Variation in symptoms of depression and anxiety in midlife women by menopausal status

Highlights

• Symptoms of depression and anxiety differ by menopausal status in midlife women.

• Perimenopause is associated with increased risk of greater symptoms of depression.

• Postmenopause is associated with increased risk of greater symptoms of anxiety.

• Women without a history of symptoms may be at risk during perimenopause and postmenopause.

Abstract

Objectives

To examine the association between menopausal status and the risk of symptoms of depression and anxiety in a community-based sample of Australian midlife women.

Study design

Female participants (mean age 50.6 ± 1.5) who were premenopausal (n = 237), perimenopausal (n = 249) or naturally postmenopausal (n = 225) were drawn from the Personality and Total Health (PATH) Through Life Project, a longitudinal study.

Main outcome measures

Symptoms of depression and anxiety were measured using the Goldberg Depression Scale and Goldberg Anxiety Scale. Generalised linear regression models with a negative binomial log link were used.

Results

Relative to premenopause and after adjusting for all relevant covariates, being perimenopausal was associated with increased risk of greater symptoms of depression (incidence rate ratio [IRR] = 1.29, p = 0.001), while being postmenopausal was associated with increased risk of greater symptoms of anxiety (IRR = 1.15, p = 0.041). Being perimenopausal or postmenopausal was associated with an increased risk of greater symptoms of depression (IRR = 1.35, p = 0.008; IRR = 1.31, p = 0.029) and anxiety (IRR = 1.22, p = 0.030; IRR = 1.32, p = 0.006) in women without a history of probable major depressive disorder or generalised anxiety disorder. Risk of symptoms did not differ with menopausal status in women with this history.

Conclusions

Menopausal status is associated with the risk of symptoms of depression and anxiety. There is a greater likelihood of increased symptoms of depression during perimenopause and symptoms of anxiety during postmenopause. In women without a history of depression or anxiety, the perimenopause and postmenopausal stages are associated with increased risk of greater symptoms of anxiety and depression relative to premenopause.

Introduction

Fluctuations in mood have been observed during periods of hormonal change, particularly surrounding events in the female life course such as puberty, the perinatal period, and the menopause transition (MT) [1], [2], [3]. There has been substantial research interest in the association between depression and menopausal status, while symptoms of anxiety have not been widely examined. The female reproductive life course can be classified into three broad stages: the reproductive period or premenopause; MT or perimenopause; and the postmenopause which follows the final menstrual period [4]. The endocrinological and physiological changes that begin in the early MT and continue during early postmenopause result in a changed hormonal environment that remains for the duration of the female lifespan [5], yet the immediate consequences and longer term effects of these changes on psychological functioning remains unclear.

Research examining the association between menopausal status and symptoms of depression has yielded conflicting results. In recent years, several large community-based studies have identified associations between the MT and both an increase in symptoms of depression [6], [7], [8], [9], and increased risk of major depressive episode [7], [10], [11]. However, others argue that symptoms of depression during this period may be a result of sociodemographic factors, life stress, and declining physical health [12], [13], [14], [15]. Questions remain surrounding the contradictory findings and factors that may increase vulnerability to depression during midlife. Symptoms consistent with anxiety are reported by women during midlife [16], yet there has been considerably less attention dedicated to the study of anxiety and menopausal status. Of these limited studies, some have identified an increase in symptoms of anxiety during perimenopause [17], [18]. One longitudinal study identified that transition to the MT was associated with heightened levels of anxiety in women without a history of anxiety during premenopause [19]. Of the anxiety symptoms examined, evidence suggests that panic attacks may be more common during postmenopause [20]. In one study, symptoms of anxiety were identified as a risk factor for distressing vasomotor symptoms such as hot flashes [21]. However, in a meta-analysis of nine studies investigating anxiety and the MT, the authors concluded that levels of anxiety remained low, but also acknowledged that many of the included studies failed to use validated psychometric instruments to measure anxiety [22]. The association between symptoms of anxiety and stage of menopause remains unclear, with a lack of research using validated measures of anxiety [22] and few studies examining anxiety during postmenopause relative to other stages.

Research that attempts to examine menopausal status and mental health is complicated by methodological challenges and inconsistencies in the measurement of reproductive stage and psychological symptoms. Further, the applicability of findings beyond the population studied and issues of issues of temporality continue to present challenges. To build upon existing research and address gaps in current findings, we examined a sample of Australian women in midlife who were premenopausal, perimenopausal, or naturally postmenopausal to determine whether menopausal status was associated with risk of symptoms consistent with depression and anxiety. We also examined the role of a past history of these symptoms on the severity of symptoms experienced during the MT and postmenopause. We expected that risk of symptoms of depression would be greater in perimenopause, and symptoms of anxiety greater in the perimenopause and postmenopause when compared to premenopause, and that participants with a history of depression or anxiety would be at increased risk of psychological symptoms during the MT and postmenopause.