Biopsychosocial risk factors of depression during menopause transition in southeast China

Abstract Objective More than 2 billion women experiencing menopause transition in China and some of them suffered depression; while the risk factors of depression are still unclearin China. We aimed to investigate the risk factors in mid-life women in Southeast China. Method This study included 1748 Chinese women aged 40 to 65 years who visit gynecology outpatient department of Women’s hospital School of Medicine, Zhejiang University during 2010 to 2018. Demographic information was collected, and the modified Kupperman Menopausal Index (mKMI) and Hamilton Rating Scale for Depression were assessed. Circulating levels of sex hormones were obtained. Ordinal logistic regression analysis was performed to identify risk factors for depression. Results The prevalence of depression symptoms was 47.43%. The majority of women had mild (38.56%) or moderate depression symptoms (8.00%); only 0.86% had severe depression. Compared with perimenopausal women, postmenopausal women had increased risks of depression. The associations between menopausal syndromes and depression were strongly positive (OR 6.69, 95% CI 5.39–8.29). Women with older age, higher follicle stimulating hormone levels, lower estradiol levels, and fewer parity had increased risk of depression. Among postmenopausal women, underweight, mKMI > 14, earlier age at menopause, shorter reproductive period, and longer duration after menopause were risk factors for depression. Conclusions The results demonstrated a high proportion of depression in women complaining of menopause. Menopausal symptoms were strongly related to the risk of depression. In postmenopausal women, estrogen related events are associated with depression. Gynecological endocrinologists in China should consider screening for depression in high-risk women.

Download Full-text

Influence of methyltestosterone postmenopausal therapy on plasma lipids, inflammatory factors, glucose metabolism and visceral fat: a randomized study

Acta Endocrinologica ◽

10.1530/eje.1.02065 ◽

2006 ◽

Vol 154 (1) ◽

pp. 131-139 ◽

Cited By ~ 18

Author(s):

Lenora M Camarate S M Leão ◽

Mônica Peres C Duarte ◽

Dalva Margareth B Silva ◽

Paulo Roberto V Bahia ◽

Cláudia Medina Coeli ◽

...

Keyword(s):

Risk Factors ◽

Insulin Resistance ◽

Blood Pressure ◽

Cardiovascular Disease ◽

Cardiovascular Risk ◽

Cardiovascular Risk Factors ◽

Postmenopausal Women ◽

Fat Mass ◽

Visceral Fat ◽

Increased Risk

Background: There has been a growing interest in treating postmenopausal women with androgens. However, hyperandrogenemia in females has been associated with increased risk of cardiovascular disease. Objective: We aimed to assess the effects of androgen replacement on cardiovascular risk factors. Design: Thirty-seven postmenopausal women aged 42–62 years that had undergone hysterectomy were prospectively enrolled in a double-blind protocol to receive, for 12 months, percutaneous estradiol (E2) (1 mg/day) combined with either methyltestosterone (MT) (1.25 mg/day) or placebo. Methods: Along with treatment, we evaluated serum E2, testosterone, sex hormone-binding globulin (SHBG), free androgen index, lipids, fibrinogen, and C-reactive protein; glucose tolerance; insulin resistance; blood pressure; body-mass index; and visceral and subcutaneous abdominal fat mass as assessed by computed tomography. Results: A significant reduction in SHBG (P < 0.001) and increase in free testosterone index (P < 0.05; Repeated measures analysis of variance) were seen in the MT group. Total cholesterol, triglycerides, fibrinogen, and systolic and diastolic blood pressure were significantly lowered to a similar extent by both regimens, but high-density lipoprotein cholesterol decreased only in the androgen group. MT-treated women showed a modest rise in body weight and gained visceral fat mass relative to the other group (P < 0.05), but there were no significant detrimental effects on fasting insulin levels and insulin resistance. Conclusion: This study suggests that the combination of low-dose oral MT and percutaneous E2, for 1 year, does not result in expressive increase of cardiovascular risk factors. This regimen can be recommended for symptomatic postmenopausal women, although it seems prudent to perform baseline and follow-up lipid profile and assessment of body composition, especially in those at high risk of cardiovascular disease.

Download Full-text

Lacune and Large Perivascular Space: Two Kinds of Cavities Are of Different Risk Factors and Stroke Risk

Cerebrovascular Diseases ◽

10.1159/000508732 ◽

2020 ◽

Vol 49 (5) ◽

pp. 522-530

Author(s):

Jiangtao Zhang ◽

Fei Han ◽

Xinyu Liang ◽

Mingli Li ◽

Dingding Zhang ◽

...

Keyword(s):

Risk Factors ◽

Cardiovascular Risk ◽

Cardiovascular Risk Factors ◽

Stroke Risk ◽

Population Based ◽

Carrier Status ◽

Perivascular Spaces ◽

Increased Risk ◽

Ordinal Logistic Regression Analysis ◽

Study Participants

Background and Purpose: To compare the risk factors and risk of stroke between lacune and large perivascular spaces (PVSs) in a community-based sample. Methods: Large PVSs were assessed using 3.0T MRI in a population-based cohort consisting of 1,204 participants. The relationship between cardiovascular risk factors, neuroimaging changes, and incidental stroke risk and the presence of lacune or large PVSs was assessed with univariate and multivariable ordinal logistic regression analysis. Results: Of the 1,204 study participants (55.7 ± 9.3 years, 37.0% men), a total of 347 large PVSs were detected in 235 (19.5%) subjects, while a total of 219 lacunes were detected in 183 subjects (15.2%). The presence of lacunes was found to be significantly associated with age, male gender, hypertension, and diabetes, whereas only age (p < 0.01) and ApoEε4 carrier status (p < 0.01) were related to the presence of large PVSs. Those who had lacunes detected on MRI at baseline had a significant increased risk of stroke (hazard ratio [HR] 4.68; 95% confidence interval [CI], 1.15–19.07) during the 3-year follow-up independent of age, gender, and other vascular risk factors. However, there was no significant relationship between the presence of large PVSs and incident stroke (HR 3.84; 95% CI, 0.82–18.04). Conclusions: The lack of association between large PVSs and cardiovascular risk factors or risk of stroke indicated a nonvascular pathogenic mechanism underlying large PVSs, suggesting the importance of distinguishing large PVSs from lacunes in clinical practice.

Download Full-text

A secondary analysis of internet-delivered cognitive-behaviour treatment for adults with severe depressive symptoms (Preprint)

10.2196/preprints.10204 ◽

2018 ◽

Author(s):

Derek Richards ◽

Daniel Duffy ◽

John Burke ◽

Melissa Anderson-Gibbons ◽

Sarah Connell ◽

...

Keyword(s):

Suicidal Ideation ◽

Social Functioning ◽

Beck Depression Inventory ◽

Social Adjustment ◽

Severe Depression ◽

Mental Health Issue ◽

Depression Symptoms ◽

Increased Risk ◽

Cognitive Behaviour

BACKGROUND Depression is a highly prevalent mental health issue that exacts significant economic, societal, personal and interpersonal costs. Innovative internet-delivered interventions have been designed to increase accessibility to and cost-effectiveness of treatments. These treatments have mainly targeted mild to moderate levels of depression. The increased risk associated with severe depression, particularly of suicidal ideation often results in this population being excluded from research studies. As a result, effectiveness of iCBT in more severely depressed cohorts is less researched. OBJECTIVE To examine the effect of iCBT on symptoms of severe depression, comorbid symptoms of anxiety and levels of work and social functioning. METHODS Retrospective consent was provided by participants with elevated scores (>28 severe depression symptoms) on the Beck Depression Inventory (BDI-II) who accessed an iCBT intervention (Space from Depression) with support for 8 weeks. Data was collected at baseline, post-treatment and 3-month follow-up on the primary outcome the Beck Depression Inventory-II (BDI-II), and secondary outcomes; the Generalized Anxiety Disorder-7 (GAD-7) and the Work and Social Adjustment Scale (WSAS). RESULTS Significant change was observed on all measures between pre- and post- measurement, and maintained at 3-month follow-up. Clinical improvement was observed for participants on the BDI-II from pre- to post- measurement and suicidal ideation also reduced from pre- to post- measurement. CONCLUSIONS Space from Depression was found to decrease symptoms of depression and anxiety and increase work and social functioning for individuals with severe depression symptoms. The intervention also demonstrated its potential to decrease suicidal ideation. Further investigation is required to determine why some individuals improve, and others do not. ICBT may have the potential to be used as an adjunct treatment for severe depression symptoms, but participants may require further treatment if they receive iCBT as a standalone. Although promising, further research is needed to support the utility of Space from Depression for use in or as an adjunct to treatment for severe depression.

Download Full-text

Risk factors for depression during the COVID-19 pandemic: a longitudinal study in middle-aged and older adults

BJPsych Open ◽

10.1192/bjo.2021.997 ◽

2021 ◽

Vol 7 (5) ◽

Author(s):

Jamie Rutland-Lawes ◽

Anna-Stiina Wallinheimo ◽

Simon L. Evans

Keyword(s):

Risk Factors ◽

Older Adults ◽

Longitudinal Study ◽

Regression Models ◽

Protective Factor ◽

Significant Risk ◽

Living Alone ◽

Depression Symptoms ◽

Middle Aged ◽

Increased Risk

Background The COVID-19 pandemic and resultant social restrictions have had widespread psychological ramifications, including a rise in depression prevalence. However, longitudinal studies on sociodemographic risk factors are lacking. Aims To quantify longitudinal changes in depression symptoms during the pandemic compared with a pre-pandemic baseline, in middle-aged and older adults, and identify the risk factors contributing to this. Method A total of 5331 participants aged ≥50 years were drawn from the English Longitudinal Study of Ageing. Self-reported depression symptoms in June/July 2020 were compared with baseline data from 2–3 years prior. Regression models investigated sociodemographic and lifestyle variables that could explain variance in change in depression. Results Within-participant depression scores increased significantly from pre-pandemic levels: 14% met the criteria for clinical depression at baseline, compared with 26% during the pandemic. Younger age, female gender, higher depression scores at baseline, living alone and having a long-standing illness were significant risk factors. Gender-stratified regression models indicated that older age was protective for women only, whereas urban living increased risk among women only. Being an alcohol consumer was a protective factor among men only. Conclusions Depression in UK adults aged ≥50 years increased significantly during the pandemic. Being female, living alone and having a long-standing illness were prominent risk factors. Younger women living in urban areas were at particularly high risk, suggesting such individuals should be prioritised for support. Findings are also informative for future risk stratification and intervention strategies, particularly if social restrictions are reimposed as the COVID-19 crisis continues to unfold.

Download Full-text

Impact of Estradiol Variability and Progesterone on Mood in Perimenopausal Women With Depressive Symptoms

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/clinem/dgz181 ◽

2019 ◽

Vol 105 (3) ◽

pp. e642-e650 ◽

Cited By ~ 2

Author(s):

Hadine Joffe ◽

Anouk de Wit ◽

Jamie Coborn ◽

Sybil Crawford ◽

Marlene Freeman ◽

...

Keyword(s):

Depressive Symptoms ◽

Stressful Life Events ◽

Rating Scale ◽

Depressive Symptomatology ◽

Medical Center ◽

Academic Medical Center ◽

Madrs Score ◽

Increased Risk ◽

Perimenopausal Women ◽

Menopause Transition

Abstract Context Women are at increased risk for depressive symptoms during the menopause transition. Changes in estradiol secretion and presence of vasomotor symptoms (VMS) contribute to perimenopausal depressive symptoms, but links with progesterone have not been investigated. Objective To determine whether estradiol variability, ovulatory levels of progesterone, and VMS burden are independently associated with perimenopausal depressive symptomatology. Design and Intervention Depressive symptoms, serum levels of estradiol and progesterone, and VMS frequency were assessed weekly in an 8-week observational study. Association of mood with estradiol variability, ovulatory levels of progesterone, and VMS frequency were estimated using generalized estimating equation models. Setting Academic medical center. Patients Fifty unmedicated perimenopausal women with mild-to-moderate depressive symptoms (mean Montgomery-Åsberg Depression Rating Scale [MADRS] score 15.5 ± 5.3). Main Outcome Measure Depressive symptoms (MADRS score). Results During the study, 90.0% of participants had varying estradiol levels, 51.1% had ovulatory progesterone levels, and 90% had VMS. Greater estradiol variability and absence of progesterone levels consistent with ovulation, but not VMS frequency, are associated with higher levels of depressive symptoms (β = 0.11 [95% confidence interval (95% CI), 0.04 to 0.18; P = 0.001]; β = −2.62 [95% CI, −4.52 to −0.71; P = 0.007], respectively), after accounting for higher body mass index, lifetime history of depression, and stressful life events. Conclusions Increasing dysregulation of ovarian hormones, but not VMS, associates with more depressive symptom burden during perimenopause. These results suggest that perimenopausal mood instability is driven by the underlying hormonal dysregulation of the menopause transition involving changes in both estradiol and progesterone.

Download Full-text

Effect of coronary heart disease (CHD) risk factors and medications on invasive breast cancer risk in the Raloxifene Use for The Heart (RUTH) trial

Journal of Clinical Oncology ◽

10.1200/jco.2007.25.18_suppl.1530 ◽

2007 ◽

Vol 25 (18_suppl) ◽

pp. 1530-1530

Author(s):

J. Mershon ◽

M. Geiger ◽

E. Barrett-Connor ◽

P. Collins ◽

M. Kornitzer ◽

...

Keyword(s):

Breast Cancer ◽

Risk Factors ◽

Postmenopausal Women ◽

Invasive Breast Cancer ◽

Chd Risk ◽

Increased Risk ◽

Baseline Factors ◽

Coronary Events ◽

Low Incidence ◽

Chd Risk Factors

1530 Background: RUTH enrolled 10,101 postmenopausal women at increased risk for major coronary events. Women were not enrolled based on their risk for breast cancer. The incidence of invasive breast cancer in the placebo group was low for this older population of women (mean age 67.5 years). The aim of this analysis was to determine whether CHD risk factors and selected cardiac medications were protective against invasive breast cancer in this population at increased risk for coronary events. Methods: Covariates assessed were baseline factors that are known CHD risk factors and selected medications ( Table ). Univariate analyses were performed for all covariates using placebo data. Results: The effect of baseline CHD risk factors and selected cardiac medications on the incidence of invasive breast cancer in women receiving placebo in RUTH (N=5057) Conclusions: In these postmenopausal women at increased risk for major coronary events, baseline CHD risk factors and selected cardiac medications assessed individually did not protect against invasive breast cancer. The low incidence of invasive breast cancer in the RUTH population does not appear to be due to the presence of CHD risk factors or use of cardiac medications. [Table: see text] [Table: see text]

Download Full-text

Exemestane for primary prevention of breast cancer in postmenopausal women: NCIC CTG MAP.3—A randomized, placebo-controlled clinical trial.

Journal of Clinical Oncology ◽

10.1200/jco.2011.29.18_suppl.lba504 ◽

2011 ◽

Vol 29 (18_suppl) ◽

pp. LBA504-LBA504 ◽

Cited By ~ 3

Author(s):

P. E. Goss ◽

J. N. Ingle ◽

J. Ales-Martinez ◽

A. Cheung ◽

R. T. Chlebowski ◽

...

Keyword(s):

Breast Cancer ◽

Risk Factors ◽

Primary Prevention ◽

Postmenopausal Women ◽

Bone Fractures ◽

Annual Incidence ◽

Controlled Clinical Trial ◽

Breast Cancers ◽

Increased Risk ◽

Prevention Of Breast Cancer

LBA504 Background: Limited efficacy and serious toxicities have limited uptake of tamoxifen or raloxifene as preventatives of breast cancer. Aromatase inhibitors (AIs) prevent contralateral breast cancers more than tamoxifen in adjuvant trials and have fewer serious side effects. This is the first report of an AI used in primary prevention. Methods: NCIC CTG MAP.3 is a randomized trial designed to detect a 65% reduction in annual incidence of invasive breast cancer (IBC) on exemestane (E) versus placebo (P). Eligible postmenopausal women had ≥ one of the following risk factors: Gail score >1.66%, prior ADH, ALH, LCIS or DCIS with mastectomy, age over 60. Health-related and menopause-specific quality of life (QOL) were assessed by SF-36 and MENQOL questionnaires. Results: From 2004-2010, 4,560 women were randomized: age 62.5 yrs (37-90); Gail Score 2.3 % (0.6-21); BMI 28.0 kg/m2 (15.9-65.4). Risk factors included: age >60 yrs (49%); Gail score >1.66 (40%); and prior ADH, ALH, LCIS or DCIS with mastectomy (11%). At median follow-up of 35 months there were 11 IBCs on E and 32 on P (annual incidence 0.19% vs 0.55%; HR= 0.35, 95% CI 0.18-0.70, p = 0.002); ductal (10E/27P), lobular (1E/5P). Most tumors were ER positive (7E/27P); Her2/neu negative (10E/26P); TNM stage T1 (8E/28P), N0 (7E/22P), M0 (11E/30P). E was superior in all subgroups: by Gail score, age, BMI, prior LCIS and DCIS. The annual incidence rate of IBC or DCIS was 0.35% E and 0.77% P (HR=0.47;95% CI 0.27-0.79; p = 0.004) based on 64 IBCs or DCISs (20E/44P). Clinical bone fractures, osteoporosis, hypercholesterolemia or cardiovascular events were equal in both arms. No clinically meaningful differences in QOL were detected. Conclusions: Exemestane significantly reduced invasive and pre-invasive breast cancers in postmenopausal women at increased risk for breast cancer with no serious toxicities. Exemestane should be considered a new option for primary prevention of breast cancer. Supported by the Canadian Cancer Society; Pfizer Inc. PEG supported in part by Avon Foundation.

Download Full-text

Risk factors for cognitive impairment in amyotrophic lateral sclerosis: a systematic review and meta-analysis

Journal of Neurology Neurosurgery & Psychiatry ◽

10.1136/jnnp-2020-325701 ◽

2021 ◽

pp. jnnp-2020-325701

Author(s):

Tianmi Yang ◽

Yanbing Hou ◽

Chunyu Li ◽

Bei Cao ◽

Yangfan Cheng ◽

...

Keyword(s):

Risk Factors ◽

Amyotrophic Lateral Sclerosis ◽

Cognitive Impairment ◽

Family History ◽

Rating Scale ◽

Or Education ◽

Increased Risk ◽

Bulbar Onset ◽

History Of ◽

Lateral Sclerosis

ObjectiveCognitive impairment is a common, far-reaching but imperceptible manifestation in patients with amyotrophic lateral sclerosis (ALS). We aimed to identify the risk factors for cognitive impairment in ALS.MethodsWe searched PubMed and EMBASE for cross-sectional, case–control and cohort studies that reported predictors of cognitive impairment in ALS. The obtained data were meta-analysed to generate overall ORs and 95% CIs.ResultsTwenty-seven eligible articles reporting on 6799 individuals were included out of 20 501 records. Nine predictors were identified: C9orf72 (OR 3.62, 95% CI 1.76 to 7.45), dysarthria (OR 2.25, 95% CI 1.20 to 4.22), family history of ALS (OR 1.76, 95% CI 1.18 to 2.61), predominant upper motor neuron (PUMN) phenotype (OR 1.73, 95% CI 1.09 to 2.73) and bulbar onset (OR 1.54, 95% CI 1.28 to 1.87) increased risk factors for cognitive impairment in ALS. ALS Functional Rating Scale-Revised scores, sex, age or education level were not significantly associated with cognitive impairment in ALS. In addition, C9orf72 (OR=5.94) and bulbar onset (OR=2.08) were strong predictors of ALS-frontotemporal dementia. Female sex conferred more susceptibility to executive cognitive impairment than male sex (OR=1.82).ConclusionsPatients with C9orf72 repeat expansion, dysarthria, family history of ALS, PUMN phenotype and bulbar onset had a high risk for cognitive impairment in ALS. These associations may contribute to understanding the heterogeneity of ALS.PROSPERO registration numberCRD42020201085.

Download Full-text

‘Menopause affects us all . . .’: menopause transition experiences of female ambulance staff from a UK ambulance service

British Paramedic Journal ◽

10.29045/14784726.2021.12.6.3.41 ◽

2021 ◽

Vol 6 (3) ◽

pp. 41-48

Author(s):

Larissa Stella Prothero ◽

Theresa Foster ◽

Debra Winterson

Keyword(s):

Rating Scale ◽

Well Being ◽

Menopausal Symptoms ◽

Working Environment ◽

Ambulance Service ◽

Depression Symptoms ◽

Convenience Sample ◽

Personal Impact ◽

Menopause Transition ◽

The Impact

Background: There is limited research regarding the menopause transition in the emergency services; however, all women will experience this life phase, which can have a significant impact on personal well-being, workplace attendance and performance. The aim of this survey was to explore personal and work impacts of the menopause for all female staff in the ambulance setting.Methods: A purpose-designed, 20-question survey, based on the Menopause Rating Scale and British Menopause Survey, was developed to understand menopausal symptoms and their impact on female staff in one UK ambulance service. Disseminated during 1‐31 July 2019, it resulted in a convenience sample of 522 responses, which were analysed using descriptive statistics and thematic approaches.Results: Typically, respondents were either pre-menopausal or peri-menopausal, with approximately a third being menopausal or post-menopausal. Over half worked in emergency operational delivery, and typically worked shifts or unsocial hours. For those who had experienced menopause symptoms, the most commonly reported were tiredness or low energy levels, difficulty sleeping (including insomnia) and mood changes (including anxiety or depression). Symptoms impacted respondents’ well-being, work and home life. Most had not expected the symptoms they experienced. The majority of respondents did not feel supported at work, with lack of menopausal symptom awareness and personal impact, working times and patterns, and sense of embarrassment of most concern. Other issues included lack of managerial and peer support, inadequate working environment and uniform, lack of dignity and choice, and no dedicated menopause policy.Conclusions: It is understood that this is the first survey to explore female ambulance staff menopause experiences. The impact of menopausal symptoms can be significant. Menopause awareness in this ambulance service is lacking and there is clear scope for initiatives for improved staff support and well-being. Further research is warranted to explore how best to support ambulance staff with the menopause transition.

Download Full-text

Sadness and mild cognitive impairment as predictors for interferon-alpha-induced depression in patients with hepatitis C

The British Journal of Psychiatry ◽

10.1192/bjp.bp.113.141770 ◽

2015 ◽

Vol 206 (1) ◽

pp. 45-51 ◽

Cited By ~ 10

Author(s):

Susanne Sarkar ◽

Rahul Sarkar ◽

Thomas Berg ◽

Martin Schaefer

Keyword(s):

Hepatitis C ◽

Antiviral Therapy ◽

Interferon Alpha ◽

Rating Scale ◽

Antiviral Treatment ◽

Severe Depression ◽

Hcv Infection ◽

Clinical Predictors ◽

Increased Risk ◽

Chronic Hcv

BackgroundAntiviral therapy with interferon-alpha (IFN-α) for hepatitis C virus (HCV) infection is associated with increased risk for depression.AimsTo identify clinical predictors for IFN-α-induced depression during antiviral therapy for HCV infection.MethodDepression (defined with the Montgomery–åsberg Depression Rating Scale (MADRS)) was evaluated before and during antiviral treatment in 91 people with chronic HCV infection without a history of psychiatric disorders. Cognitive function was evaluated using the Trail Making Test A/B (TMT A/B). (Trial registration at ClinicalTrials.gov: NCT00136318.)ResultsDepression during antiviral therapy was significantly associated with a baseline MADRS score of 3 or higher (P = 0.006). In total, 89% (n = 16) of patients who had a baseline score >0 for the single item sadness developed depression. Poor baseline performance in the TMT A (P = 0.027) and TMT B (P=0.033) was predictive for severe depression.ConclusionsPre-treatment screening for subthreshold depressive and cognitive symptoms will help to identify those at risk for IFN-α-associated depression among patients with chronic hepatitis C.

Download Full-text