Longitudinal pattern of depressive symptoms around natural menopause.
Longitudinal pattern of depressive symptoms around natural menopause.
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DOI：
10.1001/jamapsychiatry.2013.2819
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发表时间：
2014-01
期刊：
影响因子：
25.8
通讯作者：
Zhang R
中科院分区：
文献类型：
--
作者：
Freeman EW;Sammel MD;Boorman DW;Zhang R
抑郁症状的风险增加与绝经期的过渡有关，但绝经后早期抑郁症状的风险尚未得到很好的表征。确定绝经前后14年内女性抑郁症状的变化，确定抑郁症史与抑郁症状模式的相关性，并评估生殖激素变化率作为绝经后抑郁症状的预测因子。一组育龄晚期妇女随访14年，每年评估症状和生殖激素。在宾夕法尼亚州费城县随机确定的基于人群的样本，203例基线时绝经前并在随访期间达到自然绝经的总体健康女性。流行病学研究中心抑郁量表（CES-D）从绝经前10年到绝经后8年，CES-D高评分的患病率呈下降趋势，每年下降约15%（比值比0.85，95% CI：0.81-0.89，P<0.001）。相对于末次月经（FMP），抑郁症状的风险在FMP前几年更大，在FMP后几年更低。在有抑郁症病史的女性中，与没有抑郁症病史的女性相比，抑郁症状的可能性总体上高13倍，绝经后高8倍。在接近绝经期时首次出现抑郁症状的女性中，抑郁症状的风险在FMP后下降，绝经后第二年的风险显著降低。FMP前促卵泡激素（FSH）对数变化率每增加一个单位（SD），绝经后抑郁症状的风险降低35%（比值比0.65，95%CI 0.46-0.91，P=0.01）。最后一次月经是中年女性抑郁症状减少的总体模式的关键，在FMP之前风险较高，之后风险较低。绝经前后抑郁症的病史大大增加了风险。在绝经过渡期前没有抑郁症史的妇女在FMP后两年或两年以上患抑郁症的风险较低。
An increased risk of depressive symptoms has been associated with the transition to menopause, but the risk of depressive symptoms in the early postmenopausal years has not been well-characterized. Identify within-woman changes in depressive symptoms over a 14-year period around menopause, determine associations of a history of depression with the pattern of depressive symptoms and evaluate the rate of change in reproductive hormones as predictors of depressive symptoms postmenopause. A cohort of late reproductive-age women followed for 14 years with annual assessments of symptoms and reproductive hormones. Randomly-identified, population-based sample in Philadelphia County, PA 203 generally healthy women who were premenopausal at baseline and reached natural menopause in the follow-up interval. Center for Epidemiologic Studies Depression Scale (CES-D) The prevalence of high CES-D scores decreased from 10 years before menopause to 8 years postmenopause, with a decrease of approximately 15% of baseline per year (odds ratio 0.85, 95% CI: 0.81–0.89, P<0.001). Relative to the final menstrual period (FMP), the risk of depressive symptoms was greater in the years before and lower in the years following the FMP. Among women with a history of depression, the likelihood of depressive symptoms was 13 times greater overall and 8 times greater postmenopause compared to women with no depression history. Among women who first experienced depressive symptoms approaching menopause, the risk of depressive symptoms declined after the FMP, with a significantly lower risk after the second year postmenopause. The risk of depressive symptoms postmenopause decreased by 35% for each unit (SD) increase before the FMP in the log rate of change of follicle stimulating hormone (FSH) (odds ratio 0.65, 95% CI 0.46–0.91, P=0.01). The final menstrual period was pivotal in the overall pattern of decreasing depressive symptoms in mid-life women, with greater risk before and lower risk following the FMP. A history of depression strongly increased the risk both before and after menopause. Women who had no history of depression before the menopause transition had a low risk of depressive symptoms after two or more years following the FMP.