Four recent longitudinal studies have examined the relationship between menopausal status and depressive symptoms7–10
and/or clinical or severe depression (see )7;8;27
. Despite using different sampling frames, sizes, and compositions and varying designs and analyses, the results were consistent – they all reported that risk for depression (symptoms or disorder) increased during the perimenopause. Moreover, with the exception of Maartens, et al,9
in which 2,103 women provided data 3 years apart via mailed questionnaires, these studies did not find an increased risk for depressive symptoms in the postmenopause compared to premenopause. The null findings may have been due to insufficient power to detect a difference because of relatively small numbers of women followed through postmenopause. For example, the POAS8
reported that depressive symptoms but not disorder increased in the perimenopause and subsequently declined in the postmenopause over 4 years of follow-up. However, in this study 73% of the 332 participants remained premenopausal over the 4 years of follow-up and only 3% completed the transition, making the numbers for postmenopause and MD too small to determine statistical significance.
Also in the POAS, Freeman and colleagues27
found a significantly increased adjusted odds ratio (AOR=5.44) for the first onset of high depressive symptoms during perimenopause compared to premenopause. In the Harvard Study of Moods and Cycles, Cohen et al7
reported that women who became perimenopausal had only a marginally significant higher odds of first onset high depressive symptoms (AOR=1.9) after adjustment for age and stressful life events than did those who remained premenopausal across 8 years. For depressive disorder, the POAS also found that, in unadjusted analysis, perimenopause doubled the odds compared with premenopause, but perimenopause was no longer a significant predictor in multivariable analyses. Importantly, neither study included women who were postmenopausal and each only examined a subset of women.
The longitudinal studies examined multiple and varying potential risk factors for depression in addition to menopausal status. Freeman and colleagues8
reported that African Americans had nearly twice the odds of high depressive symptoms relative to Caucasians. However, their analyses did not adjust for socioeconomic and psychosocial factors that have been shown in other studies21;40
to account for the higher risk for depression in African Americans. Other significant predictors included a history of depression at study entry, lack of employment, severe PMS, poor sleep, and hot flashes. Although postpartum depression was significant in bivariate analyses, it did not remain significant in the multivariable analysis possibly because of the high correlation between severe PMS and postpartum depression. Woods and colleagues10
reported that number of undesirable events in the previous year, self-reported BMI, postpartum blues, and no live births each increased the odds of high depressive symptoms by 1.5 to 2 times. Hot flashes were significant in bivariate analyses, but not in multivariable ones. Maartens and colleagues9
found that being unemployed, prior depression (at T1, Edinburgh Postnatal Depression Scale (EPDS≥12), financial problems and death of partner were significant predictors of an increase in depressive symptoms over 3.5 years. This study did not include hot flashes.
The factors associated with first onset high depressive symptoms in the POAS included BMI, hot flashes, severe PMS, current smoking, and estradiol. Higher BMI, presence of hot flashes and greater variability of estradiol at 2 consecutive follicular phase blood draws increased the odds whereas current PMS and smoking significantly decreased them.27
Cohen and colleagues7
did not present the odds of VMS or adverse life events in the full model but their data suggest that only the perimenopausal women with VMS or adverse life events had a significantly increased risk of first onset depression. Freeman and colleagues 27
reported results that contrasted with those from SWAN.24
They found that only BMI and variability of estradiol measured in two consecutive follicular phase blood draws were associated with significant odds of depressive disorders. Hot flashes, premenstrual symptoms (PMS), and smoking were non-significant. In their analysis, perimenopause was not a significant predictor, which may have been due to the confounding of estradiol variability and hot flashes with perimenopause or the small number of women with a depressive disorder.