Depression, anxiety, and fear of death in postmenopausal women

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.

Is Pilates effective in improving depressive disorders? A comprehensive overview

Depressive disorders are disabling conditions that account for high social costs. Pilates demonstrated to have several beneficial effects on health. Objective of this manuscript was to systematically review the literature about the effects of Pilates on depressive disorders. A bibliographic search was conducted in the main database sources (Pubmed, Medline, and Scopus). The inclusion criteria consisted of articles written in English language about the effectiveness of Pilates on depressive symptoms. Most of included studies are randomized controlled trials (10 out of 12). The available literature agrees in indicating that Pilates is effective in improving depressive symptoms especially when compared to inactivity and when this practice is administered for a medium-long period (8-16 weeks). In addition, Pilates seems to have at least comparable effectiveness than aerobic exercise. Pilates can be considered a reliable complementary treatment for people with depressive disorders. These findings should be interpreted considering the different types of practice administered as well as the different duration of the programs or rating scales used to assess mood symptoms. Studies with a more homogenous design are needed to confirm and make generalizable the results presented in this review.

The relationship between depressive symptoms and physical performance in postmenopausal women: a cross-sectional investigation

OBJECTIVE

The relationship between depressive symptoms and declining physical performance in postmenopausal women has been extensively examined. However, various confounding factors can influence this association. This study aimed to investigate the link between depressive symptoms and physical performance in postmenopausal women while considering potential interfering factors.

METHODS

In this cross-sectional study, 137 postmenopausal women were categorized into two groups based on the presence of depressive symptoms (n = 58; mean ± SD age, 60.12 ± 8.45 y) and absence of depressive symptoms (n = 79; mean ± SD age, 60.72 ± 7.45) using the Geriatric Depression Scale (short version) (GDS-15). Thoracic kyphosis angle was measured using the flexicurve method. Physical performance was assessed through various tests, including Timed Up and Go, Five Times Stand and Sit Test, 6-minute Walking Speed, 10-meter Usual Walking Speed, 10-meter Fast Walking Speed, and dynamometry. The study compared variables between the two groups and used linear regression models adjusted for dynamometry, kyphosis angle, age, antidepressant usage, sitting time, and fall history to evaluate the relationship between GDS-15 scores and physical performance.

RESULTS

Significant differences were observed in physical performance, body mass index, kyphosis angle, antidepressant usage, sitting time, and fall history between women with and without depressive symptoms. The GDS-15 showed a negative association with all walking speed tests (10-meter Usual Walking Speed, m/s; P < 0.001; B = -0.01; 10-meter Fast Walking Speed, m/s; P < 0.001; B = -0.02; 6-minute Walking Speed, m/s; P < 0.004; B = -0.01) and a positive association with the Five Times Stand and Sit Test ( P < 0.002; B = 0.21) and Timed Up and Go ( P < 0.001; B = 0.13) tests, regardless of grip strength, kyphosis angle, age, antidepressant use, sitting time, or fall history in postmenopausal women.

CONCLUSIONS

This study underscores the independent and substantial impact of depressive symptoms on the physical performance of postmenopausal women. These findings emphasize the importance of addressing both mental health and physical well-being when providing care and support for this demographic.

Keep Moving to Retain the Healthy Self: The Influence of Physical Exercise in Health Anxiety among Chinese Menopausal Women

Menopause is a period of high incidence of chronic diseases. Women experience various physical and psychological discomforts during menopause, and hormonal changes exacerbate mood swings in menopausal women and also cause them to begin to experience excessive worry and anxiety about their health problems. This study was a cross-sectional survey investigating the relationship between physical activity and women's health anxiety. Using cluster sampling, a valid sample of 455 females aged 45-50 was collected from 78 communities in five municipal districts in Changsha, China, and AMOS v.23 was adopted to construct a structural equation model to verify the hypotheses. The results indicate that interpersonal competence and emotional intelligence are negatively associated with health anxiety. Furthermore, interpersonal competence and emotional intelligence mediate the relationship between physical exercise and health anxiety, which means that menopausal women with more physical exercise, higher interpersonal competence, and higher emotional intelligence reported lower health anxiety. Finally, to alleviate menopausal women's health anxiety and reduce their risk of chronic diseases, the government, community, and family should create conditions and opportunities for women to participate in group physical activities.

Carnosic Acid Mitigates Depression-Like Behavior in Ovariectomized Mice via Activation of Nrf2/HO-1 Pathway

The peri- and post-menopausal periods have been described as the "window of vulnerability" for the development of depressive symptoms that impair women activities and quality of life. The etiopathogenesis of these symptoms is multifactorial and may confer resistance to traditional antidepressants. Attention is now directed toward phytochemicals for their pleiotropic functions and safer profiles. This study investigated the possible perturbation of the nuclear factor erythroid 2-related factor 2 (Nrf2) signaling pathways as an underlying mechanism of post-ovariectomy depression and highlighted the potential benefits of carnosic acid (CA) on the associated behavioral, biochemical, and histopathological alterations. Female Balb/c mice were randomly assigned to be sham-operated or ovariectomized (OVX). After 3 weeks, OVX mice received either a vehicle, CA (20 mg/kg/day), or tin protoporphyrin IX (SnPP-IX; a heme oxygenase-1 (HO-1) inhibitor; 50 μmol/kg/day) for 3 weeks. Our findings revealed that OVX mice had depressive but not anxiety-like behavior. Suppressed Nrf2 and its downstream signaling, and augmented proinflammatory markers were observed in both the hippocampus and prefrontal cortex. CA treatment alleviated depressive behavior, induced the expression of Nrf2, HO-1, thioredoxin-1, and brain-derived neurotrophic factor, and enhanced serotonin levels. CA also suppressed oxidative stress, reduced TNF-α, IL-1β, and iNOS mRNA expression, and ameliorated OVX-induced histopathological changes. SnPP-IX aggravated post-OVX behavioral, neurobiochemical, and histological deteriorations, and reduced CA-protective effects. In conclusion, Nrf2/HO-1 signaling suppression and the associated proinflammatory state are key mechanisms in post-OVX depression. CA exerts multifaceted neuroprotection in OVX mice and represents a promising candidate for clinical evaluation as an antidepressant.

Evaluation of depression, social support and quality of life in perimenopausal and postmenopausal women in semi-rural Turkey

BACKGROUND

This study aimed to determine the prevalence of depression in perimenopausal and postmenopausal women in a semi-rural area in a city in Turkey and to evaluate perceived social support and quality of life by examining some of the variables thought to be related.

METHODS

The study was conducted on 827 perimenopausal and postmenopausal women aged 40-60 years. The questionnaire included sociodemographic characteristics, some variables associated with depression, questions from the Beck Depression Inventory, Multidimensional Scale of Perceived Social Support, and European Health Impact Scale - Quality of Life-8 (EUROHIS-QOL-8) scale.

RESULTS

The prevalence of depression was 23.1% (n = 191) in the study. The prevalence of depression was found to be higher in single/widowed/separated individuals (odds ratio (OR): 2.539; 95% CI: 1.593-4.047) and at poor income levels (1.980; 1.000-3.021). The frequency of depression was found to be lower in those who gave birth once or twice (0.470; 0.294-0.752), those with a high level of social support (0.959; 0.948-0.971), and those with a high level of QOL (0.836; 0.794-0.879). There was a moderate negative correlation between the depression scale and QOL scale scores (r = -0.405, P = 0.001). A weak negative correlation was found between depression and social support scores (r = -0.383, P = 0.001).

CONCLUSION

Women are more vulnerable to depression in premenopausal and postmenopausal periods. Being single/widowed, having a poor income level, having low social support, and low QOL are important risk factors which increase the frequency of depression.

Thalamocortical bistable switch as a theoretical model of fibromyalgia pathogenesis inferred from a literature survey

Fibromyalgia (FM) is an unsolved central pain processing disturbance. We aim to provide a unifying model for FM pathogenesis based on a loop network involving thalamocortical regions, i.e., the ventroposterior lateral thalamus (VPL), the somatosensory cortex (SC), and the thalamic reticular nucleus (TRN). The dynamics of the loop have been described by three differential equations having neuron mean firing rates as variables and containing Hill functions to model mutual interactions among the loop elements. A computational analysis conducted with MATLAB has shown a transition from monostability to bistability of the loop behavior for a weakening of GABAergic transmission between TRN and VPL. This involves the appearance of a high-firing-rate steady state, which becomes dominant and is assumed to represent pathogenic pain processing giving rise to chronic pain. Our model is consistent with a bulk of literature evidence, such as neuroimaging and pharmacological data collected on FM patients, and with correlations between FM and immunoendocrine conditions, such as stress, perimenopause, chronic inflammation, obesity, and chronic dizziness. The model suggests that critical targets for FM treatment are to be found among immunoendocrine pathways leading to GABA/glutamate imbalance having an impact on the thalamocortical system.

Altered brain rhythms and behaviour in the accelerated ovarian failure mouse model of human menopause

To date, potential mechanisms of menopause-related memory and cognitive deficits have not been elucidated. Therefore, we studied brain oscillations, their phase–amplitude coupling, sleep and vigilance state patterns, running wheel use and other behavioural measures in a translationally valid mouse model of menopause, the 4-vinylcyclohexene-diepoxide-induced accelerated ovarian failure. After accelerated ovarian failure, female mice show significant alterations in brain rhythms, including changes in the frequencies of θ (5–12 Hz) and γ (30–120 Hz) oscillations, a reversed phase–amplitude coupling, altered coupling of hippocampal sharp-wave ripples to medial prefrontal cortical sleep spindles and reduced δ oscillation (0.5–4 Hz) synchrony between the two regions during non-rapid eye movement sleep. In addition, we report on significant circadian variations in the frequencies of θ and γ oscillations, and massive synchronous δ oscillations during wheel running. Our results reveal novel and specific network alterations and feasible signs for diminished brain connectivity in the accelerated ovarian failure mouse model of menopause. Taken together, our results may have identified changes possibly responsible for some of the memory and cognitive deficits previously described in this model. Corresponding future studies in menopausal women could shed light on fundamental mechanisms underlying the neurological and psychiatric comorbidities present during this important transitional phase in women’s lives.

Risk of Depression during Menopause in Women from Poland, Belarus, Belgium, and Greece

Introduction: Menopause is a physiological period in a woman’s life, but it is often accompanied by symptoms that affect mental well-being and general health, including a tendency for depression. Aim of the study: To evaluate the predisposition to the symptoms of depression in women from Poland, Belarus, Belgium, and Greece. Material and methods: the method of diagnostic survey was used, and the research tools were: The Menopause Rating Scale, the Kupperman Index, Beck Depression Inventory, and a self-made survey questionnaire. Results: Hormone replacement therapy (HRT) was used by 15.8% of Polish, 19% of Belgian, 14.3% of Belarusian, and 15.2% of Greek women patients. The mean value of the Kupperman Index (range 0–63) in Poland was 14.8 ± 8.6, in Belgium—15.5 ± 6.6, Belarus—14.0 ± 9.4, and Greece—10.8 ± 6.5, while the total measure of Menopause Rating Scale (MRS) (range 0–44) was 12.2 ± 7.6 in Poland, 13.8 ± 6.5 in Belgium, 10.8 ± 8.0 in Belarus and 12.9 ± 7.4 in Greece. The severity of mental distress followed a similar pattern across all countries (slightly stronger than mild). The results for somatic complaints were similar, whereas the level of sexual issues varied, with the highest in Belgium and the lowest in Belarus. The mildest symptoms of menopause were experienced by Belarusian women and the most severe by Belgian women. The severity of depression, according to the Beck Depression Inventory (range 0–63), was as follows: Poland 10.5 ± 7.9; Belgium—11.1 ± 5.7; Belarus—13.7 ± 5.7; Greece—11.8 ± 6.6. Conclusions: The differences between the development of perimenopausal-related symptoms across countries were statistically significant. The incidence and severity of depression showed statistically significant differences between the countries studied—the highest was in Belarus and the lowest in Poland. Depression levels were not differentiated by subjects’ age or the use of hormone therapy but by subjects’ education. In Poland and Belarus, increased menopausal pain measured by the Kupperman Index altered levels of depression; in Belgium, there were no such correlations, and in Greece, the correlation was statistically significant, but its strength was negligible. A clearer correlation of the effects of development in menopausal symptoms on the level of depression was shown when measured with the MRS scale—in Greece and Belgium, the correlation was relatively weak, but in Poland and Belarus, it was relatively high.

The mediating and moderating effects of depression on the relationship between cognitive function and difficulty in activities of daily living among postmenopausal women

OBJECTIVE

Cognitive function and depression impact critically the daily functioning of menopausal women. This study aimed to explore the mediating and moderating effects of depressive symptoms on the association between cognitive function and activities of daily living (ADL) difficulty in postmenopausal women.

METHODS

A total of 2,596 postmenopausal women from the China Health and Retirement Longitudinal Study completed the Chinese version of the Mini-Mental State Examination, basic ADL (BADL) and instrumental ADL (IADL) scales, and 10-item Short-Form Center for Epidemiological Studies Depression. We constructed structural equation modeling to examine the association between cognitive function, depressive symptoms, and BADL/IADL difficulty.

RESULTS

The prevalence of BADL/IADL difficulty in postmenopausal women was 22.5% and 31.5%, respectively. After adjustments for demographic and health-related covariates, cognitive decline (contributed by four cognitive dimensions with different weights) was significantly associated with BADL/IADL difficulty (contributed by six-item daily activities with different weights). Depressive symptoms mediated and explained 28.8% and 23.2% of cognitive function associations with BADL and IADL difficulty, respectively. The Johnson-Neyman technique identified a threshold of eight and four for depressive symptoms, beyond which the protective effect of cognitive function on BADL and IADL emerged.

CONCLUSIONS

Depressive symptoms mediated and moderated the association between cognition and BADL/IADL difficulty in postmenopausal women. Compared with BADL, IADL may be more sensitive to changes in cognitive function. More strength should be put on developing comprehensive intervention techniques focusing on simultaneous intervention of multidimensional cognitive function and depression to maintain and improve the quality of life of postmenopausal women.