Controversy has existed over the contribution of the menopause transition to first episodes of clinical depression. In 2 studies of women between 35 and 47 years of age who did not have a history of major depression, 1 found that women who became perimenopausal during the 5 years of follow-up were more likely to develop depressive symptoms compared with those who remained premenopausal (Freeman et al., 2006; Cohen et al., 2006) and the other saw higher odds of depressive disorder during perimenopause (Freeman et al., 2006).

In Dr. Bromberger's study, women were enrolled through telephone surveys using random dialing or through voter registration lists from the Pittsburgh area. Those who met the eligibility criteria were followed for 10 years; they were asked to fill out a survey once a year regarding symptoms of depression. The study evaluated longitudinally the contribution of indicators of menopausal status, health-related factors, and life stressors to the onset of a first episode of clinical depression.

Women were 42 to 52 years of age, had their uterus intact and at least 1 ovary, menses within the past 3 months, and had not used reproductive hormones in the 3 months prior to enrolment.

The results show that stressful life events were associated with first episodes of depression, such as loss of a job, loss of a spouse through death or divorce, as well as problems with children and families and ongoing relationships. Other factors that contributed to a first episode of depression were low role functioning due to physical health problems at baseline, anxiety disorder history at baseline, low social functioning at baseline, and a stressful life event at the last interview visit. Also, frequent vasomotor symptoms at the last interview visit were a factor.

Dr. Bromberger and colleagues concluded that both earlier and proximal factors, menopausal, health and stress factors independently increased the risk of having a first episode of depression among middle-aged women.


The study is partially funded by the National Institutes of Mental Health.

[Presentation title: Predictors of First Episodes of Clinical Depression in Midlife Women. Poster NR289]

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