressant in model 2, the results were similar to those of the model 1. This association remained statistically significant and changed little when additional controlling for SHBG and FSH in fully adjusted model 3. The fully adjusted OR of depressive symptoms in model 3 was 2.423 (1.142–5.143) in quartile 4 (the highest) versus quartile 1 (the lowest) of the baseline SFA intake. LimitationsAssessment of depression and SFA intake was based on a self-report scale. ConclusionsBaseline SFA intake is a predictor for depressive symptoms assessed 4 years later in midlife women. This underlines the importance of targeting SFA intake in the prevention of major depression in midlife women.

Associations among menopausal status, menopausal symptoms, and depressive symptoms in midlife women in Hunan Province, China

Objective: This study aimed to determine the associations among menopausal status, menopausal symptoms, and depressive symptoms in midlife women in Hunan, China.Methods: A secondary analysis involving 3199 women aged 40–55 years was performed based on data from the Women Health Needs Survey 2018 in Hunan Province, central south China. The depressive symptoms were determined using the 9-item Patient Health Questionnaire. The menopausal symptoms were assessed using the Kupperman Menopausal Index. Demographic characteristics and menopausal status were measured using self-administered questionnaires.Results: The prevalence of depressive symptoms was 19.3%. The three most common menopausal symptoms were insomnia (48.0%), fatigue (42.7%), and mood swing (39.8%). The increase in depressive symptoms was significantly associated with menopausal status and menopausal symptoms. After controlling for demographic variables, multivariate logistic regression showed that menopausal transition (odds ratio [OR] = 1.14, 95% confidence interval [95% CI] = 1.12–1.86), postmenopause (OR =1.52, 95% CI = 1.09–2.11), and four menopausal symptoms including mood swing (OR = 1.32, 95% CI = 1.03–1.70), depressive mood (OR = 2.28, 95% CI = 1.79–2.91), palpitations (OR = 1.37, 95% CI = 1.06–1.77), and urinary tract infection (OR = 1.49, 95% CI = 1.16–1.92) were associated with depressive symptoms.Conclusions: Independent of demographic variables, menopausal transition, postmenopause, and four menopausal symptoms (mood swing, depressive mood, palpitations, and urinary tract infection) increase the risk of depressive symptoms.

Association of dietary n-3 polyunsaturated fatty acids intake with depressive symptoms in midlife women

Background: To study the association of n-3 polyunsaturated fatty acid (n-3 PUFA) intake from diet with depressive symptoms in midlife women. Methods: Data for this cross-sectional study were retrieved from baseline assessment of the Study of Women's Health Across the Nation (SWAN). Logistic regression and restricted cubic spline models were performed to examine the association n-3 PUFA intake with depressive symptoms. Results: A total of 3054 women aged 42–52 years were included in the present study. In overall midlife women, n-3 PUFA intake was not significantly associated with depressive symptoms (CES-D score ≥16) after adjustment for potential confounders. In early perimenopausal women, n-3 PUFA intake was inversely associated with depressive symptoms after adjustment for potential confounders. The fully adjusted OR with 95% CI of depressive symptoms were 0.062 (0.009–0.457) in the highest quartile (n-3 PUFAs intake was categorized by quartiles) compared with the lowest quartile for n-3 PUFA intake. Restricted cubic spline analyses showed that n-3 PUFA intake were dose–response inversely associated with depressive symptoms in early perimenopausal women. However, in premenopausal women, no significant association between depressive symptoms and n-3 PUFA intake was observed. Limitations: This was a cross-sectional study, limiting causal inferences. Conclusion: Dietary n-3 PUFA may be inversely associated with depressive symptoms in early perimenopausal women, but not in premenopausal women.

Associations of dietary trans fatty acid intake with depressive symptoms in midlife women

BackgroundTo study the association of trans fatty acid intake from diet with depressive symptoms in midlife women. MethodsData for this cross-sectional study were retrieved from baseline assessment of the Study of Women's Health Across the Nation (SWAN). Linear regression, logistic regression and restricted cubic spline models were performed to examine the association trans fatty acid intake with depressive symptoms. ResultsA total of 3095 women aged 42–52 years were included in the present study. Trans fatty acid intake was positively associated with CES-D (Center for Epidemiological Studies-Depression) scores in unadjusted, age-, race/ethnicity-, total family income- and education-adjusted and fully adjusted linear regression model. The fully adjusted regression coefficient with 95% confidence intervals (CIs) of trans fatty acid intake were 0.146 (0.047-0.246) for CES-D score. Trans fatty acid intake was positively associated with depressive symptoms (CES-D score ≥16) in each logistic regression model. The fully adjusted odds ratios (ORs) with 95% CI of depressive symptoms were 1.410 (1.019-1.951) in quartile 4 compared with quartile 1 for trans fatty acid intake. Sensitivity analyses showed that the association between trans fatty acid and depressive symptoms were not affected by use of antidepressant. Stratified analysis showed that, in fully adjusted model, the trans fatty acid intake was not significantly associated with depressive symptoms in early perimenopausal women. LimitationsThis was a cross-sectional study, limiting causal inferences. ConclusionTrans fatty acid may be positively associated with depressive symptoms in premenopausal women, but not in early perimenopausal women.

Association between Physical Activity and Depressive Symptoms: Midlife Women in SWAN

The relation of physical activity (PA) and positive mood has been the focus of considerable research, which were primarily cross-sectional. This study was done to evaluate the relation between PA and high depressive symptoms across time and to examine whether being physically active attenuates the risk of depressive symptoms in midlife women. The present study is a longitudinal observational study on the menopausal transition in a multiethnic population. Ten years of data on 2891 women were analyzed. The participants were women from seven geographic areas nationwide, age 42-52 yr at baseline, still menstruating, and not using exogenous reproductive hormones. PA was measured with the Kaiser Permanente Physical Activity Scale. The main outcome measure, depressive symptoms, was assessed with the Center for Epidemiological Studies Depression Scale (CES-D), with primary outcome of CES-D score of 16 or higher. In mixed effect logistic regression models adjusted for covariates, compared with inactivity, PA meeting PA guidelines (approximating public health guidelines) and PA below PA guidelines were each associated with lower risk of high depressive symptoms (CES-D score of 16 or higher) (odds ratio, 0.52; 95% confidence interval, 0.40-0.70; and odds ratio, 0.81; 95% confidence interval, 0.67-0.98, respectively] across 10 yr. Being married, Japanese and Hispanic ethnicity, current smoking, reporting very upsetting life events, using antidepressive medications, having hot flashes, and high body mass index were all positively associated with high depressive symptoms, whereas high social support was negatively associated. Higher PA was associated with lower levels of depressive symptoms persistently over 10 yr, independent of potential confounders. Our findings suggest that reaching moderate-intensity PA levels during midlife may be protective against depressive symptoms.

Associations between aspects of pain and cognitive performance and the contribution of depressive symptoms in mid-life women: A cross-sectional analysis

Pain has been associated with cognitive problems in pain patients. This study evaluated the extent to which experiences of pain are associated with cognitive performance in a community sample of mid-life women, and the contribution of depressive symptoms to this association. A cross-sectional analysis was used with data from the Study of Women's Health Across the Nation (SWAN). Associations between aspects of pain and cognitive performance were evaluated using statistical models with and without depressive symptoms. The cognitive performance score was a composite of three cognitive tests, the Digit Span Backward Test, the Symbol Digit Modalities Test and the East Boston Memory Test. Greater pain experiences that interfered with daily work were independently associated with poorer cognitive performance, [β (SE) −0.074 (0.021); p value<0.01] and this association was partially explained by depressive symptoms [β (SE) −0.061 (0.022); p value<0.01 after adjusting for depressive symptoms]. Additionally, an independent association between a greater composite pain score and poorer cognitive performance was identified without adjusting for depressive symptoms, [β (SE) −0.002 (0.0009); p value<0.05] but was no longer significant after adjusting for depressive symptoms. Our results suggest that in mid-life women, greater pain is associated with poorer cognitive performance, and depressive symptoms play an important role in this association. Clinicians should be aware of these relationships when evaluating patients.

Longitudinal Pattern of Depressive Symptoms Around Natural Menopause

An increased risk of depressive symptoms has been associated with the transition to menopause, but the risk of depressive symptoms in the early postmenopausal years has not been well characterized. To identify within-woman changes in depressive symptoms during a 14-year period around menopause, determine associations of a history of depression with the pattern of depressive symptoms, and evaluate the rate of change in reproductive hormones as predictors of depressive symptoms following menopause. A randomly identified, population-based sample in Philadelphia County, Pennsylvania, of 203 late-reproductive-age women who were premenopausal at baseline and reached natural menopause. Center for Epidemiologic Studies Depression Scale. The prevalence of high scores on the Center for Epidemiologic Studies Depression Scale decreased from 10 years before to 8 years after the final menstrual period (FMP), with a decrease of approximately 15% of baseline per year (odds ratio, 0.85; 95% CI, 0.81-0.89; P < .001). Relative to the FMP, the risk of depressive symptoms was higher in the years before and lower in the years after the FMP. Among women with a history of depression, the likelihood of depressive symptoms was more than 13 times greater overall and 8 times greater after menopause compared with women with no depression history. Among women who first experienced depressive symptoms approaching menopause, the risk of depressive symptoms declined after the FMP, with a significantly lower risk the second year after menopause. The risk of depressive symptoms after menopause decreased by 35% for each unit (SD) increase before the FMP in the log rate of change of follicle-stimulating hormone (odds ratio, 0.65; 95% CI, 0.46-0.91; P = .01). The FMP was pivotal in the overall pattern of decreasing depressive symptoms in midlife women, with higher risk before and lower risk after the FMP. A history of depression strongly increased the risk both before and after menopause. Women who had no history of depression before the menopause transition had a low risk of depressive symptoms 2 or more years after the FMP.

Employment status, depressive symptoms, and waist circumference change in midlife women: the Study of Women's Health Across the Nation (SWAN)

PurposeChanges in employment status have shown inconsistent associations with adiposity. This study tested whether the presence of elevated depressive symptoms explains variability in the time-varying association between employment status and central adiposity. MethodEmployment status, depressive symptoms, and waist circumference (WC) were assessed annually over 10 years in a multiethnic sample of 3220 midlife women enrolled in the Study of Women's Health Across the Nation. Linear mixed-effects models tested time-varying associations of employment status, depressive symptoms, and their interaction with WC. ResultsWC increases were greatest during the years of combined nonemployment and elevated depressive symptoms (1.00 cm/y) and lowest in the years of full-time employment and elevated depressive symptoms (0.25 cm/y), compared with the years of full-time employment and nonelevated depressive symptoms (0.51 cm/y). Employment status was unrelated to WC in years without elevated depressive symptoms. The pattern of results was unchanged when analyses were restricted to preretirement observations and did not vary according to WC at baseline or ethnicity/race. ConclusionsIdentifying and managing depressive symptoms in midlife women who are not working may help prevent increases in central adiposity.

Are there bi-directional associations between depressive symptoms and C-reactive protein in mid-life women?

Objective To test whether depressive symptoms are related to subsequent C-reactive protein (CRP) levels and/or whether CRP levels are related to subsequent depressive symptoms in mid-life women. Methods Women enrolled in the Study of Women’s Health Across the Nation (SWAN) were followed for 7 years and had measures of CES-Depression scores and CRP seven times during the follow-up period. Women were pre- or early peri-menopausal at study entry and were of Caucasian, African American, Hispanic, Japanese, or Chinese race/ethnicity. Analyses were restricted to initially healthy women. Results Longitudinal mixed linear regression models adjusting for age, race, site, time between exams, and outcome variable at year X showed that higher CES-D scores predicted higher subsequent CRP levels and vice versa over a 7-year period. Full multivariate models adjusting for body mass index, physical activity, medications, health conditions, and other covariates showed that higher CRP levels at year X predicted higher CES-D scores at year X + 1, p = 0.03. Higher depressive symptoms predicted higher subsequent CRP levels at marginally significant levels, p = 0.10. Conclusions Higher CRP levels led to higher subsequent depressive symptoms, albeit the effect was small. The study demonstrates the importance of considering bi-directional relationships for depression and other psychosocial factors and risk for heart disease.

Relations among menopausal symptoms, sleep disturbance and depressive symptoms in midlife

Objectives To investigate the relations among hot flashes, other menopausal symptoms, sleep quality and depressive symptoms in midlife women. Methods A large population-based cross-sectional study of 639 women (ages 45–54 years) consisting of a questionnaire including the Center for Epidemiologic Studies-Depression (CES-D) Scale, demographics, health behaviors, menstrual history, and menopausal symptoms. Results After controlling for menopausal status, physical activity level, smoking status and current self-reported health status elevated CES-D score is associated with frequent nocturnal hot flashes, frequent trouble sleeping, experiencing hot flashes, nausea, headaches, weakness, visual problems, vaginal discharge, irritability, muscle stiffness, and incontinence. Conclusions The present study found significant links between depressive symptoms and several menopausal symptoms including hot flashes, sleep disturbance, irritability, muscle stiffness, and incontinence after controlling for covariates. These findings suggest that a potential mechanism in which bothersome menopausal symptoms may influence depressed mood during the midlife is through sleep disturbance.