Associations of hormones and menopausal status with depressed mood in women with no history of depression
Associations of hormones and menopausal status with depressed mood in women with no history of depression
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DOI：
10.1001/archpsyc.63.4.375
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发表时间：
2006-04-01
影响因子：
--
通讯作者：
Nelson, DB
中科院分区：
文献类型：
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作者：
Freeman, EW;Sammel, MD;Nelson, DB
内容：无抑郁症病史的妇女在绝经过渡期报告的抑郁情绪是否与绝经状态和生殖激素变化有关是有争议的，缺乏科学信息。目的：确定绝经过渡期新发抑郁症状和诊断的抑郁障碍，并确定绝经状态、生殖激素和其他危险因素与这些病例的相关性。设计：一项确定抑郁情绪危险因素的女性内纵向（8年）研究。设置：一个随机确定的基于人群的队列的子集。参与者：在队列登记时没有抑郁病史的绝经前女性。主要结果测量：采用抑郁症流行病学研究中心量表（CES-D）评估抑郁症状，和精神障碍的初级保健评估PRIME-MD用于识别抑郁障碍的临床诊断。高CES-D评分（>= 16）发生在女性绝经过渡期的可能性是绝经前的4倍多（比值比，4.29; 95%可信区间，2.39-7.72; P <0.001）。在调整吸烟、体重指数、经前综合征、潮热、睡眠不佳、健康状况、就业和婚姻状况后，女性绝经状态的变化、促卵泡激素和促黄体激素水平的升高以及雌二醇、促卵泡激素和促黄体激素在女性自身平均水平附近的变异性增加均与高CES-D评分显著相关。抑郁症的诊断是21/2倍更可能发生在绝经过渡期相比，当妇女是绝经前（比值比，2.50; 95%可信区间，1.25-5.02; P = 0.01）;激素指标也与该结果显著相关。过渡到绝经期及其变化的激素环境与无抑郁症史的女性新发抑郁情绪密切相关。
Context: Whether depressed mood reported in the transition to menopause by women with no history of depression is associated with menopausal status and changes in reproductive hormones is controversial and lacks scientific information.Objectives: To identify new onset of depressive symptoms and diagnosed depressive disorders in the menopausal transition and to determine the associations of menopausal status, reproductive hormones, and other risk factors with these cases.Design: A within-woman, longitudinal (8-year) study to identify risk factors of depressed mood.Setting: A subset of a randomly identified, population-based cohort.Participants: Premenopausal women with no history of depression at cohort enrollment.Main Outcome Measures: The Center for Epidemiological Studies of Depression scale (CES-D) was used to assess depressive symptoms, and the Primary Care Evaluation of Mental Disorders (PRIME-MD) was used to identify clinical diagnoses of depressive disorders.Results: High CES-D scores (>= 16) were more than 4 times more likely to occur during a woman's menopausal transition compared with when she was premenopausal (odds ratio, 4.29; 95% confidence interval, 2.39-7.72; P < .001). Within-woman change in menopausal status, increased levels of follicle-stimulating hormone and luteinizing hormone, and increased variability of estradiol, follicle-stimulating hormone, and luteinizing hormone around the woman's own mean levels were each significantly associated with high CES-D scores after adjusting for smoking, body mass index, premenstrual syndrome, hot flashes, poor sleep, health status, employment, and marital status. A diagnosis of depressive disorder was 21/2 times more likely to occur in the menopausal transition compared with when the woman was premenopausal (odds ratio, 2.50; 95% confidence interval, 1.25-5.02; P = .01); the hormone measures were also significantly associated with this outcome.Conclusion: Transition to menopause and its changing hormonal milieu are strongly associated with new onset of depressed mood among women with no history of depression.