The prevalence and associated factors of depression during pre-, peri-, and post-menopausal period among the middle-aged women of Dhaka city

Global prevalence of depression in menopausal women: A systematic review and meta-analysis

BACKGROUND

An association between the menopause and depression is widely reported. This review aims to determine the global prevalence of depression in menopausal women (this includes women in perimenopause and postmenopause).

METHODS

PubMed, Web of Science, Embase, and PsycINFO databases were systematically searched from database inception until March 1, 2024. Studies with validated methods for assessing the prevalence of depression in perimenopausal and postmenopausal women were included. Two authors independently extracted relevant data. Random effects meta-analysis and Meta-regression analysis were performed using Stata software.

RESULTS

Total of 55 studies (76,817 participants) were included in the review. A random effects model was used to calculate pooled prevalence. The pooled depression prevalence in menopausal women was 35.6 % (95 % CI: 32.0-39.2 %), with 33.9 % (95 % CI: 27.8-40.0 %) in perimenopausal women, and 34.9 % (95 % CI: 30.7-39.1 %) in postmenopausal women. Subgroup analyses indicated that region, screening tool, study design, and setting moderated the prevalence of depression. Meta-regression indicated that smaller sample sizes and poorer study quality were significantly associated with a higher prevalence.

LIMITATIONS

There was a high degree of heterogeneity across the included studies. Only articles published in English were included. There was significant publication bias in this meta-analysis. There is insufficient information about many risk factors of menopausal depression in current meta-analysis.

CONCLUSIONS

Depression is common among menopausal women worldwide. To reduce the negative impact of depression on health outcomes in menopausal women, regular screening and the availability of effective prevention and treatment measures should be made available for this population.

Prevalence and associated factors of depression in postmenopausal women: a systematic review and meta-analysis

BACKGROUND

Depression is a prevalent mental health problem in postmenopausal women. Given its significant impact on the quality of life and overall well-being of postmenopausal women, there is need for a comprehensive review and meta-analysis of the existing research globally. This systematic review and meta-analysis evaluated the global prevalence of depression and potential associated factors in postmenopausal women.

METHODS

The Cochrane Library, PubMed, EMBASE, Web of Science, MEDLINE, and PsycINFO databases were systematically searched from inception to March 22, 2023. The meta-analysis used the random-effects model to calculate the prevalence of depression rates and associated factors. In addition, subgroup analysis and sensitivity analysis were performed. Publication bias was assessed using funnel plots, Egger's test, and nonparametric trim-and-fill tests.

RESULTS

The meta-analysis included 50 studies that involved 385,092 postmenopausal women. The prevalence of depression in postmenopausal women was 28.00% (95% CI, 25.80-30.10). Among the factors relevant to depression among postmenopausal women, marital status (OR: 2.03, 95%CI: 1.33-3.11), history of mental illness (OR: 2.31, 95%CI: 1.50-3.57), chronic disease (OR: 3.13, 95%CI: 2.20-4.44), menstrual cycle (OR: 1.42, 95%CI: 1.17-1.72), abortion numbers (OR: 1.59, 95%CI: 1.40-1.80), menopausal symptoms (OR: 2.10, 95%CI: 1.52-2.90), and hormone replacement therapy (OR: 1.76, 95%CI: 1.31-2.35) were risk factors, while physical activity (OR: 0.56, 95%CI: 0.53-0.59), number of breastfed infants (OR: 0.43, 95%CI: 0.19-0.97), menopause age (OR: 0.44, 95%CI: 0.37-0.51) were preventive factors.

CONCLUSIONS

This study demonstrated that the prevalence of postmenopausal depression is high, and some risk factors and protective factors associated with it have been identified. It is necessary to improve screening and management and optimize prevention and intervention strategies to reduce the harmful effects of postmenopausal depression.

Association between sleep duration and depression in menopausal women: a population-based study

Aims

This research investigated menopausal women older than 50 years to find whether there were any independent relationships between the duration of sleep they got and their prevalence of depression.

Methods

National Health and Nutrition Examination Survey (NHANES) datasets from 2011-2020 were utilized in a cross-sectional study. Using multivariate linear regression models, the linear relationship between sleep duration and depression in menopausal women was investigated. Fitted smoothing curves and thresholds impact evaluation were used to investigate the nonlinear relationship. Then, subgroup analyses were performed according to smoking, drinking alcohol, diabetes, hypertension, heart disease, and moderate activities.

Results

This population-based study included a total of 3,897 menopausal women (mean age 65.47 ± 9.06 years) aged≥50 years; 3,159 had a depression score <10, and 738 had a depression score≥10. After controlling for all covariates, the prevalence of depression was 17% higher among participants with short sleep duration [OR=1.17, 95%CI=(0.65, 1.70), P<0.0001] and 86% [OR=1.86, 95%CI=(1.05, 2.66), P<0.0001] compared to participants with normal sleep duration. In subgroup analyses stratified by smoking and diabetes, the sleep duration and depression scores of non-smokers [β=-0.18, 95%CI= (-0.33, -0.02), P=0.0241] and diabetics were independently negatively correlated [β=-0.32, 95%CI= (-0.63, -0.01), P=0.0416]. Using a two-segment linear regression model, we discovered a U-shaped relationship between sleep duration and depression scores with an inflection point of 7.5 hours. Less than 7.5 hours of sleep was associated with an increased risk of developing depression [β=-0.81, 95%CI= (-1.05, -0.57), P<0.001]. However, sleeping more than 7.5 hours per night increased the risk of depression considerably [β=0.80, 95%CI= (0.51, 1.08), P<0.001].

Conclusions

Depression is associated with sleep duration in menopausal women. Insufficient or excessive sleep may increase the risk of depression in menopausal women.

Heartache and Heartbreak: An Observational and Mendelian Randomization Study

Background

Depression has a significant effect on cardiovascular disease (CVD), but uncertainties persist regarding which modifiable risk factors mediate the causal effects. We aim to determine whether depression is causally linked to CVD and which modifiable risk factors play potential mediating roles.

Methods

We used a two-sample Mendelian randomization (MR) approach and NHANES 2007-2018 data to estimate the effects of depression on various CVD cases and investigated 28 potential mediators of the association between depression and CVD.

Results

The results of our MR analysis indicated that genetically determined depression was associated with increased risk of several CVD, including coronary heart disease (odds ratio (OR) = 1.14; 95% confidence interval (CI): 1.05,1.22), myocardial infarction (OR = 1.19; 95% CI, 1.09,1.31), atrial fibrillation (OR = 1.14; 95% CI, 1.06,1.22), and stroke (OR = 1.13; 95% CI, 1.05,1.22). However, there was no causal association between depression and heart failure. Four out of 28 cardiometabolic risk factors, including hyperlipidemia, hypertension, diabetes, and prescription opioid use, were identified as mediators of the association between depression and various CVDs. Observational association analyses from NHANES data yielded consistent results.

Conclusion

Our findings demonstrated that depression has a causal detrimental effect on various CVDs. Four causal mediators (hyperlipidemia, hypertension, diabetes, and prescription opioid use) were screened to explain the causal effect. Implementing targeted management strategies for these risk factors may be warranted to mitigate the public health burden of CVD among individuals with depression.

D-Pinitol attenuates postmenopausal symptoms in ovariectomized mice

AIMS

Menopause is a natural process in women that can lead to post-menopausal syndrome with symptoms such as hot flushes, weight gain, anxiety, cognitive decline, and depression. Hormonal replacement therapy is commonly prescribed. However, it has serious adverse effects. Herbal medicinal products and isoflavones are used as alternatives. D-Pinitol found in Pinaceae and Fabaceae families has anti-inflammatory and antioxidant effects. However, it has not received as much attention as isoflavones. In this study, we investigated whether D-pinitol could alleviate post-menopausal symptoms using an ovariectomized (OVX) mouse model.

MAIN METHODS

Female ICR mice were divided into six groups: sham (vehicle), OVX (vehicle), OVX + D-pinitol (10, 30, 100 mg/kg, p.o.), and OVX + estradiol (0.5 mg/kg, s.c.). Treatment with vehicle, D-pinitol, and estradiol began at seven weeks post ovariectomy. We employed several behavioral tests, hot-flush test, and Western blot analysis.

KEY FINDINGS

We found that D-pinitol treatment (30, 100 mg/kg, p.o.) reversed cognitive dysfunction in OVX mice (novel object recognition and Y-maze test). Additionally, D-pinitol alleviated anxiety-like behaviors (elevated plus-maze) and reversed depressive-like behaviors (splash test, tail suspension test). It also normalized increased basal tail skin temperature in OVX mice. Moreover, D-pinitol administration reversed decreased expression of ERβ and synaptophysin and phosphorylation of ERK and PI3K-Akt-GSK-3β induced by OVX in the hippocampus and prefrontal cortex.

SIGNIFICANCE

These findings indicate that D-pinitol might be a promising candidate for treating post-menopausal symptoms by increasing ERβ and synaptophysin expression levels and activation of ERK or PI3K-Akt-GSK-3β signaling pathway, at least in part.

Psychological health of postmenopausal women: a bibliometric analysis in the recent decade

The aim of this study is to analyze the publication trends on the psychological health of postmenopausal women by performing a bibliometric and visualization analysis that can be used as a foundation for understanding current and future research plans. Publications were retrieved from Dimensions database from 2012 to June 2022. VOSviewer software was used for data mining and visualization. A total of 1718 papers were selected by keyword search and delimiting criteria. To evaluate the productive nations, authors, journals, articles and frequent joint citations, citation analysis, author keyword co-occurrence analysis, co-authorship analysis and co-citation analysis were performed. Results depict that the USA contributed the most papers (n = 457). Maximum articles (n = 192) were published in 2021. The highest number of articles are published in Menopause: The Journal of the North American Menopause Society and Climacteric: The Journal of the International Menopause Society. Out of the top 10 contributing organizations in the field, six organizations were from the USA. R. Nappi of Italy is the most productive author with 20 articles and 1138 citations. From the point of average citations per article, H. Joffe has the highest score (71.5). The data reported in this analysis contribute to discussions about the development, growth and current state of psychological health of postmenopausal women as well as its impact. These findings offer helpful guidance for researchers in choosing their potential fields of study and integrating different approaches to solve complicated issues, finding potential co-authors and choosing the right institutions for supporting academic studies or collaborative research.

Prevalence of insomnia among the post-menopausal women who suffered from COVID-19 in Bangladesh: A nationwide cross-sectional study

Objectives

The impact of the pandemic on sleeping problems in all age groups has been widely reported, but insomnia in post-menopausal women has been understudied worldwide. The study sought to determine the prevalence and associated factors for insomnia in post-menopausal women who were infected with COVID-19 in Bangladesh.

Material and methods

A cross-sectional telephonic survey was conducted from August to December 2021 among post-menopausal women with a history of COVID-19 infection in Bangladesh. Data on socio-demographic factors, lifestyle and behavioral factors, COVID-19-associated factors, and self-reported pre-existing co-morbidities were collected. A validated scale Insomnia Severity Index (ISI) was applied to assess the level of insomnia . Bivariate and multiple linear regression analyses were performed to assess the associated factors with insomnia.

Results

Of the total 900 participants, the prevalence of insomnia was reported at 70%, with 33.67% moderately severe, 25.11% subthreshold, and 11.22% severe insomnia. Participants with increased ISI scores were significantly more likely to be retired, had 2-4 children, felt disturbed by COVID-19 related news, hospitalized for COVID-19 management, receieved the first dose of vaccine, and experienced post COVID-19 symptoms such as fatigue, lack of concentration, and memory loss. On the other hand, living in a nuclear family and taking care of COVID-19-infected family members were significantly negatively associated with insomnia.

Conclusions

Our findings indicate the need to safeguard the well-being considerations of post-menopausal women through a well-designed comprehensive social safety net program for the present pandemic and similar crises in the future.

Prevalence of Psychosomatic and Genitourinary Syndrome Among Menopausal Women: A Systematic Review and Meta-Analysis

Introduction

The menopausal transition represents the passage from reproductive to non-reproductive life and is characterized by a number of menstrual disturbances. We systematically reviewed the evidence on the prevalence of psychosomatic and genitourinary syndrome among menopausal women and compared the risk of symptoms between premenopausal, perimenopausal, and post-menopausal women.

Methods

We performed a systematic search in MEDLINE, CINAHL, and ScienceDirect through March 2021. Case series/reports, conference papers and proceedings, articles available only in abstract form, editorial reviews, letters of communication, commentaries, systematic reviews, and qualitative studies were excluded. Two reviewers independently extracted and assessed the quality of data using the Joanna Briggs Institute Meta-Analysis. The outcomes were assessed with random-effects model using the Review Manager software.

Results

In total, 29 studies had a low risk of bias and were included in the review. Our findings showed that the pooled prevalence of somatic symptoms in post-menopausal women (52.6%) was higher than in the premenopausal and perimenopausal stages (34.6 and 39.5%, respectively). There was a low prevalence of psychological symptoms in premenopausal women (28.4%). The genitourinary syndrome was highest among post-menopausal women (55.1%), followed by perimenopausal (31.9%) and premenopausal (19.2%) women.

Conclusion

Post-menopausal women have a higher risk of experiencing menopausal symptoms particularly genitourinary syndrome than premenopausal and perimenopausal women. It is pertinent for healthcare professionals to evaluate the symptoms in order to provide them with a better quality of life.

Systematic Review Registration

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021235958

Prevalence and factors associated with depression among the mothers of school-going children in Dhaka city, Bangladesh: A multi stage sampling-based study

Background

Motherhood is associated with extra stress, and mothers of young children are particularly prone to developing depression and mental health problems.

Methodology

This analytical cross-sectional study was conducted in Dhaka city, Bangladesh, from June to December 2019. Mothers of school-going children were recruited through a multistage sampling technique. Dhaka city was divided into two divisions and then further subdivided into public and private sectors. Six schools were selected from each sector by using a simple random sampling technique. A list of class five to eight students were collected from each school by systematic random sampling. Data were collected through face-to-face interviews using semi-structured questionnaires. The rate of depressive symptoms was measured by the validated Zung Self-Rating Depression Scale (SDS).

Result

A total of 324 women participated in this study; the majority of the women (85.5%) were Muslim, 67.0% were housewives, and 53.1% had a girl child. Among the women, 15.4% had mild, 22.2% had moderate, and 20.1% had severe depression. Most of the child's behavioral and lifestyle factors were associated with the mother's depression. Adjusted analyses indicate that if a child is often unhappy, depressed, or tearful [(OR (95%CI = 22.27 (8.39-59.11)], gets nervous in new situations or easily loses confidence [(OR (95%CI) = 5.45 (2.96-10.00)], often lies or cheats [(OR (95%CI) = 8.93 (3.76-21.22)], gets afraid easily [(OR (95%CI) = 7.09 (3.79-13.24)], watches television for 3 h or more [(OR (95%CI) = 23.77 (6.46-87.48)] browses the internet for 3 h or more [(OR (95%CI = 7.37 (2.76-19.67)] were associated with mother's depression.

Conclusion

The study concludes that depression among the mothers of school-going children in Dhaka city of Bangladesh is high. Several lifestyles and behavioral factors of school-going children are significantly associated with the mothers' depression.

Effects of Group and Individual Culturally Adapted Cognitive Behavioral Therapy on Depression and Sexual Satisfaction among Perimenopausal Women

Aims: Previous research has shown the efficacy of culturally adapted Cognitive Behavioral Therapy (CA-CBT) in reducing depression, yet its effect on increasing sexual satisfaction is not well documented. In this study, an embedded randomized controlled trial design was used to examine the effect of group and individual CA-CBT on depression and sexual satisfaction among perimenopausal women. Method: A total of 64 depressed Iranian perimenopausal women were randomly assigned to two formats of treatments; sixteen sessions of group CA-CBT and eight sessions of individual CA-CBT, as well as a waitlist control group. Depression and sexual satisfaction were measured using BDI-II and ENRICH, respectively, at T1 (pre-treatment), T2 (post-treatment) and T3 (follow-up). Results: Repeated measures ANOVA indicated that the women who underwent both group and individual CA-CBT had effectively reduced depression and increased sexual satisfaction between pre-treatment and post-treatment, and it was sustained after six months of follow-ups with large effect sizes of significant differences (p < 0.001), but the control group did not. Conclusion: The results showed promising evidence for the efficacy of both treatment groups of CA-CBT for depression and sexual satisfaction among perimenopausal women. The population mental health burden among perimenopausal women may likely be reduced by propagating this effective treatment.