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Pasokh Z, Seif M, Ghaem H, Rezaianzadeh A, Johari MG. Age at natural menopause and development of chronic diseases in the female population of Kharameh, Iran: A historical cohort study. Health Sci Rep 2024; 7:e2042. [PMID: 38650726 PMCID: PMC11033488 DOI: 10.1002/hsr2.2042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 03/19/2024] [Accepted: 03/21/2024] [Indexed: 04/25/2024] Open
Abstract
Background and Aims Declines in estradiol levels after menopause have been reported to be associated with several health outcomes. This study aimed to determine the effect of age at natural menopause (ANM) on some of the most common chronic diseases. Methods This historical cohort study was performed on 2636 postmenopausal women aged 40-70 years participating in phase one of the PERSIAN cohort study in Kharameh, Iran, during 2015-2017. The effect of early (<45 years), intermediate (45-53 years), and late menopause (>53 years) on chronic diseases such as hypertension, diabetes, ischemic heart diseases, stroke, thyroid diseases, and depression was assessed using classic logistic regression for diseases with an incidence rate of more than 10% and Firth's logistic regression for diseases with an incidence of less than this amount. Results The mean age of women was 53.48 ± 8.59. Respectively, early and intermediate menopause was associated with ischemic heart disease (odds ratio [OR = 1.61, 95% confidence interval [CI]: 1.08-2.42; p = 0.020), (OR = 1.57, 95% CI: 1.13-2.21; p = 0.008) and thyroid diseases (OR = 3.10, 95% CI: 1.64-6.24; p < 0.001), (OR = 1.83, 95% CI: 1.02-3.57; p = 0.042). furthermore, early menopause was a risk factor for diabetes (OR = 1.46, 95% CI: 1.07-2.00; p = 0.018), depression (OR = 4.79, 95% CI: 2.20-11.79; p = <0.001) and stroke (OR = 3.00, 95% CI: 1.08-9.32; p = 0.034). Conclusions In this study, women with diabetes, ischemic heart diseases, stroke, thyroid disorders, and depression had a younger ANM compared to their healthy counterparts. Therefore, applying appropriate strategies to postpone the age of menopause, can reduce the incidence of these types of chronic diseases.
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Affiliation(s)
- Zahra Pasokh
- Student Research Committee, Department of Epidemiology, School of HealthShiraz University of Medical SciencesShirazIran
| | - Mozhgan Seif
- Non‐Communicable Diseases Research Center, Department of Epidemiology, School of HealthShiraz University of Medical SciencesShirazIran
| | - Haleh Ghaem
- Non‐Communicable Diseases Research Center, Department of Epidemiology, School of HealthShiraz University of Medical SciencesShirazIran
| | - Abbas Rezaianzadeh
- Colorectal Research Center, Department of Epidemiology, School of HealthShiraz University of Medical SciencesShirazIran
| | - Masoumeh Ghoddusi Johari
- Breast Diseases Research Center, Community Medicine DepartmentShiraz University of Medical SciencesShirazIran
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Zhang S, Yang H, Li Z, Zhang S, Wu Y. A study of the effect of number of children on depression among rural older women: empirical evidence from China. J Biosoc Sci 2024; 56:182-206. [PMID: 37718633 DOI: 10.1017/s0021932023000172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
The association between early reproductive events and health status in later life has always been of interest across disciplines. The purpose of this study was to investigate whether there was an association between the number of children born in the early years of elderly women and their depression in later life based on a sample of older women aged 65 years and above with at least one child in rural China. Data from the Chinese Longitudinal Healthy Longevity Survey in 2018, this study used the ordinary least square method to conduct empirical research. This study has found a significant correlation between an increase in the number of children and depression in older rural women. When considering the sex of the child, the number of daughters had a greater and more significant impact on depression. Number of children may exacerbate depression of older women through declining self-rated health and reduced social activity, while increased inter-generational support alleviated depression. The association between number of children born and depression also existed in urban older women, though not significant. Therefore, it is suggested to accelerate the improvement of supporting policies related to childbirth, developing a healthy and scientific fertility culture, and improving rural maternal and child health services. Women should be assisted in balancing their roles in the family and in society, and in particular in sharing the burden of caring for children. Targeted efforts to increase old-age protection for older people.
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Affiliation(s)
- Shuo Zhang
- School of Sociology and Population Studies, Renmin University of China, Beijing, China
| | - Hualei Yang
- School of Public Administration, Zhongnan University of Economics and Law, Wuhan, China
| | - Zhiyun Li
- School of Politics and Public Administration, Qingdao University, Qingdao, China
| | - Siqing Zhang
- School of Government, Nanjing University, Nanjing, China
| | - Yuanyang Wu
- School of Medicine and Health Management, Tongji Medical School, Huazhong University of Science and Technology, Wuhan, China
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Ichiki T, Koyama A, Imai M, Nishi Y, Abe Y, Fukunaga R, Murakami R, Nagaoka M, Takebayashi M, Fujise N. The trajectory of non-depressed suicidal ideation in community-dwelling older people in a rural area in Japan: a prospective longitudinal study with a 3-year follow-up. Psychogeriatrics 2023; 23:831-837. [PMID: 37448176 DOI: 10.1111/psyg.13006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 06/26/2023] [Accepted: 06/28/2023] [Indexed: 07/15/2023]
Abstract
BACKGROUND Suicidal ideation is closely related to severe suicidal behaviour and is an important predictor of suicide attempt and completion, including in older people. Older people tend to have many opportunities to be conscious of death, and may have vague suicidal ideation because of various loss experiences, even if they are not depressed. We hypothesised that suicidal ideation among older people might be a risk factor for later transition to depression. The present study aimed to clarify risk factors that predict the incidence of depression in older people 3 years post-baseline in a rural area of Japan, and to examine the subsequent course of depression among non-depressed older people with suicidal ideation. METHODS In 2015 and 2018, survey questionnaires were mailed to residents aged 65 years and over living in a rural area in Japan. Participants were divided into a depression group and a non-depression group using 15-item Geriatric Depression Scale scores 3 years post-baseline. Logistic regression analysis was used to identify predictive factors of late-life depression 3 years post-baseline. RESULTS We received 597 valid responses, with a 3-year follow-up rate of 78.8%. Regarding suicidal ideation, 6.7% of non-depressed older people exhibited suicidal ideation at baseline. Of these, 9.8% exhibited depression after 3 years post-baseline. Logistic regression analysis indicated that development of late-life depression is significantly associated with suicidal ideation, being female, and poor health-related quality of life (HRQOL). CONCLUSIONS The results revealed that suicidal ideation, being female, and poor HRQOL were predictive factors of the development of late-life depression 3 years post-baseline in a rural area of Japan. These findings provide novel information regarding the transition to depression among community-dwelling older people who are not depressed but have suicidal ideation. Whereas suicidal ideation is considered to be a symptom of depression, the current results suggest that suicidal ideation may precede depression in some older people.
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Affiliation(s)
- Takahiro Ichiki
- Department of Neuropsychiatry, Kumamoto University Hospital, Kumamoto, Japan
- Department of Neuropsychiatry, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan
| | - Asuka Koyama
- Faculty of Social Welfare, Kumamoto Gakuen University, Kumamoto, Japan
| | - Masaki Imai
- Department of Neuropsychiatry, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan
- Kumamoto Mental Health Hospital, Kumamoto, Japan
| | | | | | | | | | - Maiko Nagaoka
- Health Care Center, Kumamoto University, Kumamoto, Japan
| | - Minoru Takebayashi
- Department of Neuropsychiatry, Faculty of Life Science, Kumamoto University, Kumamoto, Japan
| | - Noboru Fujise
- Health Care Center, Kumamoto University, Kumamoto, Japan
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Kim S, Kim SM, Kim DS, Han S, Hong JS, Seo JS. Level of Psychological and Somatic Symptoms Predict Perimenopausal Syndrome Severity Better Than Obstetric and Psychiatric History Do Among Korean Women. Psychiatry Investig 2023; 20:18-26. [PMID: 36721882 PMCID: PMC9890039 DOI: 10.30773/pi.2022.0249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 10/30/2022] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVE Menopause symptoms can vary in type, duration, and severity. The purpose of this study was to investigate the key factors predicting severe symptoms among Korean perimenopausal women with various demographic data, obstetric and psychiatric histories, and menopausal symptoms screening scale scores. METHODS Data were collected from 1,060 women, and 4 latent classes were identified using latent profile analysis, with 6 major categories of menopausal complaints. Among the 4 classes, we selectively used data from the "all unimpaired" and "all impaired" groups. Menopause rating scale (MRS), sociodemographic, obstetric, and psychiatric factors were assessed, and hierarchical logistic regression analyses were conducted with the "all impaired" group as a dependent variable. RESULTS Marital status and scores on the psychological and somatic subscales of the MRS were statistically related to being in the "all impaired" group. Otherwise, family history of menopausal symptoms, menarche age, and history of other psychiatric disorders were not statistically significant predictors of being in the "all impaired" group. CONCLUSION The psychological and somatic subscales of the MRS predict the severity of perimenopausal syndrome better than obstetric and psychiatric history do among Korean perimenopausal women. Psychological and somatic symptoms as well as genitourinary symptoms in menopausal patients should be closely evaluated.
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Affiliation(s)
- Soyeon Kim
- Department of Psychiatry, College of Medicine, Chung-Ang University, Seoul, Republic of Korea
| | - Sun Mi Kim
- Department of Psychiatry, College of Medicine, Chung-Ang University, Seoul, Republic of Korea
| | - Da Seul Kim
- Department of Psychiatry, College of Medicine, Chung-Ang University, Seoul, Republic of Korea
| | - Seunga Han
- Department of Political Science, Vanderbilt University, Nashville, TN, USA
| | - Ji Sun Hong
- Department of Psychiatry, College of Medicine, Chung-Ang University, Seoul, Republic of Korea
| | - Jeong Seok Seo
- Department of Psychiatry, College of Medicine, Chung-Ang University, Seoul, Republic of Korea
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Hypertension and Low Body Weight Are Associated with Depressive Symptoms Only in Females: Findings from the Shika Study. Behav Sci (Basel) 2022; 12:bs12110413. [PMID: 36354390 PMCID: PMC9687659 DOI: 10.3390/bs12110413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 10/24/2022] [Accepted: 10/26/2022] [Indexed: 11/17/2022] Open
Abstract
Although the relationship between hypertension and depression is influenced by several physiological factors, including body weight and other lifestyle factors, such as eating behavior, the specific involvement of depression in hypertension remains unclear. Therefore, this epidemiological study examined the role of body weight in the relationship between hypertension and depressive symptoms among the middle-aged and elderly living in the community of Shika town. In total, 1141 males and 1142 females with mean ages of 69.09 and 70.61 years, respectively, participated this study. Physiological factors, including blood pressure, body mass index (BMI), and lifestyle, were investigated in a medical check-up in Shika town. Depressive symptoms were evaluated using the Geriatric Depression Scale 15 (GDS-15). A two-way analysis of covariance exhibited a significant interaction between the two hypertensive groups and body size groups on GDS in females. The post hoc Bonferroni method showed that in the hypertensive groups, GDS was significantly higher in the underweight group (BMI < 18.5) than in the standard/overweight group; however, this relationship was not observed in the no-hypertensive groups. Multiple regression analysis also verified this relationship. Therefore, it is suggested that the combination of hypertension and being underweight is associated with depressive symptoms only in females.
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Nakamura K, Sawada N, Kitamura K, Watanabe Y, Tsugane S. Menstrual and reproductive factors and limitations in activities of daily living: A case-control study within the Japan Public Health Center-based Prospective Study. J Obstet Gynaecol Res 2021; 47:3903-3912. [PMID: 34482606 DOI: 10.1111/jog.14959] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 06/23/2021] [Accepted: 07/22/2021] [Indexed: 02/07/2023]
Abstract
AIM Although menstrual/reproductive factors are known to be associated with physical disability, little is known about these associations in relation to activities of daily living (ADL). This study aimed to clarify associations between menstrual/reproductive factors and ADL limitations in peri- and postmenopausal women. STUDY DESIGN A nested case-control study of the Japan Public Health Center-based Prospective (JPHC) Study. METHODS The main outcome measure was self-reported ADL levels in the 10-year follow-up questionnaire survey of the JPHC Study conducted between 2000 and 2004 (N = 36 460). Women who "live inside almost independently, but go out with assistance" or had a lower level of activity were considered to have ADL limitations ("cases"), and all others served as controls. Candidate menstrual/reproductive predictors were as follows: menarcheal age, menopausal status, menopausal age, regularity of menses, menstrual cycle, number of pregnancies, age at first pregnancy, number of deliveries, age at first delivery, and breast feeding. Multiple logistic regression analyses were conducted, and odds ratios adjusted for age and past lifestyle were calculated. RESULTS Mean ages of cases (N = 592) and controls (N = 38 656) were 68.3 (SD = 7.6) and 61.1 (SD = 7.7) years, respectively. With respect to menopausal age, groups aged <45 and ≥55 years had significantly higher adjusted ORs (1.44, 95% CI: 1.09-1.90 and 1.55, 95%CI: 1.09-2.18, respectively) than the reference group (50-54 years). Multiparous women had significantly lower ORs than nulliparous women. CONCLUSION Our findings suggest that menopausal age and parity may predict future ADL limitations in women.
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Affiliation(s)
- Kazutoshi Nakamura
- Division of Preventive Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Norie Sawada
- Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
| | - Kaori Kitamura
- Division of Preventive Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Yumi Watanabe
- Division of Preventive Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Shoichiro Tsugane
- Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
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Wang H, Chen M, Xin T, Tang K. Number of children and the prevalence of later-life major depression and insomnia in women and men: findings from a cross-sectional study of 0.5 million Chinese adults. BMC Psychiatry 2020; 20:267. [PMID: 32471396 PMCID: PMC7260797 DOI: 10.1186/s12888-020-02681-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 05/18/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Pregnancy and parenthood have been associated with physical and mental health. Previous literature concerning the impacts of parity on mental health was inconsistent and lack epidemiolocal evidence. China, with growing mental health problems and changing fertility patterns, faces unique challenges. This study aims to examine the relationship between parity and the prevalence of major depression and insomnia among men and women in the Chinese population. METHODS Baseline data from a Chinese population-based study of 512,891 adults (59.01% women) from 10 areas, aged 30-79 were analyzed. Number of children was based on self-report by the participants. Major depression (MD) was assessed using the Composite International Diagnostic Inventory. Insomnia symptoms were accessed by a questionnaire comparable to that used in the Diagnostic and Statistical Manual of Mental Disorders. Logistic regression was used to assess the relationship between MD/Insomnia and number of children, after stratifications and adjustments. RESULTS For women, each additional child was associated with a 9% decreased odds of MD (OR: 0.91, 95%CI: 0.88-0.96), with the associations significant for those who lived in urban areas (OR: 0.76, 95%CI: 0.70-0.83), or had a lower education (OR: 0.90, 95%CI: 0.85-0.94), or had lower household income (OR: 0.89, 95%CI: 0.85-0.94), or had ever used alcohol (OR: 0.89, 95%CI: 0.84-0.93). The association between per additional children and MD was not significant in men (OR: 1.02, 95%CI: 0.97-1.07), but a decreased odd of MD with per additional child was found in men who lived in urban areas (OR: 0.81, 95%CI: 0.71-0.96). For women, each additional child was associated with a 4% decreased odds of insomnia (OR: 0.96, 95%CI: 0.95-0.96). Each additional child was also associated with a 2% decreased odds of insomnia in men (OR: 0.98, 95%CI: 0.97-1.00). CONCLUSIONS MD and insomnia were inversely associated with number of children in women while the association was not overall significant in men. The association was mediated by socioeconomic and lifestyle factors. Future mental health public health programs should address parity and sex differences when designing interventions.
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Affiliation(s)
- Hanyu Wang
- grid.12527.330000 0001 0662 3178Research Center for Public Health, School of Medicine, Tsinghua University, Haidian District, Beijing, China ,grid.11135.370000 0001 2256 9319School of Health Humanities, Peking University Health Science Center, No. 38 Xueyuan Road, Haidian District, Beijing, China
| | - Minne Chen
- grid.10698.360000000122483208Department of Sociology, University of North Carolina at Chapel Hill, 103 S Bldg Cb 9100, Chapel Hill, United States
| | - Tong Xin
- grid.11135.370000 0001 2256 9319Department of Global Health, Peking University Health Science Center, No. 38 Xueyuan Road, Beijing, 100191 China
| | - Kun Tang
- Research Center for Public Health, School of Medicine, Tsinghua University, Haidian District, Beijing, China.
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Li X, Sun N, Yang C, Liu Z, Li X, Zhang K. C-Reactive Protein Gene Variants in Depressive Symptoms & Antidepressants Efficacy. Psychiatry Investig 2019; 16:940-947. [PMID: 31711279 PMCID: PMC6933135 DOI: 10.30773/pi.2019.0117] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 09/05/2019] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Although the pathogenesis of depression remains unclear, C-reactive protein (CRP) levels are commonly elevated in depressed patients. Thus, CRP single-nucleotide polymorphisms (SNPs) that influence CRP levels may be associated with depression. In the present study, we explored whether CRP SNPs are related to depressive symptoms and antidepressants efficacy in Han Chinese patients. METHODS We analyzed data from 440 patients with first-episode depression. We obtained genome CRP SNPs, scores of the 17-item Hamilton Rating Scale for Depression 17 (HAMD17) and its four-factor at baseline and after 6 weeks. Quantitative trait analysis was performed using UNPHASED software and curative effects were analyzed using SPSS software. RESULTS Male patients with SNP rs1800947G exhibited lower insomnia scores and rs2794521CC exhibited lower scores of anxiety/ physical symptoms, total HAMD17 score. Female patients with rs2794521TT exhibited higher scores of insomnia and lower antidepressants efficacy. CONCLUSION CRP SNPs rs1800947 and rs2794521 may be associated with depressive symptoms in patients with depression in a sexspecific fashion. Furthermore, rs2794521 may be a predictor of the efficacy of antidepressants in female patients.
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Affiliation(s)
- Xinxin Li
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, China.,Shanxi Medical University, Taiyuan, China
| | - Ning Sun
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Chunxia Yang
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Zhifen Liu
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Xinrong Li
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Kerang Zhang
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, China
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Li F, He F, Sun Q, Li Q, Zhai Y, Wang X, Zhang T, Lin J. Reproductive history and risk of depressive symptoms in postmenopausal women: A cross-sectional study in eastern China. J Affect Disord 2019; 246:174-181. [PMID: 30583142 DOI: 10.1016/j.jad.2018.12.031] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 11/03/2018] [Accepted: 12/16/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Although there are potential mechanisms of female hormones in depression, conflicting results still exist in epidemiological studies. This study aimed to determine whether reproductive history, an important indicator of estrogen exposure across the lifetime, is associated with risk of depressive symptoms in postmenopausal women. METHODS We analyzed the baseline data from Zhejiang Ageing and Health Cohort Study including 5537 postmenopausal women. Depressive symptoms were assessed through the application of Patient Health Questionnaire-9 scale (PHQ-9). Logistic regression models, controlling for an extensive range of potential confounders, were generated to examine the association between reproductive history and risk of depressive symptoms in later life. RESULTS Longer reproductive period (Odds Ratio (OR) = 0.972, 95% Confidence Interval (CI) 0.955-0.989), regular menstrual cycle (OR = 0.723, 95% CI 0.525-0.995), later age at first gave birth (OR = 0.953, 95% CI 0.919-0.988) were significantly associated with a reduced risk of late-life depressive symptoms. Among women with regular menstrual cycle, longer cycle length increased the risk (OR = 1.050, 95% CI 1.016-1.085). Meanwhile, more full-term pregnancies and more incomplete pregnancies were related to higher prevalence of depressive symptoms. Women who underwent tubal sterilization as only type of contraceptive surgery were found less likely to suffer depressive symptoms in later life (OR = 0.433, 95% CI 0.348-0.538). LIMITATIONS Cross-sectional data could not make a causation conclusion. CONCLUSIONS Our results indicated that reproductive factors were significantly associated with risk of depressive symptoms in postmenopausal women. Further longitudinal studies are needed.
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Affiliation(s)
- Fudong Li
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
| | - Fan He
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
| | - Qiang Sun
- Tongxiang Center for Disease Control and Prevention, Jiaxing, Zhejiang, China
| | - Qiuyue Li
- Tongxiang Center for Disease Control and Prevention, Jiaxing, Zhejiang, China
| | - Yujia Zhai
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
| | - Xinyi Wang
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
| | - Tao Zhang
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
| | - Junfen Lin
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China.
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Laird KT, Krause B, Funes C, Lavretsky H. Psychobiological factors of resilience and depression in late life. Transl Psychiatry 2019; 9:88. [PMID: 30765686 PMCID: PMC6375932 DOI: 10.1038/s41398-019-0424-7] [Citation(s) in RCA: 107] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 12/28/2018] [Accepted: 01/26/2019] [Indexed: 12/18/2022] Open
Abstract
In contrast to traditional perspectives of resilience as a stable, trait-like characteristic, resilience is now recognized as a multidimentional, dynamic capacity influenced by life-long interactions between internal and environmental resources. We review psychosocial and neurobiological factors associated with resilience to late-life depression (LLD). Recent research has identified both psychosocial characteristics associated with elevated LLD risk (e.g., insecure attachment, neuroticism) and psychosocial processes that may be useful intervention targets (e.g., self-efficacy, sense of purpose, coping behaviors, social support). Psychobiological factors include a variety of endocrine, genetic, inflammatory, metabolic, neural, and cardiovascular processes that bidirectionally interact to affect risk for LLD onset and course of illness. Several resilience-enhancing intervention modalities show promise for the prevention and treatment of LLD, including cognitive/psychological or mind-body (positive psychology; psychotherapy; heart rate variability biofeedback; meditation), movement-based (aerobic exercise; yoga; tai chi), and biological approaches (pharmacotherapy, electroconvulsive therapy). Additional research is needed to further elucidate psychosocial and biological factors that affect risk and course of LLD. In addition, research to identify psychobiological factors predicting differential treatment response to various interventions will be essential to the development of more individualized and effective approaches to the prevention and treatment of LLD.
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Affiliation(s)
- Kelsey T Laird
- Department of Psychiatry, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA, USA
| | - Beatrix Krause
- Department of Psychiatry, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA, USA
| | - Cynthia Funes
- Department of Psychiatry, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA, USA
| | - Helen Lavretsky
- Department of Psychiatry, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA, USA.
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Lifelong estradiol exposure and risk of depressive symptoms during the transition to menopause and postmenopause. Menopause 2018; 24:1351-1359. [PMID: 28719421 DOI: 10.1097/gme.0000000000000929] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Depression risk increases during the menopausal transition (MT) and initial postmenopausal years-both times of significant fluctuations of estrogen. Research to date provides limited support for the hypothesis that estrogen fluctuations play a role in the greater susceptibility to midlife depression. Importantly, not all women report depressive symptoms during the MT, and recent reports suggest that duration of exposure to estradiol throughout the adult years may also play a role in vulnerability to depression. This study examines patterns of estrogen exposure during the reproductive years and risk of depression during the MT and early postmenopausal years. METHODS A longitudinal, US community-based, multiethnic study of menopause. Data were collected at baseline and annually for 10 years, and included 1,306 regularly menstruating premenopausal women, aged 42 to 52 years at study entry. The main outcome was incidence of high level of depressive symptoms, Center for Epidemiological Studies Depression Scale (CES-D) score at least 16, in the MT and initial postmenopausal years, independent of premenopausal depression symptoms. Risk factors examined were duration of estrogen exposure (menarche to MT), duration of hormonal birth control use, pregnancies, and lactation. RESULTS In a multivariate adjusted model, longer duration of estrogen exposure from menarche to MT onset was significantly associated with a reduced risk of depression (CES-D ≥16) during the MT and 10 years or less postmenopause (odds ratio 0.85, 95% confidence interval 0.78-0.92). Longer duration of birth control use was associated with a decreased risk of CES-D at least 16 (odds ratio 0.90, 95% confidence interval 0.83-0.98), but number of pregnancies or breastfeeding was not. CONCLUSIONS Patterns of reproductive lifetime exposure to estrogen are associated with risk of high depressive symptoms during the MT and initial postmenopausal years; longer exposure to estrogen seemed protective.
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Schoenrock SA, Oreper D, Young N, Ervin RB, Bogue MA, Valdar W, Tarantino LM. Ovariectomy results in inbred strain-specific increases in anxiety-like behavior in mice. Physiol Behav 2016; 167:404-412. [PMID: 27693591 DOI: 10.1016/j.physbeh.2016.09.026] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 09/23/2016] [Accepted: 09/27/2016] [Indexed: 12/31/2022]
Abstract
Women are at an increased risk for developing affective disorders during times of hormonal flux, including menopause when the ovaries cease production of estrogen. However, while all women undergo menopause, not all develop an affective disorder. Increased vulnerability can result from genetic predisposition, environmental factors and gene by environment interactions. In order to investigate interactions between genetic background and estrogen depletion, we performed bilateral ovariectomy, a surgical procedure that results in estrogen depletion and is thought to model the post-menopausal state, in a genetically defined panel of 37 inbred mouse strains. Seventeen days post-ovariectomy, we assessed behavior in two standard rodent assays of anxiety- and depressive-like behavior, the open field and forced swim tests. We detected a significant interaction between ovariectomy and genetic background on anxiety-like behavior in the open field. No strain specific effects of ovariectomy were observed in the forced swim assay. However, we did observe significant strain effects for all behaviors in both the open field and forced swim tests. This study is the largest to date to look at the effects of ovariectomy on behavior and provides evidence that ovariectomy interacts with genetic background to alter anxiety-like behavior in an animal model of menopause.
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Affiliation(s)
- Sarah Adams Schoenrock
- Department of Genetics, School of Medicine, University of North Carolina, Chapel Hill, NC, United States; Neurobiology Curriculum, University of North Carolina, Chapel Hill, NC, United States
| | - Daniel Oreper
- Department of Genetics, School of Medicine, University of North Carolina, Chapel Hill, NC, United States; Bioinformatics and Computational Biology Curriculum, University of North Carolina, Chapel Hill, NC, United States
| | - Nancy Young
- Department of Psychiatry, School of Medicine, University of North Carolina, Chapel Hill, NC, United States
| | - Robin Betsch Ervin
- Department of Psychiatry, School of Medicine, University of North Carolina, Chapel Hill, NC, United States
| | - Molly A Bogue
- The Jackson Laboratory, Bar Harbor, ME, United States
| | - William Valdar
- Department of Genetics, School of Medicine, University of North Carolina, Chapel Hill, NC, United States
| | - Lisa M Tarantino
- Department of Genetics, School of Medicine, University of North Carolina, Chapel Hill, NC, United States; Department of Psychiatry, School of Medicine, University of North Carolina, Chapel Hill, NC, United States; Division of Pharmacotherapy and Experimental Therapeutics, Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, United States.
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Pubertal maturation and affective symptoms in adolescence and adulthood: Evidence from a prospective birth cohort. Dev Psychopathol 2016; 27:1331-40. [PMID: 26439078 DOI: 10.1017/s0954579414001448] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The higher prevalence of affective symptoms among women compared to men emerges in adolescence, and it has been associated with pubertal maturation. However, it remains unclear whether pubertal timing has long-term influences on affective symptoms. Using data from the British 1946 birth cohort, we investigated whether pubertal timing was associated with affective symptoms over the life course, distinguishing those with symptoms in adolescence only, symptoms in adulthood only, and symptoms in both adolescence and adulthood. In females, there was no evidence that early pubertal maturation was a risk factor for affective symptoms. However, those with particularly late menarche (≥15 years) showed a lower risk of adult-onset affective symptoms (odds ratio = 0.54, 95% confidence interval = 0.31, 0.95). This effect of late pubertal timing was not explained by a range of sociobehavioral factors. In contrast, in males, late pubertal timing was associated with increased risk of adolescent-onset affective symptoms that tracked into adulthood (odds ratio = 2.10, 95% confidence interval = 1.44, 3.06). This effect was partly explained by low prepubertal body mass index. Sex-specific effects of pubertal timing on the long-term risk of affective symptoms might be due to different effects of gonadal hormonal on the central nervous system, as well as different social experiences during puberty.
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Lee JY, Park YK, Cho KH, Kim SM, Choi YS, Kim DH, Nam GE, Han KD, Kim YH. Suicidal ideation among postmenopausal women on hormone replacement therapy: The Korean National Health and Nutrition Examination Survey (KNHANES V) from 2010 to 2012. J Affect Disord 2016; 189:214-9. [PMID: 26451506 DOI: 10.1016/j.jad.2015.09.068] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Revised: 09/28/2015] [Accepted: 09/30/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND Suicide is a major public health problem around the world. Some studies have found that hormone replacement therapy (HRT) is associated with depression in postmenopausal women. Depression is a well-known risk factor for suicide; therefore, we investigated the relationship between HRT and suicidal ideation in postmenopausal Korean women. METHODS We included 2286 postmenopausal women with or without HRT from the Korean National Health and Nutrition Examination Survey 2010-2012. The use and duration of HRT and mental health status, including stress, depressive mood, and suicidal ideation and attempts, were assessed by self-report questionnaires. RESULTS The proportion of participants with depressive mood and suicidal ideation was higher in the HRT group than the non-HRT group (all p values<0.05). As the duration of HRT increased, the percentage of participants with suicidal ideation increased (p for trend=0.006). After adjusting for all covariates, the odds ratio (95% confidence intervals) for suicidal ideation was 1.742 (1.223-2.482) in the women with HRT, compared to women without HRT. HRT duration longer than 10 years was associated with suicidal ideation (odds ratio=2.089 and 95% confidence intervals=1.069-4.084). LIMITATIONS The cross-sectional design, a possibility of incorrect answer about menopausal status, and no assessment of the type of HRT are the main limitations of this study. CONCLUSION Postmenopausal women receiving HRT, especially for more than 10 years, showed increased suicidal ideation compared with postmenopausal women without HRT. Physicians should pay attention to mood symptoms and suicidal ideation in postmenopausal women with HRT.
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Affiliation(s)
- Ji-Yoon Lee
- Department of Family Medicine, Korea University College of Medicine, Seoul, South Korea
| | - Yong-Kyu Park
- Department of Medical Statistics, Catholic University College of Medicine, Seoul, South Korea
| | - Kyung-Hwan Cho
- Department of Family Medicine, Korea University College of Medicine, Seoul, South Korea
| | - Seon-Mee Kim
- Department of Family Medicine, Korea University College of Medicine, Seoul, South Korea
| | - Youn-Seon Choi
- Department of Family Medicine, Korea University College of Medicine, Seoul, South Korea
| | - Do-Hoon Kim
- Department of Family Medicine, Korea University College of Medicine, Seoul, South Korea
| | - Ga-Eun Nam
- Department of Family Medicine, Korea University College of Medicine, Seoul, South Korea
| | - Kyung-Do Han
- Department of Medical Statistics, Catholic University College of Medicine, Seoul, South Korea
| | - Yang-Hyun Kim
- Department of Family Medicine, Korea University College of Medicine, Seoul, South Korea.
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Keyes K, Agnew-Blais J, Roberts AL, Hamilton A, De Vivo I, Ranu H, Koenen K. The role of allelic variation in estrogen receptor genes and major depression in the Nurses Health Study. Soc Psychiatry Psychiatr Epidemiol 2015; 50:1893-904. [PMID: 26169989 PMCID: PMC4655148 DOI: 10.1007/s00127-015-1087-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 06/28/2015] [Indexed: 12/16/2022]
Abstract
PURPOSE The role of exogenous and endogenous sex hormones in the etiology of depression remains elusive, in part because sex hormone variation is often correlated with behaviors, life stage changes, and other factors that may influence depression. Estrogen receptor alpha (ESR1) and beta (ESR2) are known to regulate gene expression and estrogen response in areas of the brain associated with major depression and are unlikely to be correlated with exogenous factors that may influence depression. METHODS We examined whether functional polymorphisms in these genes are associated with lifetime major depression and chronic major depression among a sample of women from the Nurses' Health Study II (N = 2527). DSM-IV depressive disorder symptoms were assessed by structured interview in 2007. Genotyping was performed on DNA extracted from blood using Taq-man. RESULTS Women with the AA alleles of ESR2 RS4986938 had the higher prevalence of lifetime major depression than women with other allele frequencies (36.7 % for those with AA versus 28.5 % with GA and 29.1 % with GG, p = 0.02) and chronic major depression (14.7 % for those with AA versus 9.3 % with GA and 9.1 % with GG, p = 0.01). History of post-menopausal hormone (PMH) use modified the association of ESR1 polymorphism RS2234693 with any lifetime depression; specifically, those with the TT allele had the highest risk of lifetime depression among PMH users, and the lowest risk of depression among non-PMH users (p value for interaction = 0.02). Further, carriers of the AA alleles in ESR1 polymorphism RS9340799 had increased prevalence of lifetime major depression only among lifetime PMH users (p = 0.007). CONCLUSIONS Our findings support the hypothesis that estrogen receptor polymorphisms influence risk for major depression; the role of estrogen receptors and other sex steroid-related genetic factors may provide unique insights into etiology.
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Affiliation(s)
- K Keyes
- Department of Epidemiology, Columbia University, Mailman School of Public Health, 722 West 168th Street, New York, NY, 10032, USA.
| | - J Agnew-Blais
- Department of Epidemiology, Harvard University, 181 Longwood Avenue, Boston, MA, 02115, USA
| | - A L Roberts
- Department of Social and Behavioral Sciences, Harvard University, 677 Huntington Avenue, Boston, MA, 02115, USA
| | - A Hamilton
- Department of Epidemiology, Columbia University, Mailman School of Public Health, 722 West 168th Street, New York, NY, 10032, USA
| | - I De Vivo
- Department of Epidemiology, Harvard University, 181 Longwood Avenue, Boston, MA, 02115, USA
| | - H Ranu
- Harvard T.H. Chan School of Public Health, Harvard University, 655 Huntington Avenue, Boston, MA, 02115, USA
| | - K Koenen
- Department of Epidemiology, Columbia University, Mailman School of Public Health, 722 West 168th Street, New York, NY, 10032, USA
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Jung SJ, Shin A, Kang D. Menarche age, menopause age and other reproductive factors in association with post-menopausal onset depression: Results from Health Examinees Study (HEXA). J Affect Disord 2015; 187:127-35. [PMID: 26339923 DOI: 10.1016/j.jad.2015.08.047] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Revised: 08/17/2015] [Accepted: 08/21/2015] [Indexed: 12/20/2022]
Abstract
BACKGROUND Although there are plausible mechanisms of female hormones in depression, epidemiological evidence has shown conflicting results. OBJECTIVE This study aimed to evaluate the associations between female hormonal events and post-menopausal depression and further investigate the relative association between the age of menarche, the age of menopause and depression. METHODS Among 111,589 women who took part in the Health Examinees (HEXA) Study, a total of 60,114 postmenopausal participants were included in the final analysis. Each participant provided information on depression and questions related to reproductive history. The outcome variable was self-reported by the history of depression diagnosed by physicians and the Center for Epidemiologic Studies Depression Scale (CES-D) score. With the multivariate logistic regression, odds ratios were calculated. Possible interactions between depression prevalence and the ages of menarche and menopause were assessed. RESULTS A total of 2.2% (1342/60,114) women were diagnosed with depression after menopause, and 5.9% (500/8472) showed depressive symptoms. As the age of menopause and duration of reproductive years increased, the odds ratio of depression decreased (P-trend <0.001). As the age of menarche increased, the likelihood of physician-diagnosed depression also increased (P-trend 0.048). As the number of both spontaneous and induced abortions increased, the odds ratio of depression increased (P-trend <0.001). LIMITATION it is possible that women show inaccuracies in recalling their hormonal events and reporting other past mental disorders as depression. CONCLUSION Both the ages of the initiation and the termination of menstruation were associated with the increased odds ratio of post-menopausal depression. However, the age of menopause seems to be more important.
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Affiliation(s)
- Sun Jae Jung
- Department of Biomedical Science, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Aesun Shin
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Daehee Kang
- Department of Biomedical Science, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Cancer Research Institute, Seoul National University Hospital, Seoul, Republic of Korea.
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17
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Jung SJ, Shin A, Kang D. Hormone-related factors and post-menopausal onset depression: results from KNHANES (2010-2012). J Affect Disord 2015; 175:176-83. [PMID: 25622021 DOI: 10.1016/j.jad.2014.12.061] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Revised: 12/31/2014] [Accepted: 12/31/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND Although hypotheses have been proposed regarding the biological mechanisms of hormonal fluctuations in mood disorders, few epidemiological studies have addressed this issue. The aim of this study was to examine the association between hormone-related life events and postmenopausal depression. METHODS Of 13,918 women who participated in the Korean National Health and Nutrition Examination Survey (KNHANES) V, a total of 4869 post-menopausal women who had completed information on depression onset age and additional reproductive factors were included in the analysis. A multivariate logistic regression was applied to calculate the odds ratios between reproductive factors and post-menopausal onset depression. RESULTS A total of 276 women (5.7%) were diagnosed with depression after menopause. Longer reproductive years were associated with a reduced risk of depression (for more than 35 reproductive years: OR=0.41, 95% CI: 0.27-0.62, P-trend<0.001). Similarly, a later age of menopause (52 years and older) corresponded to a decreased risk of depression (OR=0.35, 95% CI: 0.22-0.55) compared to the women with a menopausal age younger than 46 years. Greater numbers of pregnancies and exogenous hormone use were also associated with increased risk of depression. LIMITATIONS All data were collected from interviews using questionnaires. There may be some inaccuracies in recall of lifetime reproductive events, but women generally recalled their hormonal events correctly. CONCLUSION Early menopause and the use of exogenous hormones were associated with the risk of post-menopausal depression. Clinicians should closely monitor and consider further screening for depressed women who undergo early menopause or those with exogenous hormone use.
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Affiliation(s)
- Sun Jae Jung
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Aesun Shin
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Daehee Kang
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea.
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Hoyt LT, Falconi AM. Puberty and perimenopause: reproductive transitions and their implications for women's health. Soc Sci Med 2015; 132:103-12. [PMID: 25797100 DOI: 10.1016/j.socscimed.2015.03.031] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
This scoping review synthesizes existing research on two major transitions in females' lives: puberty and perimenopause. These two periods of vast physiological change demarcate the beginning and the end of the reproductive life cycle and are associated with major neuroendocrine reorganization across two key systems, the hypothalamic-pituitary-gonadal (HPG) axis the hypothalamus-pituitary-adrenal (HPA) axis. Despite growing evidence suggesting that the timing and experience of puberty and perimenopause are related to various physical and mental health outcomes (e.g., mood disorders, metabolism, cardiovascular health, autoimmune conditions, and cancer), these two processes are rarely examined together. In this paper, we bridge these disparate literatures to highlight similarities, isolate inconsistencies, and identify important areas for future research in women's health.
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Affiliation(s)
- Lindsay Till Hoyt
- Robert Wood Johnson Foundation Health & Society Scholar at the University of California, San Francisco and Berkeley, 3333 California St., Suite 465, San Francisco, CA 94143, USA.
| | - April M Falconi
- School of Public Health, University of California, Berkeley, 13A University Hall, Berkeley, CA 94720, USA.
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C-reactive protein gene variants: independent association with late-life depression and circulating protein levels. Transl Psychiatry 2015; 5:e499. [PMID: 25603415 PMCID: PMC4312833 DOI: 10.1038/tp.2014.145] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Revised: 10/28/2014] [Accepted: 12/06/2014] [Indexed: 12/25/2022] Open
Abstract
C-reactive protein (CRP) is a heritable biomarker of systemic inflammation that is commonly elevated in depressed patients. Variants in the CRP gene that influence protein levels could thus be associated with depression but this has seldom been examined, especially in the elderly. Depression was assessed in 990 people aged at least 65 years as part of the ESPRIT study. A clinical level of depression (DEP) was defined as having a score of ⩾16 on The Center for Epidemiologic Studies Depression scale or a diagnosis of current major depression based on the Mini-International Neuropsychiatric Interview and according to Diagnostic and Statistical Manual of Mental Disorders-IV criteria. Five single-nucleotide polymorphisms spanning the CRP gene were genotyped, and circulating levels of high-sensitivity CRP were determined. Multivariable analyses adjusted for socio-demographic characteristics, smoking, ischemic pathologies, cognitive impairment and inflammation-related chronic pathologies. The minor alleles of rs1130864 and rs1417938 were associated with a decreased risk of depression in women at Bonferroni-corrected significance levels (P=0.002). CRP gene variants were associated with serum levels in a gender-specific manner, but only rs1205 was found to be nominally associated with both an increased risk of DEP and lower circulating CRP levels in women. Variants of the CRP gene thus influence circulating CRP levels and appear as independent susceptibility factors for late-life depression.
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Ryan J, Scali J, Carrière I, Amieva H, Rouaud O, Berr C, Ritchie K, Ancelin ML. Impact of a premature menopause on cognitive function in later life. BJOG 2014; 121:1729-39. [PMID: 24802975 DOI: 10.1111/1471-0528.12828] [Citation(s) in RCA: 121] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2014] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To determine whether premature menopause (≤40 years) can have long-lasting effects on later-life cognition and investigate whether this association varies depending on the type of menopause and use of hormone treatment (HT). DESIGN Population-based cohort study. SETTING The French Three-City Study. POPULATION Four thousand eight hundred and sixty-eight women aged at least 65 years. METHODS Multivariable-adjusted logistic regression models were used to determine the association between age at menopause, type of menopause (surgical, natural), and the use of menopausal HT and later-life cognitive function. MAIN OUTCOME MEASURES Performance on a cognitive test battery (at baseline and over 7 years) and clinical dementia diagnosis. RESULTS Menopause at or before the age of 40 years, both premature bilateral ovariectomy and premature ovarian failure (non-surgical loss of ovarian function), was associated with worse verbal fluency (OR 1.56, 95%CI 1.12-1.87, P=0.004) and visual memory (OR 1.39, 95%CI 1.09-1.77, P=0.007) in later life. HT at the time of premature menopause appeared beneficial for later-life visual memory but increased the risk of poor verbal fluency. Type of menopause was not significantly associated with cognitive function. Premature menopause was associated with a 30% increased risk of decline in psychomotor speed and global cognitive function over 7 years. CONCLUSION Both premature surgical menopause and premature ovarian failure were associated with long-term negative effects on cognitive function, which are not entirely offset by menopausal HT. In terms of surgical menopause, these results suggest that the potential long-term effects on cognitive function should form part of the risk/benefit ratio when considering ovariectomy in younger women.
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Affiliation(s)
- J Ryan
- Inserm, U1061, Neuropsychiatry: Epidemiological and Clinical Research, Montpellier, France; Université Montpellier 1, Montpellier, France; Cancer & Disease Epigenetics, Murdoch Children's Research Institute, Melbourne, Vic., Australia; Department of Paediatrics, The University of Melbourne, Melbourne, Vic., Australia
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Associations between psychological well-being, mental health, and hormone therapy in perimenopausal and postmenopausal women: results of two population-based studies. Menopause 2014; 20:667-76. [PMID: 23277355 DOI: 10.1097/gme.0b013e318278eec1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE A proportion of women experience depressive and anxiety symptoms and/or disorders in connection with the menopausal transition. Estrogen-only therapy has been reported to have beneficial effects on mental health, but the effects of combined hormone therapy (HT) on mental health are less clear. We studied the associations between HT use and psychopathology in perimenopausal and postmenopausal women. METHODS Data on women who participated in the Health 2000 Survey and the National FINRISK Surveys in Finland were analyzed. RESULTS An association between current HT use and psychiatric diagnosis in the previous 12 months was found. In addition, HT use was associated with recent self-reported diagnosis of depression and with depressed mood (FINRISK), as well as with major depressive disorder and anxiety disorder (Health 2000). Associations with the following symptoms were found: nervousness, frightening thoughts, nightmares, and headache (FINRISK), feelings of depression (FINRISK and Health 2000), and unhappiness (Health 2000). No differences between different routes of administration or types of HT emerged. CONCLUSIONS Current use of HT in perimenopausal and postmenopausal women is associated with worse psychological well-being and mental health than in women not using HT. It is important to identify women in need of psychiatric support at the time of the menopausal transition.
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Lifetime endogenous reproductive factors and severe depressive symptoms in postmenopausal women. Menopause 2013; 20:1154-63. [DOI: 10.1097/gme.0000000000000098] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ryan J, Canonico M, Carcaillon L, Carrière I, Scali J, Dartigues JF, Dufouil C, Ritchie K, Scarabin PY, Ancelin ML. Hormone treatment, estrogen receptor polymorphisms and mortality: a prospective cohort study. PLoS One 2012; 7:e34112. [PMID: 22457817 PMCID: PMC3311587 DOI: 10.1371/journal.pone.0034112] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2011] [Accepted: 02/21/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The association between hormone treatment (HT) and mortality remains controversial. This study aimed to determine whether the risk of mortality associated with HT use varies depending on the specific characteristics of treatment and genetic variability in terms of the estrogen receptor. METHODOLOGY/PRINCIPAL FINDINGS A prospective, population-based study of 5135 women aged 65 years and older who were recruited from three cities in France and followed over six years. Detailed information related to HT use was obtained and five estrogen receptor polymorphisms were genotyped. The total follow-up was 25,436 person-years and during this time 352 women died. Cancer (36.4%) and cardiovascular disease (19.3%) were the major causes of death. Cox proportional hazards models adjusted for age, education, centre, living situation, comorbidity, depression, physical and mental incapacities, indicated no significant association between HT and mortality, regardless of the type or duration of treatment, or the age at initiation. However, the association between HT and all-cause or cancer-related mortality varied across women, with significant interactions identified with three estrogen receptor polymorphisms (p-values = 0.004 to 0.03) in adjusted analyses. Women carrying the C allele of ESR1 rs2234693 had a decreased risk of all-cause mortality with HT (HR: 0.42, 95% CI: 0.18-0.97), while in stark contrast, those homozygous for the T allele had a significantly increased risk of cancer-related mortality (HR: 3.18, 95% CI: 1.23-8.20). The findings were similar for ESR1 rs9340799 and ESR2 rs1271572. CONCLUSIONS/SIGNIFICANCE The risk of mortality was not associated with HT duration, type or age at initiation. It was however not equal across all women, with some women appearing genetically more vulnerable to the effects of HT in terms of their estrogen receptor genotype. These findings, if confirmed in another independent study, may help explain the differential susceptibility of women to the beneficial or adverse effects of HT.
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Affiliation(s)
- Joanne Ryan
- Inserm U1061, Université Montpellier 1, Montpellier, France.
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25
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Ryan J, Scali J, Carrière I, Peres K, Rouaud O, Scarabin PY, Ritchie KA, Ancelin ML. Oestrogen receptor polymorphisms and late-life depression. Br J Psychiatry 2011; 199:126-31. [PMID: 21804148 PMCID: PMC3623726 DOI: 10.1192/bjp.bp.111.091751] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Evidence suggests a role for oestrogen in depression but the involvement of oestrogen receptor polymorphisms remains unknown. AIMS To determine the association between oestrogen receptor polymorphisms and late-life depression and the modifying effect of hormone treatment. METHOD Depression was assessed using the Mini-International Neuropsychiatric Interview, according to DSM-IV criteria and the Centre for Epidemiologic Studies - Depression Scale. The association between oestrogen receptor α and β (ER-α and ER-β) polymorphisms with severe depression was examined in 6017 community-dwelling elderly people using multivariate logistic regression. RESULTS In women, the ER-α rs2234693 and rs9340799 polymorphisms were significantly associated with the risk of late-life depression. The A allele of ER-β rs1256049 increased the risk of depression, but only for non-current users of hormone treatment. In men, only the ER-β rs4986938 polymorphism showed a weak association with depression risk. CONCLUSIONS Oestrogen receptor polymorphisms are associated with severe late-life depression risk in women only.
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Affiliation(s)
- Joanne Ryan
- Inserm U1061, Hôpital La Colombière, 39 Avenue Charles Flahault, BP 34493, 34093 Montpellier Cedex 5, France.
| | - Jacqueline Scali
- Neuropsychiatrie : recherche épidémiologique et clinique
INSERM : U1061Université Montpellier IHôpital La Colombière39 Avenue Charles Flahault - BP 34493 - Pav 42 Calixte Cavalier 34093 Montpellier Cedex 05, FR
| | - Isabelle Carrière
- Neuropsychiatrie : recherche épidémiologique et clinique
INSERM : U1061Université Montpellier IHôpital La Colombière39 Avenue Charles Flahault - BP 34493 - Pav 42 Calixte Cavalier 34093 Montpellier Cedex 05, FR
| | - Karine Peres
- Epidémiologie et Biostatistique
INSERM : U897Université Victor Segalen - Bordeaux IIInstitut de Santé Publique, d'Épidémiologie et de Développement (ISPED)146, rue Léo-Saignat 33076 Bordeaux, FR
| | - Olivier Rouaud
- Neuroépidémiologie
INSERM : U708Université Paris VI - Pierre et Marie Curie - GH Pitié-Salpetriere, Assistance publique - Hôpitaux de Paris (AP-HP)47, Boulevard de L'Hopital 75651 Paris Cedex 13, FR
| | - Pierre-Yves Scarabin
- CESP, Centre de Recherche en Epidémiologie et Santé des Populations
INSERM : U1018Université Paris XI - Paris SudHôpital Paul BrousseAssistance publique - Hôpitaux de Paris (AP-HP)16 avenue Paul Vaillant Couturier 94807 Villejuif Cedex, France, FR
| | - Karen A. Ritchie
- Neuropsychiatrie : recherche épidémiologique et clinique
INSERM : U1061Université Montpellier IHôpital La Colombière39 Avenue Charles Flahault - BP 34493 - Pav 42 Calixte Cavalier 34093 Montpellier Cedex 05, FR,Epidemiology
Faculty of Medicine, St Mary's Hospital, Imperial College LondonSouth Kensington Campus, London SW7 2AZ, GB
| | - Marie-Laure Ancelin
- Neuropsychiatrie : recherche épidémiologique et clinique
INSERM : U1061Université Montpellier IHôpital La Colombière39 Avenue Charles Flahault - BP 34493 - Pav 42 Calixte Cavalier 34093 Montpellier Cedex 05, FR
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Abstract
Only recently has the perimenopause become recognized as a time when women are at risk for new onset and recurrence of major depression. Untreated depression at this time not only exacerbates the course of a depressive illness, but also puts women at increased risk for sleep disorders, cardiovascular disease, diabetes, and osteoporosis. Although antidepressant medication is the mainstay of treatment, adjunctive therapy, especially with estrogen replacement, may be indicated in refractory cases, and may speed the onset of antidepressant action. Many, but not all, studies, report that progesterone antagonizes the beneficial effects of estrogen. Although some antidepressants improve vasomotor symptoms, in general they are not as effective as estrogen alone for relieving these symptoms. Estrogen alone, however, does not generally result in remission of major depression in most (but not all) studies, but may provide benefit to some women with less severe symptoms if administered in therapeutic ranges. The selective serotonin reuptake inhibitors (SSRIs) in addition to estrogen are usually more beneficial in improving mood than SSRIs or estrogen treatment alone for major depression, whereas the selective norepinephrine and serotonin reuptake inhibitors do not require the addition of estrogen to exert their antidepressant effects in menopausal depression. In addition to attention to general health, hormonal status, and antidepressant treatment, the optimal management of perimenopausal depression also requires attention to the individual woman's psychosocial and spiritual well being.
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Affiliation(s)
- Barbara L Parry
- Department of Psychiatry, University of California, San Diego, USA
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Life-time estrogen exposure and cognitive functioning in later life. Psychoneuroendocrinology 2009; 34:287-298. [PMID: 18947934 DOI: 10.1016/j.psyneuen.2008.09.008] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2008] [Revised: 09/03/2008] [Accepted: 09/11/2008] [Indexed: 12/17/2022]
Abstract
CONTEXT While recent studies suggest that exogenous estrogen treatment could help reduce age-related cognitive decline and delay the onset of dementia, this has not been found consistently. Few studies have considered the influence of life-time estrogen exposure which may have an independent effect on cognition and/or modulate treatment response. OBJECTIVE The aim of this study was to examine whether factors related to estrogen exposure across the life-time were associated with cognitive function in postmenopausal women. DESIGN A battery of cognitive tests were administered at baseline and at 2 and 4 years of follow-up to evaluate cognitive performance among a population-based cohort of 996 French women aged 65 years or older, who were recruited as part of the ESPRIT study. Detailed reproductive histories were also obtained. Logistic regression models, controlling for an extensive range of potential confounding factors, were generated to determine whether hormone-related factors across a woman's lifetime were associated with poor cognitive performance in later life. RESULTS Age at first menses was negatively associated with performance on the tasks of visual memory and psychomotor speed, while a longer reproductive period was associated with better verbal fluency. Likewise, women who had their first child at a young age performed significantly worse on each of these tasks, as well as on a measure of global cognitive function. The results also suggest that current hormone therapy may be beneficial for a number of cognitive domains, however, in multivariate analysis, women performed significantly better on the task of visual memory only. In contrast, in analysis adjusted for baseline cognitive performance and a range of other factors, none of the reproductive variables were associated with a decline in cognitive performance or the incidence of dementia during the 4-year follow-up period. CONCLUSIONS In addition to hormone therapy, certain hormone-related events across the lifetime are also associated with cognitive functioning in later life. They were not observed in this study to modulate dementia risk; however, this should be verified over a longer follow-up period. Further studies will also be required to determine whether lifetime hormonal exposure may modify women's response to hormone therapy after the menopause.
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