Risk Of Suicide In Women Research Articles

Factors associated with suicide risk in young women with premenstrual dysphoric disorder: A population-based study.

Women with premenstrual dysphoric disorder (PMDD) are more likely to report suicide ideation and behavior when compared to women without PMDD. However, there is a lack of studies investigating the risk factors for suicide risk in women with PMDD. Thus, the aim of this study is to assess the factors associated with suicide risk in young women with PMDD. This is a cross-sectional study including 128 young women with PMDD who were recruited from the community. PMDD and suicide risk were assessed by trained psychologists using the Mini International Neuropsychiatric Interview (MINI-PLUS). Suicide risk evaluation includes six questions that assess suicidal intention, planning and previous attempts. Subjects who answer yes to any of the six questions are classified as having current suicide risk. The prevalence of current suicide risk in women with PMDD was 28.1%. The factors associated with suicide risk in this population were: presenting current panic disorder (OR: 18.71 [95% CI: 1.02 - 343.27], p=0.048), a non-white skin color (OR: 4.18 [CI 95%: 1.28 - 13.61], p=0.018), greater severity of depressive symptoms (OR: 1.22 [95% CI: 1.12 - 1.32], < 0.001), and history of childhood trauma (OR: 1.04 [95% CI: 1.01 - 1.08], 0.010). Our findings indicate that there are key sociodemographic and clinical factors associated with suicide risk in young women with PMDD, enabling clinicians to identify at-risk individuals who could benefit from further screening and interventions.

Validation of the Paykel Suicide Scale and the Plutchik Suicide Risk Scale in Spanish Women during the Perinatal Period

Introduction. No specific instruments are available to detect the risk of suicide in women during the perinatal period. Suicide in perinatal women is little studied despite being one of the main causes of maternal mortality. Its prevalence has increased by 100% in the United States in a decade. Moreover, it has consequences for the mother and the newborn. Objective. To validate the Paykel Suicide Scale and the Plutchik Suicide Risk Scale in Spanish women during the perinatal period. Materials and Methods. Cross‐sectional study with Spanish women who were pregnant or who had given birth less than 18 months ago. Information was collected on sociodemographic variables, obstetric variables, and the newborn. A questionnaire that included both suicide scales and the Edinburgh Postnatal Depression Scale (EDPS) was used. An exploratory factor analysis (EFA), convergent and criterion validation, as well as internal consistency analysis, were performed. Results. In total, 237 women participated. The EFA determined that in the Plutchik Suicide Risk Scale 4 components explained 54.8% of the variance, while in the Paykel Scale, a single component explained 53.0% of the variance. In the convergent validity, the risk of suicide or suicidal ideation was related to the Plutchik Suicide Risk Scale and the Paykel Suicide Scale, respectively, with the variables: perception of low social support, risk of intimate partner violence, level of anxiety, history of mental pathology, and having experienced a stressful event in the last year, among others (p &lt; 0.05). The area under the receiver operating characteristic curve for the Plutchik Suicide Risk Scale scores was 0.88 (95% CI: 0.82–0.93), and for the Paykel Scale, it was 0.90 (95% CI: 0.85–0.95). The value of Cronbach’s alpha (α) was placed for the Plutchik Suicide Risk Scale at 0.806 and for the Paykel Suicide Scale at 0.766. Conclusion. Both scales presented adequate psychometric characteristics to be used as a screening instrument for suicide risk in Spanish women in the perinatal period.

Can glutathione be a biomarker for suicide risk in women 18 months postpartum?

Suicide risk is prominent among the problems affecting populations, mainly due to the broad family, psychosocial and economic impact. Most individuals at suicidal risk have some mental disorder. There is considerable evidence that psychiatric disorders are accompanied by the activation of neuro-immune and neuro-oxidative pathways. The aim of the study is to evaluate the serum levels of oxidative stress biomarkers in women at risk of suicide after 18 months of postpartum. This is a case-control study, nested within a cohort study. From this cohort, 45 women [15 without mood disorders and 30 with mood disorders (Major depression and Bipolar disorder)] were selected at 18 months postpartum, the depression and suicide risk were assessed using the Mini-International Neuropsychiatric Interview Plus (MINI-Plus) instrument, module A and C, respectively. Blood was collected and stored for later analysis of the reactive species (DCFH), superoxide dismutase (SOD), and glutathione reduced (GSH). For data analysis, the SPSS program was used. To compare the nominal covariates with the outcome GSH levels, the Student's t-test or analysis of variance (ANOVA) was used. Spearman's correlation was performed for analysis between the quantitative covariates and the outcome. To analyze the interaction between the factors, multiple linear regression was performed. Bonferroni analysis was used as an additional/secondary result to visualize differences in glutathione levels according to risk severity. After the adjusted analysis, p-values < 0.05 were considered statistically significant. The percentage of suicide risk observed in our sample of women at 18 months postpartum was 24.4% (n = 11). After adjusting for the independent variables, only the presence of suicide risk remained associated with the outcome (β = 0.173; p = 0.007), low levels of GSH at 18 months after postpartum. Likewise, we verified the difference in GSH levels according to the degree of suicide risk, observing a significant association between the differences in glutathione means in the group of women with moderate to high risk compared to the reference group (no suicide risk) (p = 0.009). Our findings suggest that GSH may be a potential biomarker or etiologic factor in women at moderate to high risk of suicide.

Parenthood and lower risk of suicide in women and men: the total Swedish population followed across adulthood

BackgroundPrevious studies suggest a protective effect of parenthood on suicide, but little is known about how the association may change across the lifespan, or in relation to sex, marital status or occurrence of psychiatric disorders.MethodsWe followed a cohort of over 5 million Swedish women and men, from 1991 to 2011, up to max. age 75, for death by suicide using national registers. Information on childbirths/adoptions, potential confounders and modifying factors were obtained from national registers. We assessed the associations between parenthood and suicide across adulthood using within time-stratified Cox regression models, with parenthood as a time-dependent exposure.ResultsParents had a lower risk of suicide than non-parents across the lifespan, after adjusting for sociodemographic factors. The association was most pronounced in young adults, especially young women, but attenuated with increasing age and converged between sexes in older age groups. The lower risk of suicide over the life course was similar whether parents were married, unmarried or divorced, apart from married men; among them, parents only had a lower risk above age 55. The lower risk in parents was also evident in people with a history of psychiatric hospitalizations, but disappeared from age 55 in this population.ConclusionThe lower risk of suicide was present in both parents, was most pronounced in young adulthood and weakened with increasing age. Our results are consistent with a plausible mechanism where feelings of responsibility and connectedness are protective against suicide in parents.

The mediating effects of self-perception and somatoform dissociation in the relationship between domestic violence and suicidal ideation.

Domestic violence (DV) against women is a multidimensional public health problem that has both psychologically and socially devastating consequences, especially in patriarchal societies. The aim of this study was to investigate the mediating role of self-perception and somatoform dissociation in the relationship between DV and suicidal ideation in women living in Turkey. The sociodemographic data form, Severity of Violence Against Women Scale, Somatoform Dissociation Questionnaire, Social Comparison Scale, and Suicidal Ideation Scale were administered to 102 participants. In addition to descriptive statistics, linear and mediation regression analyses were performed. DV scores were significantly negatively correlated with self-perception and positively correlated with somatoform dissociation scores. While negative self-perception and increased somatoform dissociation were partial mediators in the relationship of threat and sexual violence with suicidal ideation and full mediators in the relationship of physical violence with suicidal ideation. Negative self-perception and increased somatoform dissociation were critical mediators in relation to DV and suicidal ideation in women. Psychotherapeutic approaches focused on self-perception and somatoform symptoms may reduce the risk of suicide in women who have been exposed to DV. Long-term clinical studies are needed to investigate the factors mediating suicidal ideation in women who have been exposed to DV.

Suicide Risk and Mood Disorders in Women in the Postpartum Period: a Longitudinal Study.

Suicide associated with severe psychiatric illnesses is considered the leading cause of maternal deaths. We aimed to assess the suicide risk in women who experienced depressive or mixed episodes of mood change during the postpartum period and to determine which disorder is more related to suicide risk in the same period. We conducted a longitudinal study with 706 women whose children were born from April 2007 to May 2008 in a southern city in Brazil, and received prenatal care by the Brazilian National System of Public Health. The first assessment occurred during the prenatal period and the second within 30 to 60days postpartum. The incidence of suicide risk was 10.9%. The odds of postpartum suicide risk were 6.50 (95% CI: 2.73; 15.48) higher in mothers with postpartum depression and 41.50 (95% CI: 12.11; 142.16) higher in those with mixed episodes than those who did not suffer from any mood disorder. Women with chronic episodes (who had depressive or mixed episodes during pregnancy and postpartum) were at increased odds of 4.94 (95% CI: 1.46; 16.69) of a postpartum suicide risk. The postpartum seems to be a critical period in the women's mental health. The impact of mental disorders in this period, especially mixed episodes, can increase the odds of a suicide risk onset. A good psychiatric evaluation and support during the prenatal and postpartum care may prevent the subsequent risk of suicide.

Personality type, eating behaviour and suicide risk in women in treatment for obesity.

To determine the personality types of women in treatment for obesity and the associations among their personality characteristics, eating behaviour and suicide risk. Sixty women in pharmacological treatment for obesity (clinical group: CG) and 60 women post-bariatric gastric bypass surgery (surgical group: SG) were evaluated. This was an observational and transversal study conducted in a specialized outpatient unit. Personality types were evaluated through the Myers-Briggs Type Indicator (MBTI) test. A semi-structured questionnaire that investigated sociodemographic and lifestyle characteristics was applied, along with the Binge Eating Scale (BES) and the Columbia-Suicide Severity Rating Scale (C-SSRS). Among the 16 possible personality types, the ISFJ (Introversion, Sensing, Feeling, Judging) and ESFJ (Extraversion, Sensing, Feeling, Judging) types were more frequent. In the SG, 32% of the participants presented with the ISFJ type, and 18.3% presented with the ESFJ type. In the CG, 33% presented with the ISFJ type and 25% presented with the ESFJ type. There was a higher prevalence of binge eating behaviour in the CG (Cohen's d: - 0.47; p < 0.0001) and a higher tendency to graze in the SG (p = 0.005). Participants with introverted attitudes showed a higher prevalence of severe binging (13.3% vs 3.3%, p = 0.07), suicidal thoughts throughout life (STTL) (69.5% vs 45.1%, p = 0.007), and recent suicidal thoughts (RSTs) (30.4% vs 11.7%, p = 0.01) in comparison to extraverted participants. BMI was associated with a higher chance of STTL (37.96 ± 6.41kg/m2 with STTL vs 33.92 ± 4.68kg/m2 without STTL; p = 0.01) in the CG compared to the SG. RSTs were associated with BMI in the SG (34.47 ± 3.86kg/m2 with RSTs vs 30.61 ± 5.72kg/m2 without RSTs; p = 0.01). In the multivariable analysis, personality type (ISFJ) was an independent predictor of STTL (OR: 3.6; CI 1.3-10.2; p = 0.01) and Suicidal Behaviour (SB) (OR: 9.7; CI 2.44-38.9; p = 0.001). Conversely, while BMI was an independent factor associated with binge eating, personality type was not. Women who were in pharmacological treatment for obesity or were post-bariatric surgery present specific types of personality. Introversion was associated with a higher BMI and a higher risk of suicidal thoughts. LevelV, cross-sectional descriptive study.

Suicide Risk and Restricted Emotions in Women: The Diverging Effects of Masculine Gender Norms and Suicide Capability

This study investigated whether gender moderated the association between masculine socialization pressures of restrictive emotionality and suicide risk through suicide capability (i.e., fearlessness about death). A sample of inpatients admitted for recent suicidality (n = 194) completed validated measures of restrictive emotionality, fearlessness about death, and current suicide risk. A moderated mediation effect was found opposite the hypothesized direction: fearlessness about death mediated the relationship between endorsement of the masculine gender norm of restrictive emotionality and suicide risk in women, but not men. Gender did not moderate the association between restrictive emotionality and fearlessness about death. The diverging gender effects suggest that the masculine gender norm of restrictive emotionality is associated with suicide capability in men and women, while acquired fearlessness about death is more informative of risk for suicide in women than men.

Domestic violence and suicide attempts among married women: A case-control study.

To investigate the impact of domestic violence-related factors on suicide attempt in married women. Suicide is a global public health concern that poses significant burden on individuals, families and communities. There is limited research on factors predicting suicide attempt in women. A retrospective case-control design was adopted. Using a convenience sampling method, 610 participants, admitted to a teaching referral hospital in Northwest of Iran, were recruited to the study and assigned to case or control groups based on whether or not they had attempted suicide. The participants in two groups were matched in the terms of important demographic characteristics. Domestic violence-related factors were considered as independent variables and suicide attempt as dependent variable. Descriptive statistics, and simple and multivariate logistic regression analysis were used to analyse the data. Odds ratios (OR) of domestic violence-related factors were compared between the groups. We used STROBE checklist as an EQUATOR in this study. The mean age of participants in the case and control groups was 28.4 and 29.45years, respectively. The infidelity was the strongest predictor of suicide attempt in women (OR 44.57, 95%CI 6.08-326. 63, p<0.001), followed by being threatened to physical assault by husband (OR 37.01, 95%CI 11.54-118.67, p<0.001), jealousy of husband (OR 23.46, 95%CI 11.63-47.30, p<0.001), and previous attempts to divorce (OR 16.55, 95%CI 5.91-46.31, p<0.001). Suicide attempt was significantly lower in women who reported a sense of peace in life or lived with their mother or father-in-law (p<0.001). To reduce the risk of suicide in women, violence against women should be condemned and appropriate prevention measures be taken by health professionals. Recognising risk, assessment and referral of victims of domestic violence should be an integral part of healthcare systems.

The relationship between domestic violence against women and suicide risk

The purpose of this study is to examine the relationship between domestic violence against women and suicide risk. The population of the study consisted of married women aged 18 years and over in 10 Family Health Centers located within the boundaries of Yeşilyurt Municipality of Malatya Province. The study was completed with 1025 women. In the data collection, a 6-question questionnaire prepared by the researcher upon the literature review, Domestic Violence Scale, and Suicide Probability Scale were used. Percentage distribution, arithmetic mean, independent samples t test, and correlation were used to assess the data. In the study, it was found that domestic violence levels of the women were high and their suicide risks were moderate. A statistically positive correlation was determined between DVS subscale and total mean scores of the women and their suicide risk subscale and total mean scores (p < 0.05). In the study, it was determined that as the women's exposure to domestic violence increased, their suicide risks also increased. It can be recommended to establish centers for women and organize trainings in order to prevent domestic violence and suicide risk in women.

High serum total cholesterol is associated with suicide mortality in Japanese women.

To investigate the association between serum total cholesterol (TC) and suicide using a large general population cohort with long follow-up times. Analyses included 16 341 men and 28 905 women aged 40-69 from the Japan Public Health Center-based Prospective Study followed from 1990 to 2012. TC levels were defined per clinical guidelines: low (<4.66 mmol/l [180 mg/dl]), normal (4.66-5.70 mmol/l [180-220 mg/dl]), and high (≥5.70 mmol/l [220 mg/dl]). Cox proportional hazards regression models were used to determine hazard ratios (HR) and confidence intervals (CI) for suicide according to TC level. Mean follow-up time was 19 years for men and 20 years for women. There were 185 suicides (men: 107; women: 78) during follow-up. Compared to women with normal TC, women with high TC had a significantly increased risk of suicide (HR = 1.90, 95% CI, 1.13-3.19). Incremental increases (0.26 mmol/l [10 mg/dl]) of low-density lipoprotein (HR = 1.11, 95% CI, 1.02-1.21) and non-high-density lipoprotein cholesterol (HR = 1.09, 95% CI, 1.01-1.18) were also associated with increased risk of suicide in women. There was no association between TC levels, or lipid fractions, and suicide in men. High TC levels may be associated with an increased risk of suicide in women.

The buffer role of meaning in life in hopelessness in women with borderline personality disorders

Meaning in life has been found to be a protective factor against suicidal ideation. The aim of this study was to investigate whether meaning in life can moderate and buffer the association between suicide risk factors and hopelessness in women with borderline personality disorders. One hundred twenty-four women diagnosed with borderline personality disorder completed self-report measures of suicide risk factors, hopelessness, and meaning in life. The main result from this study was that meaning in life moderated the association between suicide risk factors and hopelessness. Meaning in life is an important variable in the prevention and treatment of risk of suicide in women with borderline personality disorder.

Association between obesity and suicide in woman, but not in man: a population-based study of young adults

The relationship between obesity and suicide risk is still unclear with controversial research results. The aim of this study is to investigate the relationship between obesity and suicide risk for men and women in a population-based study of young adults. This is a cross-sectional population-based study that identified young adults between 18 and 35 years of age. Suicide risk was investigated through the structured clinical interview Mini. Weight and height were assessed, and participants were classified as normal-weight body mass index (BMI < 30) or obese (BMI > 30). The prevalence of obesity was of 19.9% of the total sample (n = 1953). Obesity was more prevalent among women and participants between 27 and 35 years of age. Suicide risk was present in 13.0% of the sample and more prevalent among women. In our study we found an association between obesity and suicide risk for women, but not for men. Obesity was associated with a higher prevalence of suicide risk in women. Given the strength of the relationship between BMI and suicide, identifying the mechanisms associated with obesity, especially for women, can lead to new insights into the prevention of suicide risk

Gender Differences in Suicidal Risk Factors among Individuals with Mood Disorders

Objective: Suicide is a leading cause of death, especially for individuals who have a diagnosed mood disorder. There is conflicting evidence regarding factors that may heighten risk for suicide and whether they differ for men and women. The aims of this study were to identify the degree to which gender influences suicide risk among patients with mood disorders, or moderates the effects of other demographic and clinical suicide risk factors. Methods: The sample included 268 women and 154 men who were part of a geographically diverse, multi-center registry of the National Network of Depression Centers. Measures of depression, anxiety, childhood adversity, psychiatric diagnosis, living arrangement and employment status were analyzed, along with gender, to determine their association with suicidal risk. Results: Multiple regression analysis indicated that men had greater suicide risk than women. In addition, factors that predicted suicide risk differed by gender. Childhood adversity was more strongly associated with suicide risk for women (beta=0.22, p<0.000) than for men (beta=0.04, NS) while anxiety predicted suicide risk for men (beta=0.25, p<0.000) but not for women (beta=0.05, NS). Severity of depression was the primary predictor for both sexes (beta=0.79, p<0.000). Specific mood diagnosis, living arrangement and employment status did not predict suicide risk. Conclusions: Findings indicate the importance of regularly assessing severity of depressive and anxiety symptoms, with attention to anxiety as a key factor that may heighten suicide risk for men. Results suggest a profound role for early cumulative trauma in exacerbating later suicide risk for women, indicating a need to also screen for childhood adversity. Further research is warranted to identify the gender-specific effect of different adversities and types of anxiety in development of suicidal ideation and suicide completion.

Testosterone differs between suicide attempters and community controls in men and women of China

ObjectiveTo understand how physiological markers of men and women characterize the differences in suicide attempt, we hypothesize that attempted suicides have higher level of testosterone than their non-suicidal counterparts, which should be true of both men and women. MethodsIn Shandong Province of China, 245 rural suicide attempters aged 16–50years were consecutively recruited from October 1, 2009 to March 31, 2011. They were compared with 245 age and gender matched community controls. Blood sample was extracted at the time of interview for both patients and controls, and the plasma testosterone level was tested for comparisons. ResultsThe testosterone level was significantly higher for male suicide attempters than for their community counterparts, with the OR of 1.211 (95%CI: 1.055–1.391), even when some other factors were adjusted, such as education years, family SES, marital status, coping skills, impulsivity, and psychiatric disorders. There was also a tendency that high testosterone level was related to female suicide attempt, with the OR being 1.209 (95%CI: 0.719–2.031). ConclusionsTestosterone, as a form of physiological marking, is somewhat another predictor of attempted suicide. Besides other factors, it might be the testosterone, not gender, which explains the suicide risks and the gender ratio of the rates. The lack of sample size limited this current study to establish a significant and positive relationship between testosterone and suicide risk in women as found in men.

기혼여성의 자녀특성과 자살생각의 관련성

Background: There are some data to support the theory of a protective effect of parenthood against suicide, as proposed by Durkheim in 1897. We conducted this study to examine the relationship between children characteristics and suicidal ideation among Korean married women. Methods: The data were obtained from the Korean National Health and Nutrition Examination Surveys IV, conducted in 2007-2009, respectively (3,202 married women aged 20-49 years). The children characteristics are the age of the youngest child and the number of children living with subject. Data were analyzed by using logistic regression with SAS 9.2. Results: The risk for suicidal ideation was higher among married women having a young child (aged <7 years). It had strong effect on suicidal ideation in non-employee subjects. The odds ratio for suicidal ideation of women having a youngest child aged 2-3 years compared with reference groups was 1.673 with statistical significance. But the association of suicidal ideation with number of children shows insignificant. Conslusion: The findings suggest a different result with the theory, the protective effect of being a parent of young child on suicide risk for women, first suggested by Durkheim and supported by previous studies and the need for further prospective investigation that lead to policies according children characteristics aimed at improving married women's life.

Per capita alcohol consumption and suicide mortality in a panel of US states from 1950 to 2002.

introduction and aims: The relationship between per capita alcohol consumption and suicide rates has been found to vary in significance and magnitude across countries. This study utilises a panel of time-series measures from the US states to estimate the effects of changes in current and lagged alcohol sales on suicide mortality risk. Generalised least squares estimation utilised 53 years of data from 48 US states or state groups to estimate relationships between total and beverage-specific alcohol consumption measures and age-standardised suicide mortality rates in first-differenced semi-logged models. An additional litre of ethanol from total alcohol sales was estimated to increase suicide rates by 2.3% in models utilising a distributed lag specification while no effect was found in models including only current alcohol consumption. A similar result is found for men, while for women both current and distributed lag measures were found to be significantly related to suicide rates with an effect of approximately 3.2% per litre from current and 5.8% per litre from the lagged measure. Beverage-specific models indicate that spirits is most closely linked with suicide risk for women while beer and wine are for men. Unemployment rates are consistently positively related to suicide rates. DISCUSSION AND CONCLUSIONS" Results suggest that chronic effects, potentially related to alcohol abuse and dependence, are the main source of alcohol's impact on suicide rates in the USA for men and are responsible for about half of the effect for women.

Social support and suicide in Japanese men and women – The Japan Public Health Center (JPHC)-based prospective study

Although the important role of social support in mental health is acknowledged, no prospective study has yet examined the relation of social support to suicide. Here, we investigated the association between social support and suicide in a cohort of Japanese men and women. A total of 26,672 men and 29,865 women aged 40–69 years enrolled in the Japan Public Health Center-based prospective study in 1993–1994 completed a self-administered questionnaire which included four items of social support, and were followed for death through December 2005. Hazard ratios (HRs) and 95% confidence intervals (95% CI) of suicidal death by social support index were estimated using a Cox proportional hazards regression model. A total of 180 suicidal deaths were recorded during an average of 12 years’ follow-up. Men and women with the highest level of social support had a significantly decreased risk of suicide, with HRs (95% CI) for the highest versus lowest social support group of 0.56 (0.33–0.94) and 0.38 (0.16–0.89) in men and women, respectively. Esteem support and having four or more friends were associated with a lower risk of suicide in women [0.32 (0.13–0.77)] and in both sexes [men: 0.56 (0.36–0.88); women: 0.65 (0.32–1.30)], respectively, whereas confident support was not. These findings suggest that social support may be important for suicide prevention. Avoiding social isolation may decrease the incidence of suicide in men and women, and esteem support can provide additional benefit for women.

P03-453 - Mental pain and suicide risk in women with major depression

ObjectivesPrevious studies have provided evidence on the possible relationship between mental pain (psychache) and suicide. The aim of the present study was to investigate whether more intense psychache is related with higher suicide risk independently of the severity of depression.MethodsOrbach's Mental Pain Scale was administered in 58 women with major depression: 24 inpatients and 34 outpatients. Severity of depressive symptoms was evaluated by the Beck Depression Inventory. Suicide Risk Scale was used for the assessment of suicide risk. Level of physical pain was measured by McGill Pain Questionnaire-Short form. Pearson's correlation was used to examine the relationship between variables and a multiple regression analysis was performed to examine the independent strength of the associations.ResultsSuicide risk was significantly and positively associated with the level of current psychache and the severity of depressive symptoms, and negatively with the age of onset of the illness. The levels of physical pain or worst-ever psychache were also correlated with suicide risk; however, these associations did not remain significant in the multiple regression models.ConclusionsHigher levels of mental pain may be a factor of vulnerability to suicidal behaviour in major depression. Higher symptom severity and earlier onset of the illness may also contribute to suicide risk. The association between physical pain and suicide risk appears to be mediated by mental pain or other aspects of the illness.

Perimenopausal Depression

Perimenopausal Depression