5th European Congress on Menopause

Lorraine Dennerstein, AO, MBBS, PhD, FRANZCP, DPM

Disclosures

July 19, 2000

In This Article

Depression

Psychological symptoms are frequently reported by middle-aged women.[2] The midlife years coincide with a number of psychological and social changes, which may prove stressful for women. These include children leaving home, changing marital dyad (for example, a change in the dynamics of the relationship between a husband and wife when children leave home), reappraisal of work-related goals, and ill health of parents.[3] These are also the years of endocrine change coinciding with the menopausal transition.[4] An important clinical concern is whether mood complaints of middle-aged women reflect the endocrine changes or the psychosocial stressors in women's lives.

Some studies have suggested an increase in minor psychological symptoms in the years just before the final menstrual period (see review[3]). These studies have tended to be of cross-sectional research design. No direct association between depression and menopausal status has been found by population-based prospective studies in which standardized psychological measures and instruments have been used.[5,6,7,8] A 6-year follow-up study of 354 Australian middle-aged women[9] found that mood scores decreased significantly over time and were not related to natural menopausal transition, follicle-stimulating hormone, estradiol, inhibin, age, or education. Depressed mood was significantly predicted by baseline mood scores, premenstrual complaints, negative attitudes toward aging and menopause, parity of 1, experience of bothersome symptoms, poor self-rated health, negative feelings for partner, no partner, current smoking, low exercise, daily hassles, and high stress. The menopausal transition amplified the effect on depressed mood of low-paid work, poor health, and daily hassles. While these results describe the overall trends for a population group, they do not indicate whether there may be particular subgroups who may respond to hormonal change differently.

Depressed mood observed during midlife could be the result of continuation of earlier depression, emergence of new depression, resolving depression, or oscillating depression.[8] Intraindividual analysis, based on repeated measurements in the same woman, can describe the dynamics of any change in depressed mood. Interindividual analysis, using cluster analysis, can then identify groups of patterns.

This kind of innovative analysis was used to determine whether there are subgroups of premenopausal and early perimenopausal women who show different patterns of depressed mood. On Sunday, July 2, 2000, Nancy Woods, Professor and Dean, University of Washington, Seattle, presented results from the longitudinal Seattle Midlife Women's Health Study, begun in 1990.[8] Between 1990 and 1992, premenopausal and early perimenopausal women were enrolled in this study. Urine samples were collected daily for 1 month each year to monitor hormonal functioning. Depressed mood was assessed with the Centre for Epidemiological Studies Depression (CESD) scale annually.

Results presented at the Congress were based on 195 women who completed 6 annual measures. By the end of the 6 years of follow-up, the women's mean age was 47 years. A number of distinct patterns were identified by cluster analysis: emerging depression; low level of depression throughout follow-up; moderate levels of depression throughout follow-up; high scores of depression that resolved during follow-up; high scores of depression that remained throughout follow-up; and consistently nondepressed mood throughout follow-up. The latter pattern was the most common pattern observed -- that is, most women were not depressed throughout the 6 years of the study. About 10% of the women were depressed throughout the study, and this prevalence rate is consistent with known prevalence rates for depression in this age group.

Women whose depression was resolving during the study were more likely to have become postmenopausal. As noted, a number of factors (physical, psychosocial, and lifestyle) can influence the pathways of depressed mood. Hierarchical causal modeling will allow the investigators to identify whether there are particular risk factors associated with each pattern of mood described above.

These findings should be of interest to clinicians because they may be able to identify women at risk of adverse change in mood early in the menopausal transition. Women most at risk are likely to be those who are already depressed; who have a past history of depression or of adverse mood changes linked to other phases of hormonal change; or who are experiencing ill-health, bothersome symptoms, or stress and who do not have a supportive relationship with a partner.

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