Midlife Symptoms Research Articles

Chronic stress, social support, and symptoms at midlife. Is there a buffering effect?

This study was designed to examine associations among measures of stress, social support, and symptoms at midlife. Specifically, the study examined whether support buffered against the negative effects of stress on severity of symptoms grouped via factor analyses into emotional instability, vaso-somatic symptoms, mood disturbances, and aches and pains. We used cross-sectional data from n = 119 women aged 40-55 in Nagaland, India. Midlife symptoms were measured with the help of questionnaires, and factor analysis was used to identify latent factors. Stress and social support were measured by Perceived Stress Scale and Multidimensional Scale of Perceived Social Support, respectively. Chronic stress was measured by fingernail cortisol. After adjusting for menopausal status, tobacco use, body mass index, and socioeconomic status, cortisol level was positively associated with emotional instability (p < 0.01), vaso-somatic symptom score (p < 0.05), and total symptoms at midlife (p < 0.05). Familial support was negatively associated with emotional instability (p < 0.05) and total symptoms at midlife (p < 0.05). However, no significant associations were observed with spousal or friend support. Although no significant interactions between stress, social support, and symptoms at midlife were observed, spousal support when stratified as high and low support using the means, perceived stress and vaso-somatic symptoms indicated an interaction. Cortisol level and support from family were independently associated with symptoms at midlife. The study highlights the importance of family ties and support for navigating the stressors of everyday life among women in Nagaland.

Trajectories in depressive symptoms and midlife brain health

Depressive symptoms may either be a risk factor or prodromal to dementia. Investigating this association in midlife may help clarify the role of depression in cognitive aging. We aimed to identify trajectories in depressive symptoms in early to mid-life and related cognitive and brain outcomes in midlife. This study includes 3944 Black and White participants (ages 26−45 years at baseline) from the Coronary Artery Risk Development in Young Adults (CARDIA) study with 20 years of follow-up. Depressive symptoms were assessed using the Center for Epidemiological Studies Depression scale at five time points over 20 years. Growth mixture modeling (GMM) was used to identify depressive symptom trajectories. Participants completed a neuropsychological battery 20 years after baseline, including the Digit Symbol Substitution Test (DSST), Rey-Auditory Verbal Learning Test (RAVLT), Stroop Test, Montreal Cognitive Assessment (MoCA), and category and letter fluency tests. A sub-sample of participants (n = 662) underwent brain magnetic resonance imaging (MRI) to characterize gray matter volumes and white matter hyperintensities (WMHs). We identified four classes of depressive symptom trajectories: a “declining” class (n = 286, 7.3%) with initially high symptoms and subsequent decline, a class with consistently high symptoms (“steady high”; n = 264, 6.7%), a class with late increases in symptoms (“increasing”; n = 277, 7%), and a class with consistently low symptoms (“steady low”; n = 3117, 79.0%). The steady high and the increasing classes had poorer performance on all cognitive tests, while the declining class had poorer performance on the DSST, verbal fluency, and MoCA. Compared to the steady low symptom class, the steady high class had lower volumes in the entorhinal cortex (β: −180.80, 95% CI: −336.69 to −24.91) and the amygdala (β: −40.97, 95% CI: −74.09 to −7.85), the increasing class had more WMHs (β: 0.55, 95% CI: 0.22 to 0.89), and the declining class was not significantly different in any brain measures. Trajectories in depressive symptoms in young to mid-adulthood show distinct cognitive and brain phenotypes in midlife. Steady high depressive symptoms may represent a group that is at risk for dementia, whereas increasing symptoms in midlife may be associated with white matter damage.

Bothersome symptoms at midlife in relation to body fat percentage.

Increasing obesity has been associated with a higher frequency of symptoms at midlife. Bothersomeness represents an important measure of perceived symptom severity, but has received relatively little consideration, and relationships between symptom bothersomeness and obesity are not known. We evaluated the association between body fat percentage (%BF) and the bothersomeness of symptoms at midlife. This cross-sectional study included women aged 40-60 in Qatar (n = 841). Participants reported frequency and bothersomeness of midlife symptoms hypothesized to be related to body composition. Initially, we characterized the relationship between continuous %BF and presence (yes/no) and bothersomeness (yes/no) for each symptom using restricted cubic spline (RCS) models to test nonlinearity. Subsequently, we used multinomial logistic regressions to evaluate associations between %BF and multilevel symptom outcomes, where categories were: (a) no symptoms or bother, (b) symptoms without bothersomeness, and (c) symptoms with bothersomeness. The highest frequency of bothersomeness was reported for aches/stiffness in joints (51%), followed by trouble sleeping (34%), night sweats (21%), urinary incontinence (18%), hot flashes (16%), and shortness of breath (15%). In unadjusted multinomial logistic regressions, aches/stiffness in joints with and without bothersomeness had the same significant relationship with %BF. Bothersome night sweats, urinary incontinence, and hot flashes were significantly associated with %BF (p < .05), but those same symptoms without bothersomeness were not significantly associated with %BF. Our findings suggest that bothersomeness is an important variable that tracks with body fat and gives different information than report of the presence/absence of a symptom alone.

First-generation college graduates have similar depressive symptoms in midlife as multi-generational college graduates

PurposeHigher education may protect an individual against depressive symptoms, yet, disadvantaged socioeconomic status (SES) during childhood, often measured by lower parental education, may put them at higher risk for depressive symptoms later in life. This study evaluates if midlife depression is similar for first-generation and multi-generation college graduates. MethodsFor US Health and Retirement Study (HRS) participants ages 55–63 (N = 16,752), we defined a 4-category exposure from parents' (highest of mother or father's) and participant's own years of education, with 16 years indicating college completion: multi-gen (both ≥ 16 years: reference); first-gen (parents <16; own ≥ 16); only parent(s) (parents ≥ 16; own <16); and neither (both <16) college graduates across three birth cohorts. We used linear regressions to evaluate relationships between college completion and depressive symptoms measured by an 8-item Center for Epidemiologic Studies – Depression (CES-D) scale. Models pooled over time evaluated differences by sex, race/ethnicity, and birthplace. ResultsFirst-gen and multi-gen college graduates averaged similar depressive symptoms in midlife (β: 0.01; 95% CI: 0.15, 0.13). Results were similar by sex and race/ethnicity. ConclusionConsistent with resource substitution theory, college completion may offset the deleterious effects of lower parental education on midlife depressive symptoms for first-generation graduates.

Midlife symptoms and household stress are associated with fingernail cortisol.

This study investigates menopausal symptoms, household stressors, and ethnopolitical problems in relation to stress markers, including chronic stress measured by fingernail cortisol, perceived stress measured by the Perceived Stress Scale, and acute stress measured by blood pressure. Data from 151 women aged 40 to 55 years were collected from four regions in Nagaland, India, using opportunity sampling. A structured questionnaire was used to collect sociodemographic and lifestyle variables. Symptoms were grouped into emotional instability, vasosomatic symptoms, mood disturbances, and aches and pains using principal component analysis in a previous study, and stress markers included fingernail cortisol, perceived stress, and blood pressure. Community-level, household-level, and midlife symptoms were included to ascertain stressors from different sources. Our results revealed a significant positive association between a composite measure of emotional instability and stress assessed by fingernail cortisol ( β = 0.46, P < 0.001). In addition, there was a positive association between mood disturbances and fingernail cortisol ( β = 0.24, P < 0.05). This relationship persisted after controlling for body mass index, socioeconomic status, and menopausal status. In addition, household problems were positively associated with fingernail cortisol ( β = 0.25, P = 0.01). These findings highlight the potential health impacts of the psychosocial stress response associated with domestic stressors such as financial strain and concerns about children and health.

The importance of female reproductive history on self-reported sleep quality, mood, and urogenital symptoms in midlife.

This study investigated the importance of reproductive history on somatic and psychological symptoms in midlife women. A total of 503 women from 39 to 65 years of age were recruited from different localities in Slovakia. These were interviewed about their reproductive and menstrual history, sociodemographic background, and lifestyle and health status after submitting pretested questionnaires. All variables were measured by self-reporting, and multivariable logistic and ordinal regression analyses tested the associations. Women who experienced miscarriage had a greater likelihood of waking early and then sleeping poorly, and they also felt unattractive in midlife. Moreover, women with two or more miscarriages were four times more likely to experience this sleep symptom than those without miscarriage (odds ratio [OR], 4.2; 95% confidence interval [CI], 1.70-10.38; P = 0.002). In addition, women with one or two children suffered significantly less often with severe depressed mood and lack of enjoyment than women with three and more children (lack of enjoyment: with one child, the OR was 0.39 [95% CI, 0.16-0.96; P = 0.041]; with two children, the OR was 0.47 [95% CI, 0.23-0.97; P = 0.040]; depressed mood: with one child, the OR was 0.32 [95% CI, 0.12-0.84; P = 0.021]). Finally, the premenopausal and perimenopausal women were less likely to experience severe vaginal dryness than those in postmenopause. This cross-sectional pilot study suggests that women's reproductive history, as determined by parity and miscarriage, may be relevant to their midlife health and well-being. Future research is warranted.

Exploring the relationship between history of infertility and the experience of menopausal symptoms.

The aim of the study is to examine longitudinal associations of history of infertility with menopausal symptoms in midlife. Six hundred ninety-five midlife women (≥45 y old or reporting ≥12 mo of amenorrhea at the midlife visit) in Project Viva, a prospective cohort enrolled 1999-2002 during pregnancy and followed for 18 years after enrollment ("midlife visit"). Exposure was history of infertility defined as time to pregnancy ≥12 months (≥6 mo if ≥35 y), use of medical treatment to conceive, or infertility consultation or treatment in the 6-month preceding enrollment. The primary outcome was score below or above the median on the Menopause Rating Scale (MRS). Secondary outcomes included individual symptom score on the MRS and self-reported age of menopause. A total of 36.6% had a history of infertility in their lifetime. At the time of MRS completion, the women with prior infertility were older (53.4 [SD, 3.8] vs 51.2 [SD, 3.7] y) than those without infertility and a larger proportion had reached menopause (62% vs 40%). Women with prior infertility were more likely to score above the median on the MRS (Adjusted Odds Ratio [aOR], 1.45; 95% confidence interval [CI], 1.04-2.01) and had higher odds for reporting any depressive mood (aOR, 1.56; 95% CI, 1.12-2.16) and irritability (aOR, 1.57; 95% CI, 1.13-2.19). There was a trend toward greater severity of sleep problems among women with prior infertility. There was no association of prior infertility with report of other menopausal symptoms or age of menopause. Our findings suggest that women with prior infertility are more likely to have an MRS score above the median and experience depressive mood, irritability, and sleep problems during midlife than women without infertility. These findings have implications for mental health screening among midlife women.

Alcohol Use Disorder Symptoms Reported during Midlife: Results from the Monitoring the Future Study among US Adults at Modal Ages 50, 55, and 60

Background The extent to which adolescent substance use is associated with alcohol use disorder (AUD) symptoms in midlife is not yet fully explored. Methods Longitudinal data from the national Monitoring the Future study was used. The sample included 11,830 12th graders (1976–1987) who were surveyed again at modal ages 50 (37.8%), 55 (46.3%), or 60 (15.8%) in 2008–2019. Approximately 48.7% were male; 81.5% identified as non-Hispanic White. Weighted logistic and multinomial logistic regressions were used to examine associations between past 30-day use of cigarettes, marijuana, and alcohol at age 18, sociodemographics, and a midlife AUD symptom outcome (coded as non-drinking, drinking without AUD [endorsed ≤1 criterion], or AUD symptoms [endorsed 2+ criteria]). Results Prevalence of midlife AUD symptoms was 27.1%. Higher relative risk of reporting AUD symptoms (vs. drinking without AUD) was associated with age 18 substance use (any cigarette use [vs. no use], any marijuana use [vs. no use], binge drinking [vs. both no use and drinking at less than binge levels]), being male (vs. female), being non-Hispanic White (vs. non-Hispanic Black), and having a 4-year college degree. Higher relative risk of reporting non-drinking (vs. drinking without AUD) was associated with no 30-day alcohol use at age 18, being non-Hispanic Black or non-Hispanic other (vs. non-Hispanic White), and not having a 4-year college degree. Conclusions Findings suggest substance use at age 18 has meaningful associations with midlife AUD symptoms. Dissemination of prevention and intervention efforts in adolescence and early adulthood may be important for reducing hazardous midlife drinking.

Self-rated mental health in the transition to adulthood predicts depressive symptoms in midlife.

Self-rated mental health (SRMH), a single item asking individuals to evaluate their mental or emotional health, is included in some surveys as an indicator of risk for mental disorders and to monitor population health, yet little longitudinal research examines how well it predicts future outcomes. Following a life course perspective, the current longitudinal study of 502 Canadian high school seniors tracked into midlife examined to what extent SRMH at ages 20, 25, and 32years predicted depressive symptoms at ages 43 and 50. Hierarchical linear regressions showed that lower SRMH at age 25 and at 32years was a significant predictor of higher levels of depressive symptoms at ages 43 and 50, even when controlling for sex, participant education, marital/cohabitation status, self-rated physical health, and baseline depressive symptoms. The results provide evidence that SRMH assessed during the transition to adulthood may be useful as a broad and powerful measure of risk for mental health problems decades into the future.

Limited evidence of a threshold effect for increasing adiposity on risk of symptoms at midlife.

To assess the nature of relationships between increasing body mass index (BMI) and the prevalence of midlife symptoms in a population with high adiposity. In the cross-sectional Study of Women's Health in Qatar, 841 participants aged 40 to 60 years were recruited from nine primary health centers in Doha. Face-to-face interviews collected demographic, menopause, and symptom information. BMI (kg/m 2 ) was categorized as healthy, overweight, or class I, II, or III obesity. Multivariate logistic regression models were used to examine aches/stiffness in joints, trouble sleeping, shortness of breath, urinary incontinence, and hot flashes with BMI categories. Restricted cubic splines (RCSs) were used to estimate relationships between continuous BMI and each symptom and to conduct formal tests of nonlinearity. Mean BMI was 34.3 kg/m 2 (SD, 6.0 kg/m 2 ). Women with class II and III obesity had higher odds of reporting aches/stiffness than women with a healthy BMI, and the odds of reporting urinary incontinence were three times higher among women with class III obesity (odds ratio, 3.08; 95% confidence interval, 1.17-8.14). Using restricted cubic spline models, a significant nonlinear association ( P = 0.002) was observed between aches/stiffness and BMI with an apparent threshold of 38 kg/m 2 . Linear relationships were observed with BMI for urinary incontinence ( P < 0.001 for linear trend) and shortness of breath ( P = 0.005 for linear trend). Trouble sleeping and hot flashes were not associated with BMI. Even at very high levels of BMI, likelihood of urinary incontinence and shortness of breath increases with BMI. In contrast, likelihood of aches/stiffness has a nonlinear relationship with BMI, increasing to a threshold level.

Associations of hypertensive disorders of pregnancy and gestational diabetes mellitus with menopausal symptoms at midlife in Project Viva.

The aim of this study was to evaluate the associations of a lifetime history of hypertensive disorders of pregnancy (HDP) and gestational diabetes mellitus (GDM) with menopausal symptoms in midlife. This was a secondary analysis of women participating in Project Viva, an ongoing cohort enrolled during pregnancy. The exposure was lifetime history of HDP or GDM assessed for the index pregnancy by review of outpatient and hospital medical records and for all other pregnancies by interview or questionnaire at study entry (1999-2002) and the midlife visit (2017-2021). The primary outcome was the Menopause Rating Scale (MRS) applied at the midlife study visit. We used linear or logistic regression models adjusted for covariates such as baseline age, race/ethnicity, education, married/cohabiting, household income, baseline parity, age at menarche, and body mass index at midlife. Of the 676 included participants, 120 (18%) had a history of HDP, and 47 (7%) had a history of GDM. The mean (SD) age was 52 (3.9) years at the midlife visit, and 48% of the participants had experienced menopause. There were no consistent differences in total, domain-specific, or individual symptoms in women with a history of HDP or GDM. A history of HDP and/or GDM was not associated with age at the onset of natural menopause. Our findings do not support an association of a history of HDP or GDM with the severity of menopausal symptoms or age at the onset of natural menopause. Larger studies of women with a history of these pregnancy complications are needed to clarify their association with menopausal symptoms.

Brief Report: Undertreated Midlife Symptoms for Women Living With HIV Linked to Lack of Menopause Discussions With Care Providers.

Increasingly, women living with HIV are entering menopause (ie, cessation of menses for ≥1 year) and experiencing midlife symptoms. Menopausal hormone therapy (MHT) is first-line therapy for bothersome hot flashes and early menopause (ie, before age 45 years); however, its use in women living with HIV is poorly described. We conducted a cross-sectional assessment of MHT uptake and barriers to use in this group. This study was conducted across 3 Canadian provinces from 2015 to 2017. Perimenopausal and postmenopausal women living with HIV (35 years or older) in the Canadian HIV Women's Sexual and Reproductive Health Cohort Study who answered questions related to MHT use were included. Univariable/multivariable logistic regression evaluated factors associated with MHT use, adjusted for age and contraindications. Among 464 women, 47.8% (222 of 464) had a first-line indication for MHT; however, only 11.8% (55 of 464) reported ever using MHT and 5.6% (26 of 464) were current users. Only 44.8% had ever discussed menopause with their care provider despite almost all women having regular HIV care (97.8%). African/Caribbean/Black women had lower unadjusted odds of MHT treatment compared with White women [odds ratio (OR) 0.42 (0.18-0.89); P = 0.034]. Those who had discussed menopause with their care provider had higher odds of treatment [OR 3.13 (1.74-5.86); P < 0.001]. In adjusted analyses, only women having had a menopause discussion remained significantly associated with MHT use [OR 2.97 (1.62-5.61); P < 0.001]. Women living with HIV are seldom prescribed MHT despite frequent indication. MHT uptake was associated with care provider-led menopause discussions underscoring the need for care provider education on menopause management within HIV care.

Resilience and psychosocial factors linked to symptom experience during the menopause transition for women living with HIV.

Women living with HIV (WLWH) are commonly symptomatic during perimenopause and menopause (≥1 y without menstruation), however, little is known of risks for symptoms and their timing. We analyzed these unwanted experiences to inform care. WLWH (≥40 y) in the Canadian HIV Women's Sexual and Reproductive Health Cohort Study rated midlife experiences for seven symptoms and a symptom composite (from 0 to 21). Timing was categorized into four phases: i) perimenopause (flow in the last year), ii) 1-2 years from final menstrual period (FMP), iii) 2-5 years post-FMP; and iv) >5 years post-FMP. Resilience (standardized out of 100) was assessed based on Wagnild's Resilience Scale. Univariable/multivariable mixed effects linear regression assessed correlates of symptom intensity by composite score. Among 457 peri-/menopausal women mean age 54.7 (±6.6) over two time points (703 observations), 88% experienced ≥1 mild symptom; 75% were of moderate and 55% severe intensity. The most frequently reported symptoms were joint/muscle stiffness (67%), depressed mood (67%), and hot flashes (57%). After adjusting for reproductive phase, we found that women with greater resilience had fewer/lower intensity symptoms (symptom score 1.37 [2.30 to 0.44] lower; P = 0.004); those with depressive symptoms and recreational drug use (respectively) had more/higher intensity symptoms (scores 1.71 [0.61 to 2.82] [P = 0.002]; 2.89 [2.09 to 3.77] [P<0.001] higher). Symptoms were most intense in perimenopause and declined with increasing menopausal years (P = 0.03). WLWH experiences a high burden of midlife symptoms, decreased by resilience and most intense during perimenopause. Unwanted experiences were linked to psychosocial and behavioral factors. These data encourage HIV providers to adopt a bio-psychosocial approach to midlife management.

Schizotypy 17 years on: Psychotic symptoms in midlife.

Determining the long-term psychosis-related outcomes of late-teen individuals characterized initially by a nonpsychotic, schizotypic feature (elevated perceptual aberrations) can further our understanding of the developmental pathways leading to schizophrenia, nonaffective psychotic conditions, and psychotic symptoms later in adulthood. Using the well-known laboratory/psychometric high-risk approach, the present study investigated the associations between nonpsychotic perceptual aberrations measured at age 18, in individuals with no prior history of psychosis, and clinical psychotic symptom outcomes 17 years later in midlife (middle 30s). Clinical assessments for hallucinations and delusions were completed for 191 adults (95% of the original sample) in the follow-up study. Elevated perceptual aberrations at age 18 predicted increased levels of hallucinations, delusions, and total psychotic symptoms in midlife as well as psychotic illness. The associations between baseline perceptual aberrations and later psychotic symptoms were not accounted for by general nonspecific psychopathology factors such as anxiety or depression present at age 18. Early detection of subtle, nonpsychotic forms of perceptual disturbance may aid in identifying individuals at increased risk for nonaffective psychosis outcomes in adulthood. Perceptual aberrations may constitute a useful endophenotype for genetic, neurobiological, and cognitive neuroscience investigations of schizophrenia liability. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Symptom clusters predict risk of metabolic-syndrome and diabetes in midlife: the Study of Women's Health Across the Nation

Purpose. Women's cardio-metabolic risk increases in midlife. Previous work relating menopause symptoms to diabetes/Metabolic Syndrome (MetS) does not consider the adverse impact of multiple concurrent physical and psychological symptoms in midlife.Methods. Data are from 3097 participants in the Study of Women's Health Across the Nation, a cohort of midlife women followed for over 20 years. Baseline latent symptom classes (LSC) were derived from 58 questions assessing physical, psychological and menopausal symptoms. Six identified LSCs ranged from 1 (most symptoms present at high severity) to 6 (few symptoms present at low severity). Accelerated failure time models estimated time to onset of type 2 diabetes and MetS for each LSC.Results. Women with multiple high/moderate severity symptoms had an earlier onset of diabetes (13.2%, 14.1% and 20.8% earlier onset in LSCs 1, 2, 3, respectively) and MetS (15.5%, 13.0% and 19.7% earlier onset in LSCs 1, 2, 3, respectively) than women with few/low severity symptoms.Conclusions. Having multiple concurrent moderate to high intensity physical and psychological symptoms in midlife are associated with early onset of diabetes and MetS. Monitoring and subsequent intervention on a broad range of symptoms in midlife may significantly mitigate cardio-metabolic risk during this critical life stage.

Associations between depression and cardiometabolic health: A 27-year longitudinal study.

Clarifying the relationship between depression symptoms and cardiometabolic and related health could clarify risk factors and treatment targets. The objective of this study was to assess whether depression symptoms in midlife are associated with the subsequent onset of cardiometabolic health problems. The study sample comprised 787 male twin veterans with polygenic risk score data who participated in the Harvard Twin Study of Substance Abuse ('baseline') and the longitudinal Vietnam Era Twin Study of Aging ('follow-up'). Depression symptoms were assessed at baseline [mean age 41.42 years (s.d. = 2.34)] using the Diagnostic Interview Schedule, Version III, Revised. The onset of eight cardiometabolic conditions (atrial fibrillation, diabetes, erectile dysfunction, hypercholesterolemia, hypertension, myocardial infarction, sleep apnea, and stroke) was assessed via self-reported doctor diagnosis at follow-up [mean age 67.59 years (s.d. = 2.41)]. Total depression symptoms were longitudinally associated with incident diabetes (OR 1.29, 95% CI 1.07-1.57), erectile dysfunction (OR 1.32, 95% CI 1.10-1.59), hypercholesterolemia (OR 1.26, 95% CI 1.04-1.53), and sleep apnea (OR 1.40, 95% CI 1.13-1.74) over 27 years after controlling for age, alcohol consumption, smoking, body mass index, C-reactive protein, and polygenic risk for specific health conditions. In sensitivity analyses that excluded somatic depression symptoms, only the association with sleep apnea remained significant (OR 1.32, 95% CI 1.09-1.60). A history of depression symptoms by early midlife is associated with an elevated risk for subsequent development of several self-reported health conditions. When isolated, non-somatic depression symptoms are associated with incident self-reported sleep apnea. Depression symptom history may be a predictor or marker of cardiometabolic risk over decades.

Early predictors of mental health in mid-adulthood.

Substantial research has focused on the examination of factors that contribute to the development of psychiatric problems. However, much less is known about factors early in life that may protect from poor mental health outcomes in midlife. This study aimed to identify the extent to which a set of key perinatal demographic variables and adolescent academic performance were associated with good mental health in mid-adulthood. In a sample of 525 individuals (aged 34-44, 55.4% male) born and raised in Jerusalem, Israel (STREAM study) we attempted to differentiate those who did and did not report psychiatric symptoms in mid-adulthood. Using χ2 and regression analysis, we explored birth factors (year of birth, sex, birth weight, and number of older siblings, data on parental immigration and socioeconomic status), academic achievement in eighth grade and contemporaneous measures of lifestyle factors, personality traits, and perceived resilience. Participants with good mental health were more often male (P = .005) and had better academic performance already at adolescence than participants who reported psychiatric symptoms in midlife (P < .001). They reported fewer physical complaints (P = .008), were less likely to smoke (P = .001) and considered themselves to be more "resilient" (P < .001). The results showed that better academic performance in adolescence may be associated with better stress-coping strategies, resulting in fewer psychiatric complaints, more perceived resilience, and less stress-related behaviours in mid-adulthood. Future studies confirming this hypothesis could inform public mental health interventions.

Obesity, smoking, and risk of vasomotor menopausal symptoms: a pooled analysis of eight cohort studies

Frequent and severe vasomotor symptoms during menopause are linked with adverse health outcomes. Understanding modifiable lifestyle factors for the risk of vasomotor menopausal symptoms is important to guide preventive strategies. We investigated the associations between body mass index and smoking, their joint effects with the risk of vasomotor symptoms, and whether the associations differed by menopausal stage. The International Collaboration for a Life Course Approach to Reproductive Health and Chronic Disease Events pooled data on 21,460 midlife women from 8 studies (median age, 50 years; interquartile range, 49-51 years) for the cross-sectional analysis. Four studies provided data for the prospective analysis (n=11,986). Multinomial logistic regression models with 4 categories of frequency/severity for the outcome of vasomotor symptoms were used to estimate relative risk ratios and 95% confidence intervals that were adjusted for within-study correlation and covariates. At baseline, nearly 60% of the women experienced vasomotor symptoms. One-half of them were overweight (30%) or obese (21%), and 17% were current smokers. Cross-sectional analyses showed that a higher body mass index and smoking more cigarettes with longer duration and earlier initiation were all associated with more frequent or severe vasomotor symptoms. Never smokers who were obese had a 1.5-fold (relative risk ratio, 1.52; 95% confidence interval, 1.35-1.73) higher risk of often/severe vasomotor symptoms, compared with never smokers who were of normal-weight. Smoking strengthened the association because the risk of often/severe vasomotor symptoms was much greater among smokers who were obese (relative risk ratio, 3.02; 95% confidence interval, 2.41-3.78). However, smokers who quit at <40 years of age were at similar levels of risk as never smokers. Prospective analyses showed a similar pattern, but the association attenuated markedly after adjustment for baseline vasomotor symptoms. Furthermore, we found that the association between body mass index and vasomotor symptoms differed by menopausal status. Higher body mass index was associated with increased risk of vasomotor symptoms in pre- and perimenopause but with reduced risk in postmenopause. High body mass index (≥25 kg/m2) and cigarette smoking substantially increased women's risk for experiencing frequent or severe vasomotor symptoms in a dose-response manner, and smoking intensified the effect of obesity. However, the effect of body mass index on the risk of vasomotor symptoms was opposite among postmenopausal women. Maintaining a normal weight before the menopausal transition and quitting smoking at <40 years of age may mitigate the excess risk of vasomotor symptoms in midlife.

Changes in depressive symptoms over age among older Americans: Differences by gender, race/ethnicity, education, and birth cohort.

Despite concerns about recent trends in the health and functioning of older Americans, little is known about dynamics of depression among recent cohorts of U.S. older adults and how these dynamics differ across sociodemographic groups. This study examined sociodemographic differences in mid- and late-life depressive symptoms over age, as well as changes over time. Using nationally representative data from the Health and Retirement Study (1994–2014), we estimated mixed effects models to generate depressive symptoms over age by gender, race/ethnicity, education, and birth cohort in 33,280 adults ages 51–90 years. Depressive symptoms were measured using the 8-item Center for Epidemiological Studies Depression scale. Women compared to men, low compared to high education groups, and racial/ethnic minorities compared to whites exhibited higher depressive symptoms. The largest disparity resulted from education, with those without high school degrees exhibiting over two more predicted depressive symptoms in midlife compared to those with college degrees. Importantly, war babies and baby boomers (born 1942–1959) exhibited slightly higher depressive symptoms with more decreasing symptoms over age than their predecessors (born 1931–1941) at ages 51–65. We additionally observed an age-as-leveler pattern by gender, whereby females compared to males had higher depressive symptomology from ages 51–85, but not at ages 86–90. Our findings have implication for gauging the aging population's overall well-being, for public health policies aimed at reducing health disparities, and for anticipating demand on an array of health and social services.

Stress and the menopausal transition in Campeche, Mexico

BackgroundStress has been implicated as a factor in the presence and severity of symptoms during the menopausal transition. Our primary aim was to test the hypothesis that stress-sensitive biological measures and self-reported stress would be positively associated with a greater likelihood and intensity of hot flashes. Our secondary aim was to examine measures of stress in relation to the most often reported symptoms in Campeche, Mexico. We also hypothesized ethnic differences (Maya versus non-Maya) in relation to measures of stress and symptom reports.MethodsParticipants aged 40–60 (n = 305) were drawn from multiple sites across the city of San Francisco de Campeche to achieve a generally representative sample. Measures included C-reactive protein (CRP), an indicator of inflammation; Epstein-Barr virus antibodies (EBV-Ab), an indicator of immune function; the Perceived Stress Scale (PSS); a symptom checklist; anthropometric measures; and a questionnaire that elicited symptoms, ethnicity (based on language, birthplace, and last names of the woman, her parents, and her grandparents) and ten dimensions of socioeconomic status (SES). The relationships between symptoms and stress-sensitive biological and self-reported measures were examined in bivariate analyses, and with logistic and linear regressions.ResultsThe twelve most common symptoms reported, in descending order of frequency, were tiredness, muscle and joint pain, nervous tension, problems concentrating, feeling depressed, difficulty sleeping, headaches, feeling of ants crawling on the skin, loss of interest in sex, urinary stress incontinence, hot flashes, and night sweats. PSS scores were significantly associated with the likelihood of seven symptoms (yes/no), and with the intensity of ten symptoms after controlling for ethnicity, SES, education, cohabitation status, parity, smoking, body mass index, and menopausal status. The stress-sensitive biological measures of immune function (EBV-Ab and CRP) were not significantly associated with midlife symptoms. The PSS was associated with more symptoms among the Maya (e.g., feeling nervous/tense and having difficulty concentrating) than non-Maya.ConclusionPSS scores were associated with the intensity, but not the likelihood, of hot flashes. Other symptoms were also associated with self-reported stress but not with physiological measures. Maya/non-Maya differences may indicate that either symptoms or stress were experienced and/or reported in culture-specific ways.