Longitudinal change in reproductive hormones and depressive symptoms across the menopausal transition: results from the Study of Women's Health Across the Nation (SWAN).
Longitudinal change in reproductive hormones and depressive symptoms across the menopausal transition: results from the Study of Women's Health Across the Nation (SWAN).
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DOI：
10.1001/archgenpsychiatry.2010.55
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发表时间：
2010-06
影响因子：
--
通讯作者：
Matthews, Karen A.
中科院分区：
文献类型：
--
作者：
Bromberger, Joyce T.;Schott, Laura L.;Kravitz, Howard M.;Sowers, MaryFran;Avis, Nancy E.;Gold, Ellen B.;Randolph, John F., Jr.;Matthews, Karen A.
生殖激素对情绪的影响一直是大量研究的焦点。临床和流行病学研究的结果不一致。目前尚不清楚绝经过渡期血清激素水平的变化是否与抑郁症状有关。评估血清激素水平和高抑郁症状之间的关系，以及激素水平或其变化是否可以解释绝经状态与抑郁症状之间的关系。一项关于绝经期的纵向、以社区为基础的多地点研究。从1995年12月到2008年1月，在基线和每年收集一系列因素的数据。测定早期卵泡期血清样本的雌二醇、卵泡刺激素、睾酮和硫酸脱氢表雄酮水平。全国七个社区。一个以社区为基础的样本3302多民族妇女，年龄在42至52岁，仍然在使用和不使用外源性生殖激素。使用流行病学研究中心抑郁量表（CES-D）评估抑郁症状。主要结局是CES-D评分为16或更高。在多变量随机效应逻辑回归模型中，对数转换的睾酮水平与CES-D评分为16或更高的几率显著正相关（优势比=1.15; 95%置信区间，1.01-1.31），从基线到每次年度访视，对数转换睾酮的较大增加与CES的几率增加显著相关，D评分≥ 16（比值比=1.23; 95%置信区间，1.04-1.45）。受教育程度低、西班牙裔、血管痉挛症状、压力性生活事件和每次访视时社会支持低均与CES-D评分为16或更高独立相关。没有其他激素与CES-D评分为16或更高相关。在所有分析中，与绝经前相比，围绝经期或绝经后与CES-D评分为16或更高显著相关。较高的睾丸激素水平可能导致更年期过渡期的抑郁症状。这种关联是独立的绝经状态，这仍然是一个独立的预测较高的抑郁症状。
The contribution of reproductive hormones to mood has been the focus of considerable research. Results from clinical and epidemiological studies have been inconsistent. It remains unclear whether alterations in serum hormone levels across the menopausal transition are linked to depressive symptoms. To evaluate the relationship between serum hormone levels and high depressive symptoms and whether hormone levels or their change might explain the association of menopausal status with depressive symptoms previously reported in a national sample of midlife women. A longitudinal, community-based, multisite study of menopause. Data were collected at baseline and annually from December 1995 to January 2008 on a range of factors. Early follicular phase serum samples were assayed for levels of estradiol, follicle-stimulating hormone, testosterone, and dehydroepiandrosterone sulfate. Seven communities nationwide. A community-based sample of 3302 multiethnic women, aged 42 to 52 years, still menstruating and not using exogenous reproductive hormones. Depressive symptoms assessed with the Center for Epidemiological Studies Depression Scale (CES-D). The primary outcome was a CES-D score of 16 or higher. In multivariable random-effects logistic regression models, log-transformed testosterone level was significantly positively associated with higher odds of a CES-D score of 16 or higher (odds ratio=1.15; 95% confidence interval, 1.01–1.31) across 8 years, and a larger increase in log-transformed testosterone from baseline to each annual visit was significantly associated with increased odds of a CES-D score of 16 or higher (odds ratio=1.23; 95% confidence interval, 1.04–1.45). Less education, being Hispanic, and vasomotor symptoms, stressful life events, and low social support at each visit were each independently associated with a CES-D score of 16 or higher. No other hormones were associated with a CES-D score of 16 or higher. Being perimenopausal or post-menopausal compared with being premenopausal remained significantly associated with a CES-D score of 16 or higher in all analyses. Higher testosterone levels may contribute to higher depressive symptoms during the menopausal transition. This association is independent of menopausal status, which remains an independent predictor of higher depressive symptoms.
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