Risk Factors ID’d for Depression in Postmenopausal Women

A high percentage of postmenopausal women experience depression, and the risk is increased by factors including physical disabilities and having many children, scientists said.

In a cross-sectional study of 485 postmenopausal women surveyed with questionnaires, 199 (41%) were found to have depression, reported Kevser Ozdemir, PhD, of Sakarya University in Turkey, and colleagues.

Their study, online in Menopause, also identified several factors that significantly increased the risk:

• Alcohol consumption (OR 11.772, P=0.003)

• History of illness that required continuous medication (OR 3.579, P=0.001)

• Presence of physical disability (OR 2.242, P=0.001)

• History of any mental disorder with a physician’s diagnosis (OR 4.213, P=0.001)

• Having four or more living children (OR 4.174, P=0.001)

Previous studies reported depression rates as high as 70% among postmenopausal women. “The reason why our finding is different from the results in the literature is that our study was conducted among women who had attended a hospital outpatient clinic, not on a community basis,” the researchers wrote. “In addition, it is thought that the symptoms of depression are higher in the perimenopausal period than the postmenopausal period due to the loss of the reproductive cycle and hormonal transition effects.”

Despite the lower depression rate reported in the study, the results confirm that clinicians should be aware of the increased risk in these patients, Stephanie Faubion, MD, medical director of the North American Menopause Society, who was not involved in the study, said in a statement.

“The findings of this study involving postmenopausal Turkish women are consistent with existing literature and emphasize the high prevalence of depressive symptoms in midlife women, particularly those with a history of depression or anxiety, chronic health conditions, and psychosocial factors such as major stressful life events,” Faubion said. “Women and the clinicians who care for them need to be aware that the menopause transition is a period of vulnerability in terms of mood.”

Ozdemir and colleagues noted that previous studies suggested a link between the decreased estrogen production in menopause and the psychological symptoms some women experience. More specifically, tryptophan, which plays a role in the secretion of serotonin, is related to the level of estrogen in the blood. The level of free tryptophan decreases with reduced blood estrogen, which leads to less serotonin. Low levels of serotonin, in turn, is associated with depression and anxiety.

The researchers also speculated about why some of the other factors they identified might be associated with depression. For example, having many children could mean that a woman has less time for herself, her spouse, and sexual activity. In addition, postmenopausal women with many children may also have many grandchildren, also requiring care.

In Turkish culture, for example, multiple generations of family members often live together. “Thus, feelings of loneliness are minimized,” Ozdemir and co-authors said. “Therefore, depression is expected to decrease with a higher number of children. However, despite all of this, our study findings can be explained due to the decrease in time allocated by the woman to herself and her husband, and increased time spent with children as the number of children increases.”

The study included 485 postmenopausal women who visited an obstetrics and gynecology clinic in Sakarya, Turkey, from March through September 2018. Their ages ranged from 35 to 78, with an average age of 56. The majority of women (97%) experienced menopause naturally, but for a small group (13%), menopause was the result of chemotherapy or surgery.

Ozdemir and co-authors interviewed the women face-to-face and collected data on a questionnaire that included items from the Beck Depression Scale, the Hospital Anxiety and Depression Scale, and the Templer Death Anxiety Scale. The researchers found a moderate correlation between depression and anxiety but none between depression and fear of death for women in the study.

Limitations of the study, the researchers said, included its cross-sectional design and the fact that participants came from only one clinic. In addition, no formal diagnoses of depression were made by physicians — it was assessed only via the questionnaire responses.

“Depression among postmenopausal women is an important health problem that needs to be studied further,” the team wrote. “It would be beneficial to conduct awareness-raising studies, perform early diagnosis for postmenopausal women, and provide psychological counseling services for postmenopausal women.”