Risk of Psychiatric Disorders Following Symptomatic Menopausal Transition: A Nationwide Population-Based Retrospective Cohort Study

Stress, depression, and anxiety: psychological complaints across menopausal stages

Introduction

With the number of menopausal women projected estimated to reach 1.2 billion by 2030 worldwide, it is critically important to understand how menopause may affect women's emotional well-being and how many women are affected by this. This study aimed to explore (i) the relationship between psychological complaints (depression, anxiety, poor memory) across different menopausal stages and (ii) investigate the correlation between resilience, self-efficacy, and perceived stress levels, with psychological complaints and whether this was associated with menopausal stage and/or age.

Methods

287 respondents completed the Menopausal Quality of Life (MenQoL), Perceived Stress Scale (PSS-10), Brief Resilience Scale (BRS), and General Self-efficacy (GSE) scales. Parametric and non-parametric analysis were used to analyse how bothered women were by self-reported poor memory and feelings of depression and anxiety, alongside perceived stress, resilience, and self-efficacy between women in different menopausal stages using STRAW criteria. The association between protective factors (self-efficacy and resilience) and psychological complaints was analysed with partial correlation analysis controlling for menopausal stages and/or age.

Results

A significant difference was found between the levels of perceived stress, and how bothered women were by feelings of depression and anxiety between early-perimenopausal and post-menopausal women. However, with the inclusion of age as a covariate, menopausal stage no longer predicted the level of self-reported stress and anxiety in menopausal women. There was also no difference between poor self-reported memory, or of self-efficacy or resilience between women in different menopausal stages. However, self-efficacy and resilience were associated with how bothered women were by feelings of depression and anxiety, and the experience of stress. Stress was the only variable to be associated with poor self-reported memory independent of age and/or menopausal status.

Discussion

Early perimenopausal women experienced the highest level of stress and were more severely bothered by feelings of depression and anxiety, with the poorest overall self-reported psychosocial quality of life. Post-menopausal women, however, reported to have similar experiences as premenopausal women. Age explained the associations between menopausal stage, stress and anxiety, but not between depression and different menopausal stages. Resilience and self-efficacy were associated with psychological complaints independent of menopausal stage and age, suggesting that therapies focusing on increasing resilience and self-efficacy may be beneficial to help target these psychological complaints at any time.

Key Findings from Mental Health Research During the Menopause Transition for Racially and Ethnically Minoritized Women Living in the United States: A Scoping Review

Background: Racially and ethnically minoritized (REM) women experience social and structural factors that may affect their response to mental health treatment and menopausal symptoms during the menopause transition (MT). This scoping review on mental health during the MT for REM women in the United States was conducted to characterize factors associated with mental health challenges. Materials and Methods: Five databases were searched. Articles were included if focused on MT in REM women in the United States and its territories with specific mental illnesses and published in English from 2005 to 2021. Titles and abstracts and full text were screened. Screening and data collection were completed in duplicate by two reviewers in Covidence. Results: Sixty-five articles were included and indicate that REM women experience a disproportionate burden of depressive symptoms during the MT. Less evidence is reported about anxiety, Post-Traumatic Stress Disorder, psychosis, schizophrenia, and other mental illnesses. The risk factors associated with mental illness during MT are social, structural, and biological. Treatment response to therapeutic interventions is often underpowered to explain REM differences. Conclusion: Depression during the MT is associated with negative outcomes that may impact REM women differentially. Incorporating theoretical frameworks (e.g., intersectionality, weathering) into mental health research will reduce the likelihood that scientists mislabel race as the cause of these inequities, when racism and intersecting systems of oppression are the root causes of differential expression of mental illness among REM women during the MT. There is a need for interdisciplinary research to advance the mental health of REM women.

Growth of a Nipple Adenoma After Estrogen Replacement Therapy

A nipple adenoma is an epithelial tumor of the lactiferous ducts, typically affecting women aged 50-60 years old. This case report discusses a 52-year-old woman who developed a papillary adenoma of the right nipple after initiating oral estrogen replacement therapy (ERT) for perimenopausal symptoms. A 4 mm punch biopsy and subsequent immunohistochemistry stain revealed the proliferation of ductal structures consistent with a papillary adenoma and tumor cells expressing estrogen receptors (ER) and progesterone receptors (PR). Despite their benign nature, nipple adenomas may exhibit alterations in immunophenotype, including ER and PR expression, which could lead to potential tumor growth in women undergoing these treatments. This case describes the first reported growth of a nipple adenoma in the context of estrogen replacement therapy, highlighting a potential risk of hormone therapy in promoting hyperproliferation of benign tumors such as nipple adenomas. When utilizing ERT, it is important to weigh the potential advantages and risks, as its application in the management of vasomotor symptoms during menopause may increase the risk of both breast cancer and benign proliferative breast diseases. These considerations underscore the need for individualized therapy when approaching perimenopausal and postmenopausal care.

Impact of symptomatic menopausal transition on the occurrence of depression, anxiety, and sleep disorders: A real-world multi-site study

BACKGROUND

The menopause transition is a vulnerable period that can be associated with changes in mood and cognition. The present study aimed to investigate whether a symptomatic menopausal transition increases the risks of depression, anxiety, and sleep disorders.

METHODS

This population-based, retrospective cohort study analysed data from five electronic health record databases in South Korea. Women aged 45-64 years with and without symptomatic menopausal transition were matched 1:1 using propensity-score matching. Subgroup analyses were conducted according to age and use of hormone replacement therapy (HRT). A primary analysis of 5-year follow-up data was conducted, and an intention-to-treat analysis was performed to identify different risk windows over 5 or 10 years. The primary outcome was first-time diagnosis of depression, anxiety, and sleep disorder. We used Cox proportional hazard models and a meta-analysis to calculate the summary hazard ratio (HR) estimates across the databases.

RESULTS

Propensity-score matching resulted in a sample of 17,098 women. Summary HRs for depression (2.10; 95% confidence interval [CI] 1.63-2.71), anxiety (1.64; 95% CI 1.01-2.66), and sleep disorders (1.47; 95% CI 1.16-1.88) were higher in the symptomatic menopausal transition group. In the subgroup analysis, the use of HRT was associated with an increased risk of depression (2.21; 95% CI 1.07-4.55) and sleep disorders (2.51; 95% CI 1.25-5.04) when compared with non-use of HRT.

CONCLUSIONS

Our findings suggest that women with symptomatic menopausal transition exhibit an increased risk of developing depression, anxiety, and sleep disorders. Therefore, women experiencing a symptomatic menopausal transition should be monitored closely so that interventions can be applied early.

Premenstrual exacerbation of mental health disorders: a systematic review of prospective studies

Mental health disorders can be exacerbated during periods of hormonal fluctuation (e.g. pregnancy, menopause), and the risk factors for sensitivity to these fluctuations are similar to those of mental disorders (e.g. trauma). However, the extent to which hormonal fluctuations during the menstrual cycle impact symptoms of preexisting mental disorders remains unclear. Prospective methodology is considered the gold standard for measuring symptoms across the menstrual cycle. Thus, the aim of the review was to address this knowledge gap by summarising all available studies prospectively measuring symptoms of mental disorders across the menstrual cycle. A systematic review with narrative synthesis was conducted; meta-analysis was precluded due to methodological heterogeneity of included studies. Electronic databases MEDLINE, Embase, PyschINFO and CINAHL were systematically searched from inception. Risk of bias for individual studies was assessed using a modified version of the Newcastle-Ottawa Scale. The search identified 629 studies from which 35 met inclusion criteria. There was clear evidence of symptom exacerbation during the perimenstrual phase for psychotic disorders, panic disorder, eating disorders, depression and borderline personality disorder. Less consistent evidence was found for anxiety, and a different pattern of symptom exacerbation was observed in bipolar disorder. Sample size and methodology varied considerably amongst studies. Overall, there was mixed evidence for perimenstrual exacerbation across mental disorders, which could be partly explained by methodological limitations of the studies. However, hormonal fluctuations during the menstrual cycle may exacerbate psychiatric symptoms in a subgroup of individuals who are hormone sensitive.

Mental health and quality of life in postmenopausal women as a function of retrospective menopause symptom severity

OBJECTIVES

Perimenopause is commonly viewed as a window of vulnerability for developing psychiatric and eating disorders, especially for women who experience severe symptoms. However, menopausal symptoms may have a lasting effect on older women's mental health and quality of life (QOL) into postmenopause. The current study examined older (60+) postmenopausal women's mental health and QOL as a function of retrospective menopausal symptom severity.

METHODS

Participants were recruited via public online postings and included 227 postmenopausal women, ages 60 to 94 years old (M = 68.84, SD = 6.53). Participants completed an online questionnaire to assess past menopausal symptoms as well as current depression, anxiety, sleep difficulties, binge eating, QOL, and demographics. The relation between the retrospective severity of menopausal symptoms and mental health/QOL was evaluated using linear regressions, while controlling for demographic covariates.

RESULTS

Retrospective menopause symptom severity was significantly associated with depression, sleep difficulties, binge eating severity, and most QOL measures. Regarding covariates, having a psychiatric history was significantly associated with all outcome variables, except for anxiety. Time since menopause and body mass index were significantly associated with binge eating severity. Regarding specific symptom subgroups, psychological and somato-vegetative symptoms were most associated with mental health and QOL.

CONCLUSION

The menopausal transition is a significant change in a woman's life and the challenges of menopausal symptoms can have lasting impacts on women's health. It is imperative that future research seeks to further understand the lasting impacts of this transition on the lives of older women to ensure proper interventions are implemented for successful aging.

Impact of menstrual cycle events on bipolar disorder course: a narrative review of current evidence

Several lines of research suggest that reproductive-related hormonal events may affect the course of bipolar disorder in some women. However, data on associations between bipolar disorder and menarche, menstrual cycle, and menopause are mixed. This article reviews the literature on the potential effects of menarche, menstrual cycle, and menopause on bipolar disorder.A narrative review of published articles on bipolar disorder and menstrual cycle events was conducted. The primary outcome assessed was the impact of menarche, menstrual cycle and menopause on the course of bipolar illness. Databases searched were PubMed, Ovid, Scopus, PsycINFO, Medline, and Cochrane Libraries from inception to August 2021.Twenty-two studies were identified and included in the narrative synthesis. Research suggested that a subset of women with bipolar disorder are vulnerable to the impact of menstrual cycle events. Menarche seems to be associated with age at onset of bipolar illness especially in case of bipolar disorder type I and the specific age at menarche may predict some clinical features of the disorder. Menstrual cycle likely affects the course of bipolar disorder but the pattern of mood variability is not clear. Menopause appears to be not only a period of vulnerability to mood alteration, especially depressive episodes, and impairment of quality of life, but also a potential trigger of bipolar illness onset.The impact of menarche, menstrual cycle, and menopause on bipolar disorder is largely understudied. Preliminary evidence suggests that a subset of women with bipolar disorder may have their mood shifts affected by menstrual cycle events, with different patterns depending on the type of bipolar disorder also. Further researches are needed to deep the impact of menarche, menstrual cycle, and menopause on bipolar illness.

Depressive and Anxious Temperaments as Predictors of Late Onset Bipolar Disorder? Preliminary Results of a "Real World" Exploratory Study

INTRODUCTION

Bipolar disorder (BD) onset typically occurs between 15 and 30 years, being diagnosed under the age of 50 in 90% of cases, named "non-late onset BD" (non-LOBD). However, clinical observation of late-onset BD (LOBD) raised some concern regarding a differential psychopathological pattern, outcomes and treatment, including a specific affective temperament vulnerability. Therefore, an exploratory study in the "real world" was carried out by investigating psychopathological and temperamental features of a psychogeriatric cohort of LOBD and non-LOBD subjects.

METHODS

A total of 180 patients affected with BD-I, BD-II, and Cyclothymic Disorder were screened in a Mood Disorder Outpatient Service, during the timeframe January 2019-August 2021. Out of 78 enrolled outpatients, 66 (33 non-LOBD, 33 LOBD) were recruited, by the retrospective collection of sociodemographic, cognitive, psychopathological and clinical assessment, including the short-version of the Temperament Evaluation of Memphis, Pisa, and San Diego (TEMPS-M).

RESULTS

LOBD is significantly associated with higher rates of BD-II diagnosis (χ² = 27.692, p < 0.001), depressive episodes (p = 0.025), mixed states (p = 0.009), predominant depressive and anxious affective temperaments (p < 0.001). Non-LOBD is significantly associated with higher endocrinological (χ² = 6.988, p = 0.008) and metabolic comorbidity (χ² = 5.987, p = 0.014), a diagnosis of BD-I, manic episodes, and predominant hyperthymic affective temperaments (p = 0.001). GDS (p < 0.001) and MSRS (p = 0.005) scores were significantly higher in LOBD.

CONCLUSION

Further longitudinal studies with larger sample sizes and a control group are needed to determine whether LOBD may represent a distinct psychopathological entity from non-LOBD and evaluate differences (if any) in terms of prognosis and treatment between non-LOBD and LOBD.

Effects of aerobics training on anxiety, depression and sleep quality in perimenopausal women

OBJECTIVE

To investigate the effect of aerobics training on anxiety, depression and sleep disturbance in perimenopausal women.

MATERIALS AND METHODS

A total of 289 perimenopausal women with anxiety, depression or sleep disorder in Lishi district of Luliang city were treated with aerobics training. Self-rating anxiety scale, self-rating depression scale and Pittsburgh sleep scale were used to investigate the anxiety, depression and sleep status of perimenopausal women before and after intervention.

RESULTS

After aerobics training, the scores of self-rating anxiety scale, self-rating depression scale and Pittsburgh sleep questionnaire were 48.26 ± 6.47, 50.27 ± 6.54 and 10.64 ± 4.38, respectively. The levels of anxiety, depression and sleep disorder in 289 subjects were significantly lower than those before intervention (t = 3.865, 4.541, 5.596, P < 0.01). The remission rate of symptoms was significantly different in subjects with different frequency of spontaneous practice (P < 0.01), and the higher the number of spontaneous practice, the higher the remission rate of anxiety, depression and sleep disorders in subjects (P < 0.01).

CONCLUSION

aerobics training can effectively improve the anxiety and depression of perimenopausal women, improve sleep quality, the more frequency of practice, the more obvious the effect. It can be used as an intervention to improve the mental health level of perimenopausal women in terms of anxiety, depression and sleep quality in clinical promotion.

Perimenopause and First-Onset Mood Disorders: A Closer Look

Perimenopause is often a time of social, emotional, and physical change. Various factors contribute to the development of mood disorders during this time. There is a known association among women with previous history of major depressive disorder or bipolar disorder and relapse during the menopausal transition. First-onset mood disorders during this time have been less studied. A literature review in PsycInfo Ovid of records pertaining to first-onset mood disorders during perimenopause showed that this multifactorial process involves hormonal fluctuations, with estrogen being a key player. In addition, vasomotor symptoms, previous negative life events, and socioeconomic status were found to contribute to first-onset mood disorders during perimenopause. Treatment options include established medication regimens for psychiatric conditions; however, hormone therapy also has proven beneficial for this patient population. Further research, particularly on bipolar disorder, is needed to develop a clear association between perimenopause and first-onset mood disorders.

Menopause in women with schizophrenia, schizoaffective disorder and bipolar disorder

The transition to menopause, usually occurring between the ages of 40 and 55, is a time when women are particularly vulnerable. When preexisting mental illness is present, symptoms are often amplified during this period. Moreover, women with mental illnesses experience menopausal symptoms similarly to healthy women. In this narrative review we summarize the current data regarding menopause in women with schizophrenia, schizoaffective disorder, and bipolar disorder, as well as current standards of management and care. The management of chronic disease in women suffering from severe mental illness is also considered.

Peri- and Post-Menopausal Women with Schizophrenia and Related Disorders Are a Population with Specific Needs: A Narrative Review of Current Theories

Background: While gender differences in antipsychotic response have been recognized, the potential role of menopause in changing drug efficacy and clinical outcome in schizophrenia related disorders has been understudied. We aimed to review the relevant literature to test whether optimizing menopausal and post-menopausal treatment and addressing specific health needs of this stage in life will improve outcome. Methods: Non-systematic narrative review using the PubMed database (1900–July 2021) focusing on randomized controlled trial results addressing our question. Forty-nine studies met our criteria. Results: Premenopausal women show significantly better antipsychotic response than postmenopausal women. Hormone replacement therapies (HRT) should be used in postmenopausal women with schizophrenia with caution. Raloxifene, combined with antipsychotics, is effective for psychotic and cognitive symptoms in postmenopausal women with schizophrenia and related disorders. Medical comorbidities increase after menopause, but the influence of comorbidities on clinical outcomes has been poorly investigated. Preventive strategies include weighing risks and benefits of treatment, preventing medical comorbidities, and enhancing psychosocial support. Ideal treatment settings for this population warrant investigation. Conclusions: Antipsychotic dose adjustment at menopause is recommended for schizophrenia. Raloxifene may play an important role in permitting dose reduction and lessening adverse effects. Prevention of comorbidities will help to reduce the mortality rate.

At the heart of the matter: Cardiovascular health challenges among incarcerated women

Many factors appear to contribute to an increased risk for cardiovascular disease (CVD) among incarcerated women. Imprisonment is associated with a bodyweight gain and an increased prevalence of overweight and obesity. Inadequate physical activity and unhealthy nutrition further contribute to this positive energy balance. Classical CVD risk factors are common, including hypertension, diabetes mellitus, metabolic syndrome, and smoking. Moreover, imprisonment is associated with an increased incidence of mental health issues, such as depression and anxiety, with coping mechanisms, including substance abuse, being frequently adopted. Specific attitudes in the correctional environment, including hunger strikes, bullying, abuse and solitary confinement, are effectors of cardiovascular and mental ill-health. Furthermore, the plethora of psychological stressors induces an accelerated aging process, paired with CVD risk. Communicable diseases, mainly human immunodeficiency virus, opportunistic infections and inadequate sunlight exposure increase cardiovascular dysregulation. Health care needs associated with the female sex are not always met, adding to the frustration and compromised well-being. All these factors act independently and cumulatively, increasing CVD risk among incarcerated women.

Mental health aspect of quality of life in the menopausal transition

PURPOSE

To evaluate factors associated with mental health quality of life (QOL), such as depressed mood, anxiety, poor memory and sleep, among midlife women according to the menopausal status.

MATERIAL AND METHODS

Participants were 500 women aged 40-65 years. Data were collected using socio-demographic questionnaire, Women's Health Questionnaire (domains of depressed mood-DEP, anxiety-ANX, memory-MEM and sleep-SLE) and Short Form-36 (Mental Composite Score) for assessment of health-related QOL. Factors associated with poorer DEP, ANX, MEM and SLE were examined using adjusted linear regression models.

RESULTS

In premenopausal women, lower household monthly income (p = .046) was associated with higher level of DEP; higher body mass index (p = .045) was associated with higher ANX; having gynecological illnesses (p = .017) and menopause-related symptoms (p = .039) were associated with poorer MEM; being married (p = .036), drinking alcohol (p = .036) and having more physical activity (p = .041) was associated with better SLE. In postmenopausal women, worse DEP was more likely among women residing in city outskirts (p = .009), who are not married (p = .038) and with sedentary occupations (p = .049); lower education level (p = .030) was associated with more ANX; lower education level (p = .045) and having menopause-related symptoms (p = .044) were associated with poorer MEM; not engaging in regular recreation (p = .031) was associated with better SLE.

CONCLUSIONS

To improve QOL, pre- and postmenopausal women should not only be supported in the management of menopause-specific symptoms. Women should also receive recommendations as to the behavioral and personal changes when approaching the midlife period.

Neuroprotective and neurotoxic outcomes of androgens and estrogens in an oxidative stress environment

BACKGROUND

The role of sex hormones on cellular function is unclear. Studies show androgens and estrogens are protective in the CNS, whereas other studies found no effects or damaging effects. Furthermore, sex differences have been observed in multiple oxidative stress-associated CNS disorders, such as Alzheimer's disease, depression, and Parkinson's disease. The goal of this study is to examine the relationship between sex hormones (i.e., androgens and estrogens) and oxidative stress on cell viability.

METHODS

N27 and PC12 neuronal and C6 glial phenotypic cell lines were used. N27 cells are female rat derived, whereas PC12 cells and C6 cells are male rat derived. These cells express estrogen receptors and the membrane-associated androgen receptor variant, AR45, but not the full-length androgen receptor. N27, PC12, and C6 cells were exposed to sex hormones either before or after an oxidative stressor to examine neuroprotective and neurotoxic properties, respectively. Estrogen receptor and androgen receptor inhibitors were used to determine the mechanisms mediating hormone-oxidative stress interactions on cell viability. Since the presence of AR45 in the human brain tissue was unknown, we examined the postmortem brain tissue from men and women for AR45 protein expression.

RESULTS

Neither androgens nor estrogens were protective against subsequent oxidative stress insults in glial cells. However, these hormones exhibited neuroprotective properties in neuronal N27 and PC12 cells via the estrogen receptor. Interestingly, a window of opportunity exists for sex hormone neuroprotection, wherein temporary hormone deprivation blocked neuroprotection by sex hormones. However, if sex hormones are applied following an oxidative stressor, they exacerbated oxidative stress-induced cell loss in neuronal and glial cells.

CONCLUSIONS

Sex hormone action on cell viability is dependent on the cellular environment. In healthy neuronal cells, sex hormones are protective against oxidative stress insults via the estrogen receptor, regardless of sex chromosome complement (XX, XY). However, in unhealthy (e.g., high oxidative stress) cells, sex hormones exacerbated oxidative stress-induced cell loss, regardless of cell type or sex chromosome complement. The non-genomic AR45 receptor, which is present in humans, mediated androgen's damaging effects, but it is unknown which receptor mediated estrogen's damaging effects. These differential effects of sex hormones that are dependent on the cellular environment, receptor profile, and cell type may mediate the observed sex differences in oxidative stress-associated CNS disorders.

Association between suicide risk and traumatic brain injury in adults: a population based cohort study

Background

Traumatic brain injury (TBI) is a major cause of death and disability worldwide, and its treatment is potentially a heavy economic burden. Suicide is another global public health problem and the second leading cause of death in young adults. Patients with TBI are known to have higher than normal rates of non-fatal deliberate self-harm, suicide and all-cause mortality. The aim of this study was to explore the association between TBI and suicide risk in a Chinese cohort.

Method

This study analysed data contained in the Taiwan National Health Insurance Research Database for 17 504 subjects with TBI and for 70 016 subjects without TBI matched for age and gender at a ratio of 1 to 4. Cox proportional hazard regression analysis was used to estimate subsequent suicide attempts in the TBI group. Probability of attempted suicide was determined by Kaplan-Meier method.

Results

The overall risk of suicide attempts was 2.23 times higher in the TBI group compared with the non-TBI group (0.98 vs 0.29 per 1000 person-years, respectively) after adjustment for covariates. Regardless of gender, age or comorbidity, the TBI group tended to have more suicide attempts, and the risk attempted suicide increased with the severity of TBI. Depression and alcohol attributed disease also increased the risk of attempted suicide in the TBI group.

Conclusion

Suicide is preventable if risk factors are recognised. Hence, TBI patients require special attention to minimise their risk of attempted suicide.

Bipolar Disorder in the Menopausal Transition

PURPOSE OF REVIEW

We review recent data on bipolar disorder in menopausal-aged women, particularly in women undergoing the menopausal transition (MT). We discuss evidence on the severity of symptoms in bipolar women during the MT. Moreover, we address two factors in bipolar disorder and menopausal research: standardized menopausal staging and women's conceptualization of their menopausal and bipolar symptoms.

RECENT FINDINGS

While there are few studies within the last 5 years on bipolar women undergoing the MT, new evidence suggest that mood symptoms in women worsen with progression through the MT. Consistent use of the standardized menopausal staging system can facilitate understanding of the timing of worsening symptoms. Moreover, whether women conceptualize their symptoms as arising from their MT or bipolar disorder can influence whether they seek hormonal therapy or psychiatric treatment, respectively. The MT is a potential time for mood instability in vulnerable women, which can manifest as first-onset development of bipolar disorder or increased symptom severity in women with pre-existing bipolar disorder. Adoption of a standardized menopausal staging may offer novel frameworks for understanding of the role of the MT in bipolar disorder.

Sex Differences in Vulnerability and Resilience to Stress Across the Life Span

Susceptibility and resilience to stress depend on 1) the timing of the exposure with respect to development, 2) the time across the life span at which effects are measured, and 3) the behavioral or biological phenotype under consideration. This translational review examines preclinical stress models that provide clues to causal mechanisms and their relationship to the more complex phenomenon of stress-related psychiatric and cognitive disorders in humans. We examine how genetic sex and epigenetic regulation of hormones contribute to the proximal and distal effects of stress at different epochs of life. Stress during the prenatal period and early postnatal life puts male offspring at risk of developing diseases involving socialization, such as autism spectrum disorder, and attention and cognition, such as attention-deficit/hyperactivity disorder. While female offspring show resilience to some of the proximal effects of prenatal and early postnatal stress, there is evidence that risk associated with developmental insults is unmasked in female offspring following periods of hormonal activation and flux, including puberty, pregnancy, and perimenopause. Likewise, stress exposures during puberty have stronger proximal effects on girls, including an increased risk of developing mood-related and stress-related illnesses, such as depression, anxiety, and posttraumatic stress disorder. Hormonal changes during menopause and andropause impact the processes of memory and emotion in women and men, though women are preferentially at risk for dementia, and childhood adversity further impacts estradiol effects on neural function. We propose that studies to determine mechanisms for stress risk and resilience across the life span must consider the nature and timing of stress exposures as well as the sex of the organism under investigation.

Assessment of perimenopausal depression: A review

BACKGROUND

Within the female life cycle, the perimenopause is considered as a critical period for the development of depression. Prevalence rates are particularly high during this phase. Perimenopausal depression is characterized by affective symptoms as well as menopause-specific somatic complaints. Currently, a variety of questionnaires are used to assess mood during the perimenopause. The aim of this review is to determine the instruments employed to assess perimenopausal depression.

METHODS

We searched the databases PubMed, Cochrane Library and PsycINFO for human studies investigating perimenopausal depression, and subsequently screened for the assessment instruments used to measure mood and menopause. A total of 37 articles were included.

RESULTS

Altogether, 14 different instruments were applied to assess mood during menopause. The CES-D was by far the most frequently used depression scale, appearing in 16 out of the 37 studies. The methods used to identify perimenopausal status and symptoms were inconsistent.

LIMITATIONS

Due to lacking information about data and methodology, a selection bias is conceivable. Additionally, a publication bias is possible. Finally, there is inevitable subjectivity in the screening process of a systematic search.

CONCLUSIONS

The assessment of depression in the menopausal transition is highly heterogeneous, reducing the overall comparability of study results. Furthermore, menopausal complaints are not sufficiently taken into account. Accordingly, the use of a menopause-specific depression scale is highly recommended in order to account for physical and mood-related symptoms in the menopausal transition.

Infection with Trichomonas vaginalis increases the risk of psychiatric disorders in women: a nationwide population-based cohort study

Background

Trichomonas vaginalis is a protozoan parasite that causes trichomoniasis and annually infects approximately 276 million people worldwide. We observed an ambiguously higher probability of trichomoniasis in patients from the psychiatric department of Tri-Service General Hospital. Herein, we aimed to investigate the association between trichomoniasis and the risk of developing psychiatric disorders.

Methods

The nationwide population-based study utilized the database of the National Health Insurance (NHI) programme in Taiwan. A total of 46,865 subjects were enrolled in this study from 2000–2013, comprising 9373 study subjects with trichomoniasis and 37,492 subjects without trichomoniasis as the control group. Cox proportional hazards regression analysis was performed to calculate the hazard ratio (HR) of psychiatric disorders during the 14 years of follow-up.

Results

Of the study subjects with trichomoniasis, 875 (9.34%) developed psychiatric disorders compared with 1988 (5.30%) in the control group (P < 0.001). The adjusted hazard ratio (aHR) of overall psychiatric disorders in the study subjects was 1.644 (95% confidence interval, CI: 1.514–1.766; P < 0.001). More specifically, the study subjects had a higher risk for developing an individual psychiatric disorder, including depression, anxiety, bipolar disorder, schizophrenia and substance abuse. Although metronidazole treatment reduced the risk for developing several subgroups of psychiatric disorders, significant reduction was detected for depression only. Furthermore, refractory trichomoniasis (trichomoniasis visits ≥ 2) enhanced the risk of psychiatric disorders.

Conclusions

We show herein that T. vaginalis infection increases the overall risk for psychiatric disorders. The novel role of T. vaginalis in developing psychiatric disorders deserves more attention, and the control of such a neglected pathogen is of urgent public health importance.

Electronic supplementary material

The online version of this article (10.1186/s13071-019-3350-x) contains supplementary material, which is available to authorized users.

Inflaming sex differences in mood disorders

Men and women often experience different symptoms or rates of occurrence for a variety of mood disorders. Many of the symptoms of mood disorders overlap with autoimmune disorders, which also have a higher prevalence in women. There is a growing interest in exploring the immune system to provide biomarkers for diagnosis of mood disorders, along with new targets for developing treatments. This review examines known sex differences in the immune system and their relationship to mood disorders. We focus on immune alterations associated with unipolar depression, bipolar depression, and anxiety disorders. We describe work from both basic and clinical research examining potential immune mechanisms thought to contribute to stress susceptibility and associated mood disorders. We propose that sex and age are important, intertwined factors that need to be included in future experimental designs if we are going to harness the power of the immune system to develop a new wave of treatments for mood disorders.

Increased illness burden in women with comorbid bipolar and premenstrual dysphoric disorder: data from 1 099 women from STEP-BD study

BACKGROUND

The impact of comorbid premenstrual dysphoric disorder (PMDD) in women with bipolar disorder (BD) is largely unknown.

AIMS

We compared illness characteristics and female-specific mental health problems between women with BD with and without PMDD.

MATERIALS & METHODS

A total of 1 099 women with BD who participated in the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) were studied. Psychiatric diagnoses and illness characteristics were assessed using the Mini International Neuropsychiatric Interview. Female-specific mental health was assessed using a self-report questionnaire developed for STEP-BD. PMDD diagnosis was based on DSM-5 criteria.

RESULTS

Women with comorbid BD and PMDD had an earlier onset of bipolar illness (P < 0.001) and higher rates of rapid cycling (P = 0.039), and increased number of past-year hypo/manic (P = 0.003), and lifetime/past-year depressive episodes (P < 0.05). Comorbid PMDD was also associated with higher proportion of panic disorder, post-traumatic stress disorder, generalized anxiety disorder, bulimia nervosa, substance abuse, and adult attention deficit disorder (all P < 0.05). There was a closer gap between BD onset and age of menarche in women with comorbid PMDD (P = 0.003). Women with comorbid PMDD reported more severe mood symptoms during the perinatal period and while taking oral contraceptives (P < 0.001).

DISCUSSION

The results from this study is consistent with research suggesting that sensitivity to endogenous hormones may impact the onset and the clinical course of BD.

CONCLUSIONS

The comorbidity between PMDD and BD is associated with worse clinical outcomes and increased illness burden.

Menopause and illness course in bipolar disorder: A systematic review

OBJECTIVES

Menopause may be a time of increased mood symptoms for some women. This systematic review aimed to examine the severity of symptoms and prevalence of mood changes in women with bipolar disorder during peri-menopause and post-menopause.

METHODS

A systematic review was undertaken in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The two primary outcomes assessed were relapse rates and symptom severity during menopause. Databases searched were MEDLINE, EMBASE, PsychInfo, CINAHL and SCOPUS from January 1980 until December 2016.

RESULTS

Nine studies, including a total of 273 participants diagnosed with bipolar disorder and who reported menopause, were included in the narrative synthesis. Menopause was reported to be associated with increased symptoms overall, and with depression in particular (range of 46%-91%). The collection of self-reported retrospective data was the most commonly used method to record menopause status.

CONCLUSIONS

The impact of menopause on illness course for women with bipolar disorder is largely under-explored. Preliminary evidence suggests that it may be associated with increased bipolar symptoms. Further work is needed to explore how menopause may interact with bipolar disorder over time and the nature of these symptom changes, and if and how menopause may differ from other reproductive stages.

Traumatic Brain Injury and Substance Related Disorder: A 10-Year Nationwide Cohort Study in Taiwan

Whether traumatic brain injury (TBI) is causally related to substance related disorder (SRD) is still debatable, especially in persons with no history of mental disorders at the time of injury. This study analyzed data in the Taiwan National Health Insurance Research Database for 19,109 patients aged ≥18 years who had been diagnosed with TBI during 2000-2010. An additional 19,109 randomly selected age and gender matched patients without TBI (1 : 1 ratio) were enrolled in the control group. The relationship between TBI and SRD was estimated with Cox proportional hazard regression models. During the follow-up period, SRD developed in 340 patients in the TBI group and in 118 patients in the control group. After controlling for covariates, the overall incidence of SRD was 3.62-fold higher in the TBI group compared to the control group. Additionally, patients in the severe TBI subgroup were 9.01 times more likely to have SRD compared to controls. Notably, patients in the TBI group were prone to alcohol related disorders. The data in this study indicate that TBI is significantly associated with the subsequent risk of SRD. Physicians treating patients with TBI should be alert to this association to prevent the occurrence of adverse events.