Could adult female acne be associated with modern life?
Albuquerque R G R,Rocha M A D,Bagatin E,Tufik S,Andersen M L
Archives of dermatological research
In recent years, the prevalence of adult female acne has increased, but the reason for this increase remains unclear. Acne is one of the most common skin disorders. It can be triggered or worsened by endogenous and exogenous factors, including genetic predisposition, hormone concentrations, diet, smoke and stress; although the interaction with this last factor is not well understood. Modern life presents many stresses including urban noises, socioeconomic pressures and light stimuli. Women are especially affected by stress during daily routine. The recent insertion in the labor market is added to the duties of the mother and wife. Women also have a higher risk of developing psychiatric disorders such as depression and anxiety. Sleep restriction is added to these factors, with several negative consequences on health, including on hormonal secretion and the immune system. This is further complicated by the natural variation in sleep architecture across the menstrual cycle. Recent studies have brought new data about the mechanisms and possible factors involved. This review aims to establish a connection between stress, sleep deprivation and adult female acne.
A review of estrogen receptor alpha gene (ESR1) polymorphisms, mood, and cognition.
Sundermann Erin E,Maki Pauline M,Bishop Jeffrey R
Menopause (New York, N.Y.)
OBJECTIVE:There are significant individual differences in the extent to which mood and cognition change as a function of reproductive stage, menstrual phase, postpartum, and hormone therapy use. This review explores the extent to which variations or polymorphisms in the estrogen receptor alpha gene (ESR1) predict cognitive and mood outcomes. METHODS:A literature search was conducted from 1995 to November 2009 through PubMed, Embase, and PsychINFO. Twenty-five manuscripts that summarize investigations of ESR1 in mental health were reviewed. RESULTS:Among studies investigating ESR1 in relation to cognition, 11 of 14 case-control studies reported an association between ESR1 polymorphisms and risk for developing dementia. Three of four prospective cohort studies reported an association between ESR1 polymorphisms and significant cognitive decline. There are inconsistencies between case-control and cohort studies regarding whether specific ESR1 alleles increase or decrease the risk for cognitive dysfunction. The relationships between ESR1 and cognitive impairment tend to be specific to or driven by women and restricted to risk for Alzheimer disease rather than other dementia causes. Three of five studies examining ESR1 polymorphisms in relation to anxiety or depressive symptoms found significant associations. Significant associations have also been reported between ESR1 polymorphisms and childhood-onset mood disorder and premenstrual dysphoric disorder. CONCLUSIONS:A strong relationship between ESR1 variants and cognitive outcomes is evident, and preliminary evidence suggests a role of the ESR1 gene in certain mood outcomes. Insights into the discordant results will come from future studies that include haplotype analyses, analyses within specific ethnic/racial populations, and sex-stratified analyses.
Effects of anemia and iron deficiency on quality of life in women with heavy menstrual bleeding.
Peuranpää Pirkko,Heliövaara-Peippo Satu,Fraser Ian,Paavonen Jorma,Hurskainen Ritva
Acta obstetricia et gynecologica Scandinavica
OBJECTIVE:To assess the impact of anemia and iron deficiency on health-related quality of life (HRQoL) in women treated for heavy menstrual bleeding (HMB). DESIGN:Secondary analysis of a randomized controlled trial. SETTING:Five university hospitals in Finland. SAMPLE:A total of 236 women referred for HMB. METHODS:Women were randomized to treatment with hysterectomy or a levonorgestrel-releasing intrauterine system. We defined groups based on women's pretreatment hemoglobin [hemoglobin <120 g/L (anemic) vs. hemoglobin ≥120 g/L (nonanemic)] and serum ferritin (ferritin <15 μg/L vs. ≥15 μg/L) concentrations. HRQoL was compared between groups at baseline, 6 and 12 months after treatment. Hemoglobin and ferritin were followed for 5 years. MAIN OUTCOME MEASURES:HRQoL was measured by the RAND 36-item health survey (RAND-36), 5-Dimensional EuroQol and two questionnaires of mental wellbeing. RESULTS:At baseline, 63 women (27%) were anemic and 140 (60%) were severely iron deficient (ferritin <15 μg/L). Only 8% of the anemic women had taken iron supplementation. Twelve months after treatment hemoglobin had increased in both hemoglobin groups, but was still significantly lower (p < 0.001) in initially anemic women (128 g/L) compared with nonanemic women (136 g/L). Twelve months after treatment three domain scores of RAND-36 increased more (energy, p = 0.002; physical functioning, p = 0.04; social functioning, p = 0.05), and anxiety (p = 0.02) and depression scores (p = 0.002) decreased more in anemic compared with nonanemic women. Serum ferritin took 5 years to reach normal levels. CONCLUSIONS:Improved HRQoL after treatment of HMB is associated with correction of anemia. Clinicians should actively screen for anemia in women with HMB and emphasize early iron substitution as an integral part of treatment.
Menstrual cycle effects on amygdala reactivity to emotional stimulation in premenstrual dysphoric disorder.
Gingnell Malin,Morell Arvid,Bannbers Elin,Wikström Johan,Sundström Poromaa Inger
Hormones and behavior
Premenstrual dysphoric disorder (PMDD) with luteal phase related anxiety and mood swings compromise quality of life in around 4% of reproductive women. While anxiety is related to amygdala function, prior studies on amygdala reactivity both in healthy controls and women with PMDD are inconsistent with respect to menstrual cycle effects. Here women with PMDD and healthy controls were exposed to emotional faces during the mid-follicular and late luteal phase, and mean blood-oxygen-level dependence (BOLD) signal changes in the amygdala were determined with functional magnetic resonance imaging (fMRI). Women with PMDD had enhanced bilateral amygdala reactivity in the follicular phase in comparison with healthy controls, but there was no difference between groups during the luteal phase. In contrast, healthy controls displayed higher left amygdala reactivity in the luteal than in their follicular phase. However, among women with PMDD follicular phase progesterone serum concentrations were positively correlated with bilateral amygdala reactivity while depression scores were positively correlated with right amygdala reactivity in the luteal phase. In addition, women with PMDD and high scores on trait anxiety had increased right amygdala reactivity in the luteal as compared to the follicular phase. Finally, amygdala reactivity was more prone to habituation in women with PMDD, as they had enhanced amygdala reactivity in comparison with controls at the first, but not the second scanning session. Thus, while the study failed to indicate increased luteal phase amygdala reactivity in women with PMDD, our findings suggest that anxiety proneness and progesterone levels modulate menstrual cycle related amygdala reactivity in women with PMDD.
Genes involved in the pathogenesis of premature ovarian insufficiency.
Orlandini C,Regini C,Vellucci F L,Petraglia F,Luisi S
Premature ovarian insufficiency (POI) is defined by the presence of primary or secondary amenorrhea, for at least 4 months, before the age of 40 years associated with follicle stimulating homone levels in menopausal range, exciding 40 UI/L. The diagnosis is confirmed by two blood sample at least 1 month to measure the level of FSH (over 40 UI/L) and level of estradiol (below 50 pmol/L). Ovarian follicular dysfunction and/or depletion of functional primordial follicles characterized this pathology. Abnormal bleeding patterns also include oligomenrrhea and polimenorrhea; because of these irregular menstrual cycles during adolescence, diagnosis could be difficult in young women. Excluding the cases in which an etiopathogenetic agent could be identified, such as in case of chemio- and radiotherapy or extensive surgery, women with autoimmune diseases and/or infections, the etiology of POI remains idiopathic. An important genetic component exists, supported by both a frequent recurring familiar event (20-30%) and the association with other different genetic disorders in particular the X chromosome defects and the implication of some different genes with significant functions in ovarian development. For most of the women the diagnosis of POI is unexpected because of there are no obvious signs or symptoms that precede the cessation of periods with a normal menstrual history, age of menarche and fertility prior to the onset of menopause. The diagnosis of POI has a deleterious psychological impact on the emotional sphere of the women affected: anger, depression, anxiety and sadness are common and the fact that the diagnosis coincides with infertility needs a psychological support. Oral hormonal replacement therapy (HRT) administration is not recommended as first choice of treatment because of the higher hormones concentration with respect to the real hormones necessity of the patients and transdermal HRT may be preferred in women with coagulation disturbances to relief symptoms and to improve to quality of life and the sexuality of these women until the age of 50 years old which is the median age of physiological menopause. Moreover it should be considered the associate comorbidities of POI such as bone loss, cardiovascular disease and endocrine disease.
Challenges and opportunities to manage depression during the menopausal transition and beyond.
Soares Claudio N,Frey Benicio N
The Psychiatric clinics of North America
Women are at a higher risk than men of developing depression and anxiety and such increased risk might be particularly associated with reproductive cycle events. Recent evidence suggests that the transition to menopause may constitute a window of vulnerability for some women for the development of new onset and recurrent depression. Several biological and environmental factors seem to be independent predictors or modulating factors for the occurrence of depression in menopausal women; they include the presence and severity of hot flushes, sleep disturbances, history of severe premenstrual syndrome or postpartum blues, stressful life events, history of depression, socioeconomic status, and use of hormones and psychotropic agents. The regulation of monoaminergic systems by ovarian hormones might explain, at least in part, the emergence of depressive symptoms and/or anxiety in biologically predisposed subpopulations. The use of transdermal estradiol, as well as serotonergic and noradrenergic antidepressants, is an efficacious strategy in the treatment of depression and vasomotor symptoms in symptomatic women in midlife. In this review, the authors discuss the existing evidence of a greater risk for the development of depression during the menopausal transition and the putative underlying mechanisms contributing to this window of vulnerability. Hormonal and nonhormonal treatment strategies for depression and anxiety in this particular population are critically examined, although more tailored treatment options are still needed.
Depression and related disorders during the female reproductive cycle.
Miller Laura J,Girgis Christina,Gupta Renu
Women's health (London, England)
For some women, times of reproductive transition represent times of high risk for the onset or exacerbation of depressive symptoms. In order to maintain emotional stability, the female brain must adapt to fluctuations in hormones that affect neurotransmitter functioning. Difficulty with this adaptation, along with stresses related to social role transitions, may confer heightened vulnerability to depression. In this review, we summarize data regarding the course, expression and risks of depression and related symptoms during puberty and menarche, the luteal phase of the menstrual cycle, the perinatal period and perimenopause. We note treatment strategies that have been found to be effective for depressive symptoms during specific phases of the female reproductive cycle.
Sexual harassment and menstrual disorders among Italian university women: A cross-sectional observational study.
Romito P,Cedolin C,Bastiani F,Beltramini L,Saurel-Cubizolles M J
Scandinavian journal of public health
AIMS:Menstrual disorders and sexual harassment are common among young women and interfere with their life and activities. We aimed to describe the association of sexual harassment and menstrual disorders among female university students. METHODS:This cross-sectional, observational study examined the association between sexual harassment and menstrual disorders in a sample of 349 university students in Italy. Students answered an anonymous self-administered questionnaire. Descriptive bivariate analyses and logistic regression analyses were performed. Main outcome measures were associations between levels of exposure to sexual harassment (none, levels 1 and 2) and five menstrual disorders (premenstrual symptoms, heavy bleeding, pain, irregular cycles, and amenorrhea). RESULTS:Among the women interviewed (mean age 20.4 ± 1.45 years), 146 (41.8%) had experienced sexual harassment in the previous 12 months: 91 (26.1%) level 1 and 55 (15.7%) level 2. The frequency of premenstrual symptoms was 31.9% ( n=110); heavy bleeding, 35.3% ( n=124); pain, 51.4% ( n=181); irregular cycles, 55.5% ( n=195); and amenorrhea, 6.7% ( n=23). After adjustment for age, place of birth, being in a couple relationship and receiving hormone therapy, the frequency of menstrual disorders, except for amenorrhea, was increased with sexual harassment, with a regular gradient from no harassment to level 2 harassment. Introducing factors of depression, specific gynaecological problems and lifetime sexual violence did not change the results. For instance, the adjusted odds ratios of premenstrual symptoms were 2.10 [1.19-3.68] for women with level 1 harassment and 3.58 [1.83-7.03] for women with level 2 compared with women without harassment exposure. CONCLUSIONS:Sexual harassment is related to the prevalence of menstrual disorders. Healthcare providers should encourage dialogue with patients and address the issue of sexual violence or harassment.
Vitamin D and the occurrence of depression: causal association or circumstantial evidence?
Bertone-Johnson Elizabeth R
While recent laboratory-based studies have substantially advanced our understanding of the action of vitamin D in the brain, much is still unknown concerning how vitamin D relates to mood. The few epidemiological studies of vitamin D and depression have produced inconsistent results and generally have had substantial methodological limitations. Recent findings from a randomized trial suggest that high doses of supplemental vitamin D may improve mild depressive symptoms, but important questions persist concerning how vitamin D may affect monoamine function and hypothalamic-pituitary-adrenal axis response to stress, whether vitamin D supplementation can improve mood in individuals with moderate-to-severe depression, and whether vitamin D sufficiency is protective against incident depression and recurrence. At this time, it is premature to conclude that vitamin D status is related to the occurrence of depression. Additional prospective studies of this relationship are essential.
Is there a role for reproductive steroids in the etiology and treatment of affective disorders?
Rubinow David R,Schmidt Peter J
Dialogues in clinical neuroscience
A variety of hormones have been shown to play a role in affective disorders. Reproductive steroids are particularly informative in our efforts to understand the pathophysiology of affective dysregulation for several reasons: i) Reproductive endocrine-related mood disorders (premenstrual dysphoric disorder, perinatal depression, perimenopausal depression) are wonderful clinical models for investigating the mechanisms by which affective state changes occur; ii) Reproductive steroids regulate virtually every system that has been implicated as disturbed in the ontogeny of affective disorders; iii) Despite the absence of a reproductive endocrinopathy a triggering role in the affective disturbance of reproductive mood disorders has been shown clearly for changes in reproductive steroids. The existing data, therefore, support a differential sensitivity to reproductive steroids in reproductive mood disorders such that an abnormal affective state is precipitated by normal changes in reproductive steroids. The therapeutic implications of these findings for affective illness are discussed.
Hypercortisolemia is associated with severity of bone loss and depression in hypothalamic amenorrhea and anorexia nervosa.
Lawson Elizabeth A,Donoho Daniel,Miller Karen K,Misra Madhusmita,Meenaghan Erinne,Lydecker Janet,Wexler Tamara,Herzog David B,Klibanski Anne
The Journal of clinical endocrinology and metabolism
CONTEXT:Anorexia nervosa (AN) and functional hypothalamic amenorrhea (HA) are associated with low bone density, anxiety, and depression. Women with AN and HA have elevated cortisol levels. Significant hypercortisolemia, as in Cushing's disease, causes bone loss. It is unknown whether anxiety and depression and/or cortisol dysregulation contribute to low bone density in AN or HA. OBJECTIVE:Our objective was to investigate whether hypercortisolemia is associated with bone loss and mood disturbance in women with HA and AN. DESIGN AND SETTING:We conducted a cross-sectional study in a clinical research center. PARTICIPANTS:We studied 52 women [21 healthy controls (HC), 13 normal-weight women with functional HA, and 18 amenorrheic women with AN]. OUTCOME MEASURES:Serum samples were measured every 20 min for 12 h overnight and pooled for average cortisol levels. Bone mineral density (BMD) was assessed by dual-energy x-ray absorptiometry (DXA) at anteroposterior and lateral spine and hip. Hamilton Rating Scales for Anxiety (HAM-A) and Depression (HAM-D) were administered. RESULTS:BMD was lower in AN and HA than HC at all sites and lower in AN than HA at the spine. On the HAM-D and HAM-A, AN scored higher than HA, and HA scored higher than HC. Cortisol levels were highest in AN, intermediate in HA, and lowest in HC. HAM-A and HAM-D scores were associated with decreased BMD. Cortisol levels were positively associated with HAM-A and HAM-D scores and negatively associated with BMD. CONCLUSIONS:Hypercortisolemia is a potential mediator of bone loss and mood disturbance in these disorders.
Changes in coping and social motives for drinking and alcohol consumption across the menstrual cycle.
Joyce Kayla M,Hudson Amanda,O'Connor Roisin,Thompson Kara,Hodgin Megan,Perrot Tara,Stewart Sherry H
Depression and anxiety
BACKGROUND:Alcohol use has been reported to fluctuate over women's menstrual cycles (MCs), with increased intake occurring premenstrually/menstrually (phases characterized by heightened negative affect) and during the ovulatory phase (a phase characterized by positive affect). This suggests women may drink for particular emotion-focused reasons at specific points in their cycles. However, no research had yet examined MC variability in drinking motives, or links between cycle-related changes in drinking motives and alcohol consumption. METHODS:Ninety-four normally cycling women (M = 22.9 years old, SD = 4.7) completed daily diary measures (via Smartphone surveys), with questions pertaining to state drinking motives and quantity of alcohol consumed for the course of a full MC. RESULTS:Drinking motives differed by cycle phase. Women reported a slight increase in drinking to self-medicate for negative affect premenstrually, with drinking to cope peaking in the menstrual phase and declining mid-cycle. Women reported a slight increasing trend across the cycle in social motives for drinking, while enhancement motives remained relatively stable across the cycle. Cycle-related changes in drinking motives predicted increases in the quantity of alcohol consumed. Drinking to cope with negative affect predicted a greater number of drinks menstrually (days 1-5). While social motives predicted a greater number of drinks during the follicular and ovulatory phases (days 5-16), enhancement motives were unrelated to drinking quantity across cycle phase. CONCLUSIONS:Clinicians should be attentive to cycle phase when treating reproductive-aged women with alcohol disorders (e.g., encouraging the use of healthier means of coping with negative affect during menses).
Depression and anxiety disorders.
Brown C S
Obstetrics and gynecology clinics of North America
Depressive and anxiety disorders are common problems facing obstetrician-gynecologists. Although psychiatric disorders are equally common in men and women, women are at least twice as likely to present with depressive disorders and most anxiety disorders. The depressive disorders include major depression, dysthymia, seasonal affective disorder, and premenstrual dysphoric disorder. The anxiety disorders are panic disorder (with and without agoraphobia), generalized anxiety disorder, social phobia, obsessive compulsive disorder, and PTSD. One must diagnose and manage depressive and anxiety disorders during pregnancy, the purpureum, and while breastfeeding. General treatment principles include assessing suicide risk, psychotherapy, pharmacologic treatment, and an appropriate medical work-up for depressive and anxiety disorders. The SSRIs are the first-line treatment for most depressive and anxiety disorders because of data supporting their efficacy, the minimal need for dosage titration, the overall favorable side-effect profile, and the length of available clinical experience. Newer antidepressants, such as venlafaxine, bupropion, nefazodone, and mirtazapine, are options for patients unresponsive to, or intolerant of, the SSRIs. Treatment considerations include acute, maintenance, and continuation therapy, dosage regimens, adverse effects, and drug interactions. Specific guidelines are available for referring patients to a mental health specialist.
Association between the CLOCK gene 3111 T > C polymorphism and an irregular menstrual cycle in Korean adolescents.
Kim Kye-Hyun,Kim Yunsin,Ha Juwon,Shin Dong-Won,Shin Young-Chul,Oh Kang-Seob,Woo Hee-Yeon,Lim Se-Won
Journal of psychosomatic obstetrics and gynaecology
The menstrual cycle is an example of a human infradian rhythm, but an altered sleep-wake cycle or a disrupted circadian rhythm can change the regularity of the menstrual cycle. In this study, we investigated whether an irregular menstrual cycle is associated with polymorphisms in the CLOCK (3111T > C) and/or PER3 (variable number tandem repeat, VNTR) genes, which are known to have an impact on the circadian rhythm. One hundred ninety-seven postmenarchal, adolescent girls from two girls' high schools in Seoul, Korea, were studied. All participants were requested to complete the Perceived Stress Scale (PSS), the State-Trait Anxiety Inventory (STAI), and the Beck Depression Inventory (BDI) to assess the emotional distress that might cause menstrual irregularity. Every participant donated a blood sample from which DNA was extracted and genotyped for the CLOCK 3111T > C and PER3 VNTR polymorphisms. A significant association was found between the CLOCK 3111T > C genotype and irregular menstrual cycles. Subjects with the 3111T > C genotype had a high risk of an irregular menstrual cycle compared with 3111T/T homozygous subjects (odds ratio [OR] = 2.88; 95% confidence interval [CI]: 1.26-6.55). When multivariate logistic regression analysis was performed to adjust for age, PSS, STAI, BDI and BMI, subjects with the 3111T > C polymorphism showed a significantly increased OR for irregular menstrual cycles (OR = 3.09; 95% CI: 1.32-7.21). There was no significant association between the PER3 VNTR polymorphism and the irregularity of the menstrual cycle (p > 0.05). The results of this study suggest that the CLOCK 3111T > C polymorphism could be an independent risk factor for irregular menstrual cycles, irrespective of psychological distress and endocrine or metabolic conditions, and could be used as a molecular marker for gynecological studies on this aspect.
Negative affect is unrelated to fluctuations in hormone levels across the menstrual cycle: Evidence from a multisite observational study across two successive cycles.
Hengartner Michael P,Kruger Tillmann H C,Geraedts Kirsten,Tronci Enrico,Mancini Toni,Ille Fabian,Egli Marcel,Röblitz Susanna,Ehrig Rainald,Saleh Lanja,Spanaus Katharina,Schippert Cordula,Zhang Yuanyuan,Leeners Brigitte
Journal of psychosomatic research
BACKGROUND:Female sex hormones may play a crucial role in the occurrence of cycle-related mood disorders. However, the literature is inconsistent and methodologically stringent observational studies on the relationship between sex hormones and negative affect are lacking. METHODS:In this longitudinal multisite study from Hannover, Germany, and Zurich, Switzerland, we examined oestrogen, progesterone, luteinizing hormone (LH), follicle-stimulating hormone (FSH), and testosterone serum levels in association with negative affect as measured with the Positive and Negative Affect Schedule (PANAS). Negative affect and hormone assays were collected at four consecutive time points comprising menstrual, pre-ovulatory, mid-luteal and premenstrual phase across two cycles (n=87 and n=67 for the first and second cycles). The Beck Depression Inventory (BDI) was assessed once prior to the first cycle and included as a secondary measure. RESULTS:Mean negative affect scores did not significantly fluctuate across both cycles and there was in particular no symptom increase premenstrually. No sex hormone consistently related to repeated measures of negative affect across two consecutive cycles. The BDI sum-score assessed at baseline was not related to hormone levels across the first cycle. CONCLUSIONS:This is the first multisite longitudinal study on the association between negative affect and sex hormone levels encompassing two consecutive menstrual cycles. Negative affect did not fluctuate across the cycle and there was no direct and uniform association between sex hormones and self-reported negative affect. These findings suggest that moderators such as personality traits and epigenetics should be considered in future research.
[Does menstrual cycle affect mood disorders?].
Akdeniz Fisun,Karadağ Figen
Turk psikiyatri dergisi = Turkish journal of psychiatry
OBJECTIVE:This paper will present a review of the literature on the relationship between the menstrual cycle and mood disorders. METHOD:We performed a MEDLINE search of the Turkish and English language literature for the years 1955-2005 using the following terms: depression, bipolar disorder, premenstrual syndrome, premenstrual exacerbation, premenstrual dysphoric disorder, menstrual cycle, and suicide. Earlier reports had shown higher psychiatric admission during premenstrual period of the menstrual cycle and higher prevalence of suicide attempts during specific phase of the menstrual cycle. RESULTS:Women of reproductive age with mental disorders may experience a fluctuating course of illness over the menstrual cycle. Some data suggest that for a subset of women there is a relationship between phases of the menstrual cycle and increased vulnerability for an exacerbation of ongoing mood disorders (especially major depressive episode) or the development of a new episode. The question of whether the direction of mood shifts in the course of bipolar disorder is associated with specific cycle phase has been raised, albeit with limited and inconsistent data. CONCLUSION:There are a limited number of studies to elucidate these relationships and most of them lack prospective assessments, include the small number of patients and use unreliable methods of determining menstrual-cycle phases. Additionally, many reports do not specify whether the exacerbations reflect an aggravation of the underlying mood disorder or a new subset of symptoms that occur only during certain phases of the menstrual cycle. Further studies should provide more information about the contribution of premenstrual fluctuation or worsening to increased illness severity of mood disorder and treatment resistance.
Estrogenic mediation of serotonergic and neurotrophic systems: implications for female mood disorders.
Borrow Amanda P,Cameron Nicole M
Progress in neuro-psychopharmacology & biological psychiatry
Clinical research has demonstrated a significant sex difference in the occurrence of depressive disorders. Beginning at pubertal onset, women report a higher incidence of depression than men. Women are also vulnerable to the development of depressive disorders such as premenstrual dysphoric disorder, postpartum depression, and perimenopausal depression. These disorders are associated with reproductive stages involving changes in gonadal hormone levels. Specifically, female depression and female affective behaviors are influenced by estradiol levels. This review argues two major mechanisms by which estrogens influence depression and depressive-like behavior: through interactions with neurotrophic factors and through an influence on the serotonergic system. In particular, estradiol increases brain derived neurotrophic factor (BDNF) levels within the brain, and alters serotonergic expression in a receptor subtype-specific manner. We will take a regional approach, examining these effects of estrogens in the major brain areas implicated in depression. Finally, we will discuss the gaps in our current knowledge of the effects of estrogens on female depression, and the potential utility for estrogen receptor modulators in treatment for this disorder.
Symptoms of depression in late luteal phase dysphoric disorder: a variant of mood disorder?
De Ronchi Diana,Ujkaj Manjola,Boaron Federico,Muro Ambra,Piselli Massimiliano,Quartesan Roberto
Journal of affective disorders
BACKGROUND:In premenstrual syndrome, depressed mood in the luteal phase of the menstrual cycle is acknowledged, whereas the presence of symptoms of depression during the follicular phase remains in debate. METHODS:On the basis of prospective daily recording of the presence and severity of symptoms for at least two menstrual cycles, 43 women were diagnosed with Late Luteal Phase Dysphoric Disorder (LLPD) according to the criteria of the third edition revision of the Diagnostic and Statistical Manual of Mental Disorders. They were compared to a group of 85 women who showed no evidence of LLPD for two menstrual cycles. Structured psychiatric interviews were administered during the follicular phase. Only those subjects without Axis I disorders were subsequently included in the study. RESULTS:Those women with minor/moderate symptoms of depression had an odds of suffering from LLPD of 1.9 (95% CI=1.5-2.4, p<0.001) in relation to increasing severity of symptoms of depression at the total MADRS scale (1-point increase). The ORs of LLPD in relation to each dimension (1-point increase) of the emotional/affective, cognitive, and neurovegetative symptoms were 1.6 (95% CI=1.2-2.3, p=0.003), 2.8 (95% CI=0.9-8.5, p=0.077) and 3.3 (95% CI=1.9-5.9, p<0.001), respectively. LIMITATIONS:No hormonal changes that may be associated with symptoms of LLPD were determined in this study. CONCLUSIONS:LLPD is likely to represent a variant of a depressive disorder, where premenstrual psychobiological changes seem to exacerbate mild depressive symptoms and signs to which LLPD women are otherwise predisposed. This hypothesis opens new perspectives for prevention and of even treatment for LLPD. Further longitudinal studies with larger populations and evaluation of hormonal changes are needed to confirm these data.
Subjective sleep quality and characteristics across the menstrual cycle in women with and without Generalized Anxiety Disorder.
Li Sophie H,Lloyd Andrew R,Graham Bronwyn M
Journal of psychosomatic research
OBJECTIVE:Past studies have found that various psychiatric symptoms fluctuate over the menstrual cycle. Sleep disturbance is a transdiagnostic feature of psychiatric conditions and is associated with several symptoms that exhibit menstrual fluctuations. Although some evidence indicates that subjective sleep quality changes over the menstrual cycle in healthy women, no studies have investigated whether sleep fluctuates over the menstrual cycle in psychiatric populations, other than premenstrual dysphoric disorder. METHODS:The present study used a mixed between- within-groups design to compare self-reported sleep characteristics (sleep onset latency, number and duration of night-time awakenings, and total sleep time), sleep quality, insomnia symptoms, and daytime sleepiness in women with (n = 31) and without (n = 32) generalized anxiety disorder (GAD) at two time points within a single menstrual cycle - the early-follicular (low ovarian hormones) and mid-luteal (high ovarian hormones) phases. RESULTS:Women with GAD reported lower sleep quality, more insomnia symptoms, and more daytime sleepiness (η = 0.13-0.14), but comparable sleep characteristics, compared to women without GAD. In both groups, sleep variables remained stable over the menstrual phases examined. Within-person changes in estradiol and progesterone between the two menstrual phases were mostly not associated with within-person changes in sleep variables, except that larger increases in estradiol were associated with a reduction in the number of night-time awakenings from the early-follicular to mid-luteal phases (β = -0.26). CONCLUSION:These findings indicate that subjective sleep disturbance, unlike other psychiatric symptoms, may not be modulated by the menstrual cycle and ovarian hormones during the phases examined in this study.
Risk of depression and other mental health disorders in women with polycystic ovary syndrome: a longitudinal study.
Kerchner Angela,Lester Whitney,Stuart Scott P,Dokras Anuja
Fertility and sterility
OBJECTIVE:To determine the conversion risk and predictors for depression in women with polycystic ovary syndrome. DESIGN:Prospective longitudinal study. SETTING:University practice. PATIENT(S):Subjects with polycystic ovary syndrome who had participated in a previous study. INTERVENTION(S):None. MAIN OUTCOME MEASURE(S):The Primary Care Evaluation of Mental Disorders Patient Health Questionnaire was used to diagnose major depressive disorder and other depressive syndromes, anxiety syndromes, and binge eating disorder. Subjects completed a questionnaire on knowledge about polycystic ovary syndrome and treatment satisfaction. RESULT(S):A total of 60 of 103 subjects responded to the second survey. Mean time between the two surveys was 22 months (range 12-26 months). The overall prevalence of depression was 40% (24/60). Of these, 10 women screened positive for major depressive disorder or other depressive syndromes and 14 were receiving antidepressant medications. There were 11 new cases identified in the second survey (19% conversion). Total subjects with mood disorders in this study were 34/60 (56.6%), including 11.6% with anxiety syndromes and 23.3% with binge eating disorder. Difficulties with menstrual function, fertility, and body image (weight, hirsutism, acne) were not significantly different in women with and without depression. CONCLUSION(S):There is a significant risk for mood disorders (defined by the Diagnostic and Statistical Manual of Mental Disorders-IV) in women with polycystic ovary syndrome. This finding together with a high conversion risk for depression over a 1- to 2-year period underscores the importance of routine screening and aggressive treatment of mental health disorders in this population.
History of postpartum depression in a clinic-based sample of women with premenstrual dysphoric disorder.
Kepple Alyson L,Lee Ellen E,Haq Nazli,Rubinow David R,Schmidt Peter J
The Journal of clinical psychiatry
OBJECTIVE:Overlapping comorbidities between premenstrual dysphoric disorder (PMDD) and postpartum depression (PPD) suggest that these disorders represent a continuum of vulnerability with shared pathophysiology. We report the past histories of PPD (and other Axis I psychiatric illnesses) in a clinic-based sample of women meeting criteria for PMDD. METHODS:215 women, ages 19 to 51 years, who attended the National Institute of Mental Health Mood Disorders Clinic between 1988 and 2013 seeking treatment for PMDD and in whom we confirmed the diagnosis of PMDD (DSM-IV), were identified. All were administered the Structured Clinical Interview for DSM-III-R or -IV. The frequency of PPD (major or minor) was established in the subgroup of women (n = 137) who had delivered at least 1 child. RESULTS:Ninety-three women (43.3%) had a past history of a mood disorder (ie, either major [n = 67; 31.2%] or minor [n = 10; 4.7%] depression or PPD [n = 16; 7.4%; 11.7% of parous women]). Nine of the 16 women with PMDD and a past PPD had either a past major depressive episode (MDE) or subsyndromal anxiety disorder. Thirty-three women (15.3%) had a past history of an Axis I anxiety disorder. A total of 40 women (18.6%) met criteria for past alcohol or drug abuse, 3 (1.4%) met criteria for bulimia nervosa, and 2 (0.9%) met criteria for anorexia nervosa. CONCLUSIONS:Our data demonstrate that PMDD and PPD do not frequently co-occur. These data do not suggest that PMDD and PPD share similar pathophysiology beyond being ovarian-steroid-triggered mood disorders. The high comorbidity of past MDE could contribute to the increased risk both for future MDE and for PPD in some women with PMDD.
Long-term treatment of menorrhagia with mefenamic acid.
Fraser I S,McCarron G,Markham R,Robinson M,Smyth E
Obstetrics and gynecology
Thirty-six women with menorrhagia were treated with mefenamic acid during all menstrual periods for more than 1 year. These women had experienced objective and subjective benefit--menstrual blood loss was reduced and other menstrual symptoms improved during a preliminary 4-cycle double-blind placebo-controlled trial with mefenamic acid (placebo cycles: 65.6 +/- 5.3 ml; mefenamic acid cycles: 45.3 +/- 5.1 ml, mean +/- SEM). This reduction in menstrual blood loss was maintained at 6 to 9 months (49.2 +/- 9.9 ml) and at 12 to 15 months (42.8 +/- 4.8 ml) after the trial. These reductions were significant at the 6- to 9-month (paired t test = 2.18; P less than .05) and the 12- to 15-month interval (paired t test =- 4.40; P less than .001). Significant sustained reductions in blood loss were seen in the women with menorrhagia due to ovulatory dysfunctional bleeding and in those who had undergone tubal sterilization. Significant reductions were also seen in dysmenorrhea, headache, nausea, diarrhea, depression, number of sanitary towels used, and number of mefenamic acid capsules taken. A significant increase in serum ferritin was found between admission and completion of the follow-up trial in 11 women (P less than .01).
Hormone profiles and psychological symptoms in peri-menopausal women.
Ballinger C B,Browning M C,Smith A H
Hormone profiles for oestradiol, progesterone, follicle-stimulating hormone, luteinizing hormone, testosterone, androstenedione, prolactin, cortisol, thyroid-stimulating hormone (TSH) and triiodothyronine are presented for 85 peri-menopausal women. All subjects completed the 60-item General Health Questionnaire (GHQ) and 48 were interviewed using a standardized psychiatric interview. Some alterations in endocrine function were detected prior to the cessation of menstrual periods and there were changes in prolactin, cortisol, TSH and triiodothyronine in relation to menopausal status as well as in ovarian steroids and gonadotrophins. In comparison with other subjects, women with menorrhagia had higher circulating levels of oestradiol in the last week of the menstrual cycle and elevated prolactin levels. Women with high scores on the GHQ in the early post-menopausal years had significantly higher circulating levels of oestradiol than other subjects of the same menopausal status. No other significant difference in levels of reproductive hormones between high scorers and low scorers on the GHQ was detected. Women in the late pre-menopausal group who were clinically depressed had significantly higher levels of TSH and triiodothyronine than other subjects. These changes in thyroid function in the late pre-menopausal group may be related to the increase in psychiatric morbidity in the immediately pre-menopausal years reported in previous studies.
In-office endometrial ablation and clinical correlation of reduced menstrual blood loss and effects on dysmenorrhea and premenstrual symptomatology.
Chapa Hector O,Venegas Gonzalo,Antonetti Alfred G,Van Duyne Charles P,Sandate Jeffrey,Bakker Ken
The Journal of reproductive medicine
OBJECTIVE:To evaluate in-office Thermachoice III endometrial ablation on subsequent dysmenorrhea and premenstrual mood symptoms in relation to decreased menstrual blood loss. STUDY DESIGN:The study conducted was in a prospective cohort single group. Ablations were performed on 148 patients under parametrial block using dilute mepivacaine and oral anxiolysis for a diagnosis of menorrhagia. The primary endpoint was eumenorrhea or less, with secondary endpoints of dysmenorrhea reduction and premenstrual symptom alleviation. Patients were evaluated at 3 and 6 months postprocedure. Of 148 patients, 134 (90.5%) complied with follow-up. RESULTS:At 3 months, 52% were amenorrheic; 48% reporting hypomenorrhea. Results persisted at 6 months, with 50% and 48%, respectfully. Of 134 patients, 3 were considered nonresponders at 6 months. Mean hemoglobin values increased for all groups at each time endpoint. Of 115 patients, 79 reported baseline dysmenorrhea, with improvement in visual analog scale findings at both 3 and 6 months (p<0.005). Premenstrual mood symptoms of agitation, irritability and depression also improved at both 3 and 6 months. CONCLUSION:In-office Thermachoice III endometrial ablation results in decreased dysmenorrhea and improved mood in relation to decreased menstrual blood loss.
Psychosocial and other characteristics of women complaining of menorrhagia, with and without actual increased menstrual blood loss.
Hurskainen R,Aalto A M,Teperi J,Grenman S,Kivelä A,Kujansuu E,Vuorma S,Yliskoski M,Paavonen J
BJOG : an international journal of obstetrics and gynaecology
OBJECTIVE:To discover whether psychosocial factors can explain why many women with normal menstrual blood loss seek care for menorrhagia. DESIGN:Cross-sectional comparative study of women referred for menorrhagia. SETTING:Gynaecology departments of all five university teaching hospitals in Finland. SAMPLE:Two hundred and twenty-six women aged 35-49 years complaining of menorrhagia. MAIN OUTCOME MEASURES:Several psychosocial factors, seeking medical attention, menstrual blood loss. RESULTS:Twenty-nine percent of the women had their menstrual blood loss in the normal range (menstrual blood loss <60 mL). By univariate analysis, unemployment, anxiety, perceived inconvenience, abdominal pain, haemoglobin level and serum ferritin concentration distinguished this group of women from those with true menorrhagia. Unemployment, perceived inconvenience, abdominal pain and serum ferritin remained significant variables by multivariate analysis. CONCLUSIONS:A significant proportion of women with complaints of menorrhagia have their measured menstrual blood loss within the normal range. Psychosocial factors can have an impact on their seeking health care. Better understanding of the factors, which explain complaints of menorrhagia in women with normal bleeding could improve both medical outcomes and reduce the cost of treatment for menorrhagia.
The relationship between thyroxine, oestradiol, and postnatal alopecia, with relevance to women's health in general.
Post-partum hair loss is possibly due to a reduction in the levels of oestradiol and thyroxine postnatally. Alopecia and/or a persistent loss of hair condition postnatally is associated with a group of symptoms (a syndrome), wherein postnatal depression is significant, as a result of physiologically inadequate levels of thyroxine (T4) and oestradiol (E2), secondary to physiological postnatal anterior pituitary dysfunction. Using this hypothesis, the author began to apply the same hypothesis to other female patients, who were not postpartum, but with similar symptomatology. The author became aware of the necessity for an adequate level of T4 to be present for correct oestrogenization to occur. He then goes on to hypothesize on the synergistic relationship that T4 and oestradiol may have in premenstrual syndrome (PMS), infertility, dysfunctional uterine bleeding, poor placental function, osteoporosis, and anorexia nervosa. He also discusses the role lowering T4 could play in the treatment of terminal cancer breast in premenopausal women.
The impact of menstrual symptoms on everyday life: a survey among 42,879 women.
Schoep Mark E,Nieboer Theodoor E,van der Zanden Moniek,Braat Didi D M,Nap Annemiek W
American journal of obstetrics and gynecology
BACKGROUND:Menstrual symptoms such as dysmenorrhea, heavy menstrual bleeding, and perimenstrual mood disorders are known to be widespread among the general population. From studies in patients with endometriosis and premenstrual disorder, it has been shown that these symptoms can have a large impact on women's quality of life and account for substantial health care use. Furthermore, it is estimated that many women initially do not consult a doctor while facing menstrual symptoms. Consequently, the impact of menstrual symptoms on daily activities in the general population is unknown. OBJECTIVE:To obtain a nationwide overview of menstrual symptoms and their impact on everyday activities. STUDY DESIGN:Nationwide, cross-sectional, internet-based survey among 42,879 women aged 15-45 years, conducted from July to October 2017. OUTCOME MEASURES:presence of menstrual symptoms, pain or intensity score, impact on daily activities. RESULTS:Dysmenorrhea was the most common symptom, with a prevalence of 85%, followed by psychological complaints (77%), and tiredness (71%). During their menstrual period, 38% of all women reported not to be able to perform all their regular daily activities. From the women that had to skip tasks because of their symptoms, only 48.6% told their family that menstrual symptoms were the reason for the transfer of tasks. CONCLUSION:Menstrual symptoms are widespread among the general population. One in 3 women quit daily activities owing to menstrual symptoms. Half of all women did not mention menstrual complaints being the reason for transferring tasks in a family setting. These results must be interpreted with caution owing to the potential for selection bias. However, considering the impact of menstrual symptoms on daily activities in a large group of women, it is time to open the societal dialogue and improve education for both patients and doctors.
The meaning of menorrhagia: an investigation into the association between the complaint of menorrhagia and depression.
Journal of psychosomatic research
Although it is generally assumed that the complaint of menorrhagia indicates gynaecological pathology, there is evidence to suggest that it can also be a manifestation of psychological disturbance. In order to investigate this hypothesis 50 women with this complaint were assessed by means of a semi-structured interview, General Health Questionnaire (GHQ) and Eysenck Personality Questionnaire (EPQ), and blood investigations (haemoglobin and serum iron). The main finding was that 31/50 women had positive GHQ screening (GHQ+) and features consistent with mild to moderate depression. The tendency for the GHQ+ women to have evidence of less severe menstrual bleeding and greater psychological vulnerability is consistent with the original hypothesis and implies that further research in this area is warranted.
Aftermaths of surgical sterilisation with special reference to menstrual disturbances.
Purkayastha S,Bhattacharyya P K
Journal of the Indian Medical Association
With the increasing use of a variety of surgical methods for sterilisation, certain pitfalls of these surgical decisions are emerging. In the present study 216 cases who underwent sterilisation at least 2 years prior to coming for consultation with various problems have been analysed. Menstrual disturbances like menorrhagia (59.2%), dysmenorrhoea (29.6%) and metrorrhagia (5.56%) are the leading symptoms ascribable to a large extent to the operation if not the fullest extent in some cases. The physical and psychological disturbances that have evolved from sterilisation include pain abdomen (25%), vague abdominal discomfort and backache (14.8%), leucorrhoea (12.03%), obesity (8.34%), insomnia (4.17%), irritability (2.78%), depression (2.78%) and regret (1.39%).
Masked depressions in obstetrics and gynecology.
Psychotherapy and psychosomatics
The development of psychosomatic symptoms should not be viewed exclusively under the aspect of anxiety or defense against anxiety. In another study, we have shown that affects other than anxiety can lead to functional obstetric disturbances (2). The insight that depressions, above all masked depressions can be the basis of many psychosomatic symptoms in obstetrics and gynecology paves the way for good therapeutic possibilities in many cases that have been resistant to therapy heretofore. Antidepressants often bring prompt relief from symptoms. Psychotherapy is possible in numerous cases following success in prescribing antidepressants.
Depressive symptoms as predictors of discontinuation of treatment of menorrhagia by levonorgestrel-releasing intrauterine system.
Elovainio Marko,Teperi Juha,Aalto Anna-Mari,Grenman Seija,Kivelä Aarre,Kujansuu Erkki,Vuorma Sirkku,Yliskoski Merja,Paavonen Jorma,Hurskainen Ritva
International journal of behavioral medicine
It has been shown that levonorgestrel-releasing intrauterine system (LNG-IUS) is an effective treatment of menorrhagia. However, the discontinuation rate of LNG-IUS treatment is high, and little is known about the actual reasons intertwining it. We tested the hypothesis that depressive symptoms is the factor responsible for deciding to have a hysterectomy during LNG-IUS treatment. The participants (119 women, ages = 35-49 years) were randomly selected over a 3-year period (1994-1997) to receive the LNG-IUS or a hysterectomy for the treatment of menorrhagia. Depressive symptoms, based on Beck's Depression Inventory measured 6 months after the beginning of the treatment, were related to discontinuation of LNG-IUS use Odds Ratio (OR) = 3.70, 95% Confidence Intervals (CI) 1.55-8.82, p = .003 during a 5-year follow-up. This association was not attenuated after adjustment for other known risk factors. Our findings suggest that diagnosing and treating depression among patients having menstrual problems may improve the continuity of LNG-IUS treatment of menorrhagia.
Anxiety, depression, and menstrual symptoms among freshman medical students.
Sherry S,Notman M T,Nadelson C C,Kanter F,Salt P
The Journal of clinical psychiatry
Based on data from a larger longitudinal study of medical students and physicians, this study establishes the incidence of some menstrual symptoms in a nonclinical population of 82 healthy, female, first-year medical students and investigates the correlation of self-reported anxiety and depression scores with these symptoms. Findings show that nearly half reported the frequent occurrence of at least one menstrual symptom that appeared to cause discomfort but did not interfere with performance. The data suggest an association between anxiety and depression scores and certain self-reported menstrual symptoms in this population. The study suggests the need for further investigation of the nature of the relationship between dysphoric moods and menstrual symptoms in healthy women.
Severe primary hypothyroidism in an apparently asymptomatic 19-year-old woman: a case report.
Dannan Rania,Hajji Sulaiman,Aljenaee Khaled
Journal of medical case reports
BACKGROUND:Hypothyroidism is diagnosed on the basis of laboratory tests because of the lack of specificity of the typical clinical manifestations. There is conflicting evidence on screening for hypothyroidism. CASE PRESENTATION:We report a case of an apparently healthy 19-year-old Kuwaiti woman referred to our clinic with an incidental finding of extremely high thyroid-stimulating hormone (TSH), tested at the patient's insistence as she had a strong family history of hypothyroidism. Despite no stated complaints, the patient presented typical symptoms and signs of hypothyroidism on evaluation. Thyroid function testing was repeated by using different assays, with similar results; ultrasound imaging of the thyroid showed a typical picture of thyroiditis. Treatment with levothyroxine alleviated symptoms and the patient later became biochemically euthyroid on treatment. CONCLUSION:There is controversy regarding screening asymptomatic individuals for hypothyroidism; therefore, it is important to maintain a high index of suspicion when presented with mild signs and symptoms of hypothyroidism especially with certain ethnic groups, as they may be free of the classical symptoms of disease.
[Preliminary study on relationship of disease-syndrome-symptom of ovulatory disorder infertility based on factor analysis].
Li Min,Ma Kun,Shan Jing
Zhongguo Zhong yao za zhi = Zhongguo zhongyao zazhi = China journal of Chinese materia medica
OBJECTIVE:In this study, the clinical data of 240 cases of data acquisition on ovulation in patients with anovulatory infertility. METHOD:Using the method of factor analysis, summed up the distribution situation of various syndromes and the relationship of disease-syndrome-symptom. RESULT:From the study we found that polycystic ocary syndrome > premature ovarian failure > corpus luteum insufficiency > luteinized unruptured follicle syndrome > hyperprolactinemia > anovulatory dysfunctional uterine bleeding. Using the factor analysis method, the syndromes of anovulatory infertility were divided into six types and the distribution proportion of them is: kidney Yang deficiency and blood stasis > kidney Yang deficiency > kidney Yin deficiency and blood stasis > kidney Yin deficiency and liver Qi stagnation syndrome > kidney Yang deficiency and phlegm dampness stagnation > kidney Yin deficiency. By means of statistics, the traditional Chinese medicine (TCM) symptoms as abdomen pain before menstrual onset, obfuscation colour, cold lower abdomen, insomnia, fatigue, eyes dark, face dark or ring lip dark, before and after menstruation breast swelling, chest tightness, irritable insomnia, depression and lower abdomen pain during menstruation etc contribute high degree in the process. CONCLUSION:Polycystic ovary syndrome and premature are the main causes of ovulatory disorder infertility and the disease incidence rate assumed the tendency which rose year by year. The treatment of the disease of kidney yang deficiency syndrome scales biggest the disease degree of contribution. Blood stasis is the important factor in the process of pathogenesis evolution. In the study of disease distribution, we found that symptom distribution trend roughly the same and the same symptom severity in different diseases with different, which provides experience for the theory-different diseases with the same therapeutic method. These conclusions provide guidance and reference evidences for clinic practice.
Association of past and recent major depression and menstrual characteristics in midlife: Study of Women's Health Across the Nation.
Bromberger Joyce T,Schott Laura L,Matthews Karen A,Kravitz Howard M,Randolph John F,Harlow Sioban,Crawford Sybil,Green Robin,Joffe Hadine
Menopause (New York, N.Y.)
OBJECTIVE:The aim of this study was to examine the association of a history of major depression (MD) with menstrual problems in a multiethnic sample of midlife women. METHODS:Participants were 934 women enrolled in the Study of Women's Health Across the Nation, a multisite study of menopause and aging. The outcomes were menstrual bleeding problems and premenstrual symptoms in the year before study entry. The Structured Clinical Interview for the Diagnosis of DSM-IV Axis I Disorders was conducted to determine recent and past psychiatric diagnoses. Covariates included sociodemographic, behavioral, and gynecologic factors. RESULTS:One third of the participants reported heavy bleeding, 20% reported other abnormal bleeding, and 18% reported premenstrual symptoms. One third had past and 11% had recent MD. Past MD was associated with an increased likelihood of heavy bleeding (odds ratio, 1.89; 95% CI, 1.25-2.85), adjusting for recent MD, menopause status, and other covariates. Past MD was not associated with other abnormal bleeding or premenstrual symptoms in the final analysis that adjusted for recent MD. CONCLUSIONS:Midlife women with a history of MD are more likely to report heavy bleeding.
Vulnerability to perimenstrual mood change: the relevance of a past history of depressive disorder.
Bancroft J,Rennie D,Warner P
A past history of depressive illness, defined in terms of treatment by antidepressants, was found to be more common in women seeking help for premenstrual syndrome (PMS) (31.3%; N = 83) than in women complaining of menorrhagia (8.9%; N = 90) or controls (5.8%; N = 104) with dysmenorrhea sufferers (22%; N = '50) reporting intermediate rates. Such a history in the clinical groups was associated with a tendency for premenstrual depression to be relatively prolonged (i.e., persisting through the menstrual phase and sometimes into the postmenstrual week) and with more severe depressive symptoms during the premenstrual, menstrual, and to a lesser extent, postmenstrual phases of the cycle. This, association was not evident for reported heaviness of menstrual bleeding and only weakly evident for severity of pain during the menstrual phase. Women with a depressive history gave higher neuroticism scores. A history of depression, as defined, seems to increase the vulnerability of women to depressive perimenstrual mood change in terms of both duration and severity. This effect on duration may hitherto have served to obscure the relationship between history of depression and premenstrual syndrome.
Mood and anxiety disorders in patients with abnormal uterine bleeding.
Kayhan Fatih,Alptekin Hüsnü,Kayhan Ayşegül
European journal of obstetrics, gynecology, and reproductive biology
OBJECTIVE:We aimed to investigate the prevalence of mood and anxiety disorders in patients with abnormal uterine bleeding (AUB) and the relationship between mood and anxiety disorders and AUB. METHOD:96 consecutive patients with not yet classified AUB based on the PALM-COEIN classification and 94 volunteers were included in the study. Mood and anxiety disorders were ascertained by means of the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition/Clinical Version. RESULTS:Out of 96 patients, 55 (57.3%) met the criteria for at least one diagnosis of mood and anxiety disorder. The most common psychiatric disorders in patients with AUB were major depression (n=15, 15.6%), generalized anxiety disorder (n=18, 18.8%) and obsessive compulsive disorder (n=22, 22.9%), respectively. Compared with the control group, the prevalence of any psychiatric disorder (x(2)=43.52, p=0.000), any mood disorder (x(2)=10:37, p=0.001) and any anxiety disorder (Fisher's exact test, p=0.000) was higher in patients with AUB. The presence of any mood and anxiety disorder was an independent risk factor for AUB. CONCLUSION:Mood and anxiety disorders, particularly major depression, generalized anxiety disorder and obsessive-compulsive disorder were frequently observed in patients with AUB.
Is there a relationship between mood disorders and dysmenorrhea?
Balık Gülşah,Ustüner Işık,Kağıtcı Mehmet,Sahin Figen Kır
Journal of pediatric and adolescent gynecology
OBJECTIVE:Menstrual problems are common among adolescent females. Mood changes are related to menstrual problems (menorrhagia, dysmenorrhea, and abnormal menstrual cycle length). The aim of this study was to determine the relationship between depressive symptoms, anxiety, and premenstrual syndrome (PMS) with dysmenorrhea in adolescent girls. METHODS:A total of 159 adolescent girls (aged 13-19 y) with regular menstrual cycles presenting to the gynecology clinic with any complaints were included in the study during April-May 2013. All of the participants filled up the sociodemographic data collection form, FACES Pain Rating Scale, Beck anxiety inventory (BAI), Beck depression inventory (BDI), and a questionnaire form on criteria for PMS. Mann-Whitney U and chi-square tests were used to analyze the data. RESULTS:The prevalence of dysmenorrhea was 67.9%. The mean BAI and BDI scores of the patients were 13.64 ± 12.81 and 11.88 ± 10.83, respectively. Statistically significant differences were observed between patients and control groups on the BAI and BDI scoring (P < .05). At least 1 of the symptoms of the PMS was detected in all of the participants and 29 (18.2%) of them were diagnosed as premenstrual dysphoric disorder (PMDD). The mean BAI score of the patients with PMS and PMDD were 9.65 ± 9.28 and 21.31 ± 15.75, respectively. The mean BDI score of the patients with PMS and PMDD were 8.39 ± 8.62 and 19.1 ± 11.85, respectively. Statistically significant differences were observed between PMS/PMDD and BAI/BDI scoring (P = .00). CONCLUSION:Adolescent girls with dysmenorrhea have an increased risk of depression and anxiety. These results of our study are significant in emphasizing the importance of a multidisciplinary approach to primary dysmenorrhea follow-up and treatment.
Menstrual cycle effects on psychological symptoms in women with PTSD.
Nillni Yael I,Pineles Suzanne L,Patton Samantha C,Rouse Matthew H,Sawyer Alice T,Rasmusson Ann M
Journal of traumatic stress
The menstrual cycle has been implicated as a sex-specific biological process influencing psychological symptoms across a variety of disorders. Limited research exists regarding the role of the menstrual cycle in psychological symptoms among women with posttraumatic stress disorder (PTSD). The current study examined the severity of a broad range of psychological symptoms in both the early follicular (Days 2-6) and midluteal (6-10 days postlutenizing hormone surge) phases of the menstrual cycle in a sample of trauma-exposed women with and without PTSD (N = 49). In the sample overall, total psychological symptoms (d = 0.63), as well as depression (d = 0.81) and phobic anxiety (d = 0.81) symptoms, specifically, were increased in the early follicular compared to midluteal phase. The impact of menstrual cycle phase on phobic anxiety was modified by a significant PTSD × Menstrual Phase interaction (d = 0.63). Women with PTSD reported more severe phobic anxiety during the early follicular versus midluteal phase, whereas phobic anxiety did not differ across the menstrual cycle in women without PTSD. Thus, the menstrual cycle appears to impact fear-related symptoms in women with PTSD. The clinical implications of the findings and future research directions are discussed.
Reproductive Steroid Regulation of Mood and Behavior.
Schiller Crystal Edler,Johnson Sarah L,Abate Anna C,Schmidt Peter J,Rubinow David R
In this article, we examine evidence supporting the role of reproductive steroids in the regulation of mood and behavior in women and the nature of that role. In the first half of the article, we review evidence for the following: (i) the reproductive system is designed to regulate behavior; (ii) from the subcellular to cellular to circuit to behavior, reproductive steroids are powerful neuroregulators; (iii) affective disorders are disorders of behavioral state; and (iv) reproductive steroids affect virtually every system implicated in the pathophysiology of depression. In the second half of the article, we discuss the diagnosis of the three reproductive endocrine-related mood disorders (premenstrual dysphoric disorder, postpartum depression, and perimenopausal depression) and present evidence supporting the relevance of reproductive steroids to these conditions. Existing evidence suggests that changes in reproductive steroid levels during specific reproductive states (i.e., the premenstrual phase of the menstrual cycle, pregnancy, parturition, and the menopause transition) trigger affective dysregulation in susceptible women, thus suggesting the etiopathogenic relevance of these hormonal changes in reproductive mood disorders. Understanding the source of individual susceptibility is critical to both preventing the onset of illness and developing novel, individualized treatments for reproductive-related affective dysregulation. © 2016 American Physiological Society. Compr Physiol 6:1135-1160, 2016e.
The Menstrual Cycle-Response and Developmental Affective-Risk Model: A multilevel and integrative model of influence.
An integrative developmental model is presented in which menstrual cycle-related symptoms are hypothesized to result in a cascade of developmental challenges that contribute to increased affective symptoms among adolescent girls, and to long-term developmental sequelae. To provide the basis for this model a broad foundation is developed considering (a) psychological symptoms and disorders associated with reproductive events across the life span, and (b) the many and complicated effects that female reproductive steroids (estrogen & progesterone) have which trigger a variety of physical and psychological changes that are commonly associated with the menstrual cycle. The Menstrual Cycle-Response and Developmental Affective-Risk Model is driven by 3 central concepts: (a) individual differences in response to steroids are very large and thus require analysis of individual response, rather than group-level tendencies; (b) the menstrual cycle itself represents an important and complex set of biological, physical, psychological, behavioral, and social changes, and should not be studied exclusively as changing steroid levels; and (c) the effects of the menstrual cycle during adolescence and early adulthood may have long-term developmental consequences. This model integrates specific effects of the menstrual cycle with contextual and social developmental variables, and with past theoretical models. (PsycINFO Database Record
Psychological effects of yoga nidra in women with menstrual disorders: A systematic review of randomized controlled trials.
Complementary therapies in clinical practice
OBJECTIVE:To assess the effects of yoga nidra on psychological problems in women with menstrual disorders. METHODS:A search was conducted using CINAHL, the Cochrane library, Embase, PsycINFO, and PubMed electronic databases, and using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), to identify randomized controlled trials (RCTs) published in any language up to and including July 2016, which reported the psychological effects of yoga nidra in women with menstrual disorders. RESULTS:Two potential trials were identified and both were included in the review. A significant difference was observed between experimental and control groups in that anxiety and depression were significantly decreased in the experimental group when compared with the control group. CONCLUSIONS:There is evidence from two RCTs that yoga nidra may have favorable effects in terms of reducing psychological problems in women with menstrual disorders.
Association among depression, symptom experience, and quality of life in polycystic ovary syndrome.
Greenwood Eleni A,Pasch Lauri A,Cedars Marcelle I,Legro Richard S,Huddleston Heather G,
American journal of obstetrics and gynecology
BACKGROUND:Clinical stigmata of polycystic ovary syndrome include hirsutism, obesity, menstrual disturbances, and infertility. These symptoms impair health-related quality of life. Depression is also common. The relationship among depression, symptom self-perception, and quality of life in polycystic ovary syndrome is poorly understood. OBJECTIVE:We sought to investigate the relationship between health-related quality of life and depression in women with polycystic ovary syndrome. STUDY DESIGN:We conducted a secondary analysis of a multicenter, randomized clinical trial (Pregnancy in Polycystic Ovary Syndrome II, NCT00719186) comparing clomiphene citrate vs letrozole in the treatment of infertility. Subjects included 732 women ages 18-40 years with polycystic ovary syndrome by modified Rotterdam criteria. The validated Polycystic Ovary Syndrome Health-Related Quality of Life survey was self-administered, assessing the following domains: emotions, body hair, body weight, menstrual problems, and infertility; scores range from 1-7, with lower numbers indicating poorer quality of life. Depression was evaluated via the Primary Care Evaluation of Mental Disorders Patient Health Questionnaire. Quality-of-life scores were compared between depressed and nondepressed women. Multivariate linear regression models analyzed the association between depression and quality-of-life scores, controlling for age, body mass index, hirsutism score, and duration of infertility. RESULTS:In all, 64 women (8.4%) met criteria for depression. Depressed women reported reduced quality of life in all domains compared to nondepressed women: mood (3.1 vs 4.6, P < .001), body hair (3.5 vs 4.2, P = .002), weight (2.0 vs 3.5, P < .001), menstrual problems (3.3 vs 4.1, P < .001), and infertility (1.9 vs 3.0, P < .001). Global quality-of-life score was reduced in depressed women (2.8 vs 3.9, P < .001). Impairments in quality of life in depressed women persisted in all domains after controlling for objective parameters including age, body mass index, hirsutism score, and infertility duration. CONCLUSION:Depression is associated with reduced quality of life related to polycystic ovary syndrome symptoms. Disturbances in health-related quality of life in depressed women are not explained by objective measures including body mass index, hirsutism scores, and duration of infertility. Depression may color the experience of polycystic ovary syndrome symptoms and should be considered when there is significant discordance between subjective and objective measures in women with polycystic ovary syndrome.
Associations of mental health and sleep duration with menstrual cycle irregularity: a population-based study.
Kim Taeryoon,Nam Ga Eun,Han Byoungduck,Cho Sung Jung,Kim Junghun,Eum Do Hyun,Lee Sang Woo,Min Soon Hong,Lee Woohyun,Han Kyungdo,Park Yong Gyu
Archives of women's mental health
This study aimed to examine whether the characteristics of mental health and sleep duration, alone or in combination, are associated with menstrual cycle irregularity. This population-based, cross-sectional study analyzed the data from 4445 women aged 19-49 years, who participated in the Korea National Health and Nutrition Examination Survey 2010-2012. A structured questionnaire was used to assess mental health characteristics, sleep duration, and menstrual cycle irregularity. A multivariable logistic regression analysis was performed. High stress, depressive mood, and suicidal ideation were associated with increased risk of menstrual cycle irregularity after adjusting for confounding variables (odds ratio [95% confidence interval] = 1.33 [1.07-1.65], 1.56 [1.17-2.07], and 1.37 [1.01-1.87], respectively). Short sleep duration (≤ 5 h a day) was significantly associated with higher odds of severe menstrual cycle irregularity with menstrual interval of greater than 3 months (2.67 [1.35-5.27]). Participants with sleep duration of ≤ 5 h a day with psychological stress, depressive mood, or suicidal ideation had higher odds of menstrual cycle irregularity (1.96 [1.26-3.05], 2.86 [1.50-5.44], and 2.25 [1.18-4.29]). This study suggests positive associations of mental health problems and short sleep duration with menstrual cycle irregularity among Korean female adults. Therefore, strategies to deal with psychological stress, depressive mood, and sleep duration are needed for improving the reproductive health of women suffering from menstrual disturbances.
Reproductive history and risk of depressive symptoms in postmenopausal women: A cross-sectional study in eastern China.
Li Fudong,He Fan,Sun Qiang,Li Qiuyue,Zhai Yujia,Wang Xinyi,Zhang Tao,Lin Junfen
Journal of affective disorders
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.
The association between clinical and laboratory parameters in thyroid disease and nonthyroidal illness in young women.
Lisowska-Myjak B,Puchalska A,Hałasa N,Płazińska M,Strawa A
European review for medical and pharmacological sciences
OBJECTIVE:Evidence from epidemiological and clinical studies strongly suggest that young women in the preconception period are a group at risk for thyroid disorders which may lead to further aggravation of pre-existing chronic thyroid disease and complications during pregnancy. MATERIALS AND METHODS:This paper is a literature review focusing on articles published in English between 2014-2017 searched in Medline database using terms 'young women', 'subclinical hyperthyroidism', 'subclinical hypothyroidism', 'nonthyroidal illness syndrome', 'obesity', 'depression'. CONCLUSIONS:Clinical assessment of young female patient including that of obtaining full medical history with a focus on the perceived changes in appearance, psychological symptoms and menstrual irregularities supported by laboratory tests indicative of metabolic status and characteristic changes in thyroid functions, may be the key to well-reasoned and justified individual therapeutic decisions.
Age at menarche, menstrual problems, and daytime sleepiness in Chinese adolescent girls.
Wang Ze-Ying,Liu Zhen-Zhen,Jia Cun-Xian,Liu Xianchen
STUDY OBJECTIVES:Menstrual problems and daytime sleepiness are prevalent in adolescent girls. Little is known about the associations between age at menarche, menstrual problems, and daytime sleepiness. This study aimed to examine the associations of age at menarche and menstrual problems with daytime sleepiness among Chinese adolescent girls. METHODS:Of 11,831 adolescents who participated in the baseline survey of Shandong Adolescent Behavior & Health Cohort (SABHC), 5,813 were girls and included for the analysis. A structured self-administered questionnaire was used to collect information about menstrual problems, sleep, mental health, and demographics. Daytime sleepiness was measured by the Chinese Adolescent Daytime Sleepiness Scale (CADSS). RESULTS:The mean age of the girls was 15.02 (SD = 1.44) years. The prevalence rates of mild, moderate, and severe daytime sleepiness were 20.5%, 16.7%, and 5.5%, respectively. After adjusting for adolescent and family covariates (age, body mass index, physical health, physical exercise, sleep duration, sleep problems, anxious/depressive symptoms, and family social economic status), sometimes irregular (odds ratio [OR] = 1.24, 95% confidence interval [CI] = 1.01 to 1.52), often irregular menstruation (OR = 1.58, 95% CI = 1.17 to 2.12), moderate (OR=1.39, 95% CI = 1.12 to 1.72), and severe (OR = 1.46, 95% CI = 1.04 to 2.04) menstrual pain were significantly associated with increased risk of daytime sleepiness. CONCLUSIONS:Our findings suggest that menstrual irregularity and menstrual pain are associated with increased risk of daytime sleepiness. These findings emphasize the importance of evaluating and intervening menstrual problems for preventing daytime sleepiness in adolescent girls.
Hypothyroidism in Context: Where We've Been and Where We're Going.
Advances in therapy
Hypothyroidism affects up to 5% of the general population, with a further estimated 5% being undiagnosed. Over 99% of affected patients suffer from primary hypothyroidism. Worldwide, environmental iodine deficiency is the most common cause of all thyroid disorders, including hypothyroidism, but in areas of iodine sufficiency, Hashimoto's disease (chronic autoimmune thyroiditis) is the most common cause of thyroid failure. Hypothyroidism is diagnosed biochemically, being overt primary hypothyroidism defined as serum thyroid-stimulating hormone (TSH) concentrations above and thyroxine concentrations below the normal reference range. Symptoms of hypothyroidism are non-specific and include mild to moderate weight gain, fatigue, poor concentration, depression, and menstrual irregularities, while the consequences of untreated or under-treated hypothyroidism include cardiovascular disease and increased mortality. Levothyroxine has long been the main tool for treating hypothyroidism and is one of the world's most widely prescribed medicines. In adults with overt hypothyroidism, levothyroxine is usually prescribed at a starting dose of 1.6 µg/kg/day, which is then titrated to achieve optimal TSH levels (0.4-4.0 mIU/L), according to the therapeutic target. We here summarise the history of levothyroxine and discuss future issues regarding the optimal treatment of hypothyroidism. Because nearly one-third of patients with treated hypothyroidism still exhibit symptoms, it is important that levothyroxine is used more appropriately to achieve maximum benefit for patients. In order to ensure this, further research should include more accurate assessments of the true prevalence of hypothyroidism in the community, optimisation of the levothyroxine substitution dose, proper duration of treatment, and identification of patients who may benefit from combination therapy with levothyroxine plus levotriiodothyronine.Funding: Merck.Plain Language Summary: Plain language summary available for this article.
Depression, anxiety, stress, and dysmenorrhea: a protocol for a systematic review.
BACKGROUND:Dysmenorrhea is one of the most common menstrual disorders and is influenced by various factors. Psychological disorders including anxiety, depression, and stress have been suggested as influencing dysmenorrhea, but previous findings are inconsistent. This study will investigate the relationship between depression/anxiety/stress and dysmenorrhea using a systematic review and meta-analysis. METHODS:Online databases including PsycINFO, Scopus, PubMed, Science Direct, ProQuest, ISI Web of Knowledge, and Embase will be searched. Appropriate keywords and MeSH terms will be used to retrieve the journal papers published from 1990 until the end of December 2019. To improve search coverage, the reference lists of all included studies will be reviewed to find eligible papers. Inclusion criteria include the following: descriptive, cohort, case-control, and cross-sectional studies; the relationship between depression/anxiety/stress and dysmenorrhea being an objective of the study; and published in peer-reviewed journals. The paper selection, data extraction, and quality assessment of selected studies will be performed independently by two researchers, and disagreements will be resolved through discussions. The Newcastle-Ottawa Quality Assessment Scale will be used to assess the quality of selected studies. A quantitative synthesis will be performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) via the STATA software, if retrieving enough number of studies with no severe methodological heterogeneities. Otherwise, qualitative synthesis will be used to report the findings. DISCUSSION:To the best of our knowledge, this will be the first systematic review on this topic. Performing an inclusive search in major databases over a wide timescale is one key strength of the proposed study and will maximize the coverage of the original research studies on this topic. Results of present study are expected to lead to deeper understanding the relationship between common mental health conditions and dysmenorrhea. SYSTEMATIC REVIEW REGISTRATION:PROSPERO CRD42018102199.
Midlife women's health consequences associated with polycystic ovary syndrome.
Ali A T,Guidozzi F
Climacteric : the journal of the International Menopause Society
Polycystic ovary syndrome (PCOS) is one of the most common female endocrinopathies. Its symptoms may appear as early as adolescence and may include irregular menstrual periods, amenorrhea, hirsutism and obesity. Regardless of their phenotypic appearance, women with PCOS are metabolically obese. PCOS is associated with metabolic syndrome, type 2 diabetes, depression, cardiovascular disease and gynecological cancers. The metabolic disorders in obese women with PCOS are invariably due to insulin resistance, while inflammation, oxidative stress and possible interaction with environmental factors are among the features linking women with PCOS alone to metabolic disorders. The current review aims to highlight the relationship between PCOS and midlife women's health complications.
Psychological coping strategies associated with improved mental health in the context of infertility.
Chernoff Andie,Balsom Ashley A,Gordon Jennifer L
Archives of women's mental health
To examine the use of psychological coping strategies across the menstrual cycle in relation to within-person changes in depressed mood, anxious mood, and infertility-related distress, in a sample of women struggling to conceive. Sixty-five women from Canada and the USA (aged 19-43 years) trying to conceive naturally for ≥ 12 months were recruited via social media. On the first day of each participant's menstrual period, and every 3 days until the end of their cycle, participants completed questionnaires assessing depressed and anxious mood, and infertility-related distress. In addition, participants completed a 13-item coping questionnaire assessing four general coping strategies: emotional suppression, active coping, engagement in activities unrelated to trying to conceive, and downplaying the importance of biological children. The within-person effect of daily coping strategies on person-centred mood and infertility-related distress was examined. Day-to-day use of behavioural engagement was associated with lower person-centred depression scores, β(SEM) = - 3.25(.51), p < .0001, anxiety scores, β(SEM) = - 2.07(.36), p < .0001, and infertility-related daily distress, β(SEM) = - .64(.22), p = .005. Downplaying the importance of biological children was also associated with person-centred depression scores, β(SEM) = 1.14(.47), p = .016. Neither active coping nor emotional suppression was related to depression, anxiety, or distress (ps > .0125). These findings point to promising targets of future intervention studies, including promoting increased engagement in behaviours unrelated to conceiving and promoting acceptance, rather than denial and resistance, of feelings throughout the infertility journey.
Effects of Coping Flexibility in Young Women on Depressive Symptoms during Chronic Pain.
Kato Tsukasa,Kadota Masako,Shimoda Shunsuke
Behavioral medicine (Washington, D.C.)
Chronic pain is a worldwide problem that has a high prevalence rate and is often comorbid with depression. Coping flexibility, which is defined as the ability to discontinue an ineffective coping strategy-evaluation coping-and to produce and implement an alternative strategy-adaptive coping-has attracted much interest as an important factor that attenuates pain-induced stress responses, including depression. This study hypothesized that greater coping flexibility would be associated with lower depression in both women with chronic pain and those with menstrual pain. The participants included women with chronic pain ( = 292) and those with menstrual pain ( = 181) who completed questionnaires on pain intensity, pain acceptance, psychological inflexibility, and coping flexibility for chronic pain. The hierarchical multiple regressions revealed that both evaluation coping and adaptive coping predicted depression even after controlling for the effects of pain intensity, pain acceptance, and psychological inflexibility, which are well-known for their association with depression in patients with chronic pain. The hypothesis was supported in our samples. Our findings may contribute to the development of self-management without self-medication using over-the-counter analgesics by acquiring coping flexibility for chronic pain.
Testosterone and depressive symptoms during the late menopause transition.
Sander Bethany,Muftah Amira,Sykes Tottenham Laurie,Grummisch Julia A,Gordon Jennifer L
Biology of sex differences
BACKGROUND:The menopause transition is associated with an increased risk of depression. While the mechanisms behind this increased risk are not well understood, the changing perimenopausal hormonal environment has been hypothesized to play a role. The current study examined the potential influence of testosterone and the ratio of testosterone to estradiol as a potential contributor to depressed mood in the menopause transition. METHODS:Fifty non-depressed perimenopausal women ages 45-55 were recruited for this study. Once every 3 weeks, for a total of four times, the women completed the Centre for Epidemiological Studies-Depression (CES-D) scale for the measurement of depressive symptoms and provided a first-morning urine sample for the measurement of urinary testosterone as well as estrone-3-glucuronide (E1G), a urinary metabolite of estradiol. The week-to-week and mean effects of testosterone, E1G, and the testosterone/E1G ratio on CES-D score were examined. Self-reported sleep quality and vasomotor symptoms were also assessed at each of the four time points. RESULTS:Testosterone levels rose with increasing months since last menstrual period associated with testosterone levels (β(SE) = 175.3(63.2), p = .006), though this effect was moderated by body mass index (p for the interaction = .001) such that overweight women showed a less pronounced increase over time. Past and current smokers also had higher testosterone levels compared to never smokers. Week-to-week testosterone/E1G ratio was positively associated with CES-D score (β(SE) = 1.57(0.76), p = .041) but not sleep quality or vasomotor symptoms (ps > .05). Mean testosterone/E1G ratio was also positively associated with vasomotor symptom bother (β(SE) = 0.14(0.06), p = .018) and poorer sleep quality (β(SE) = - 0.34(0.09), p = .0001). CONCLUSION:These results suggest that, within the context of the menopause transition, times that are characterized by a higher testosterone-to-estradiol ratio may be associated with higher depressive symptoms. Perimenopausal women with a higher average ratio of testosterone relative to estradiol may also experience more sleep difficulties and vasomotor symptom bother.
The impact of COVID-19-related mental health issues on menstrual cycle characteristics of female healthcare providers.
Takmaz Taha,Gundogmus Ibrahim,Okten Sabri Berkem,Gunduz Anil
The journal of obstetrics and gynaecology research
AIM:To investigate the association between menstrual cycle regularity in healthcare providers and COVID-19 pandemic-related anxiety, depression, stress. METHODS:A cross-sectional study was conducted by administrating online questionnaires to female healthcare workers in Turkey. Women aged 18-40 years with regular menstrual cycles for more than 1 year before the beginning of the pandemic were included in the study and they were divided into two groups according to menstrual cycle regularity during the pandemic. The questionnaires included sociodemographic characteristics, medical and reproductive history, lifestyle information of participants, COVID-19 Stress Scales (CSS), and a short version of the Depression Anxiety Stress Scale (DASS-21). RESULTS:A total of 952 women were included in the study, 679 had regular menstrual cycles, and 273 had irregular menstrual cycles. The prevalence of irregular menses among Turkish women healthcare workers aged 18-40 years was 28.7%. The CSS subdimensions and total scores were significantly higher in the irregular menstruation group than in women with regular menstruation (p < 0.001). The DASS-21 depression, anxiety, and stress subdimensions were likewise significantly higher in women with irregular menstruation (p < 0.001). Besides, both the univariable and the multivariable logistic regression results showed the relationship between irregular menstruation and CSS total score. CONCLUSION:The current study showed the association between the COVID-19 pandemic-induced anxiety, perceived stress, depressive symptoms, and increased prevalence of menstrual cycle irregularity among healthcare providers.
Patterns of premenstrual syndrome and depression symptoms in Chinese female university students: Results of a latent profile analysis.
Hou Lulu,Zhou Renlai
Journal of affective disorders
BACKGROUND:Premenstrual syndrome (PMS) and depression co-occur frequently; however, their relationship remains controversial. This study was conducted primarily to discern heterogeneous patterns of such co-occurring symptoms in Chinese female university students, using a latent profile analysis (LPA), a person-centered statistical approach. METHODS:The PMS Scale and Beck Depression Inventory were used to examine self-reported PMS and depression symptoms in 701 Chinese female university students. LPA, multinomial logistical regression, and analyses of variance were adopted to investigate latent profiles and their validity. RESULTS:The LPA results indicated that a four-class solution characterized by low symptoms (57.2%), predominantly PMS (11.3%), predominantly depression (23.7%), and combined PMS-depression (7.8%) patterns fitted the data best. Age, first menstrual experience, and personality factors were associated with differences in nonparallel profiles characteristic of menstrual attitude. LIMITATIONS:Use of self-report measures can lead to response biases; the cross-sectional design at a single time point limits the examination of changes in symptom characteristics and members within the category over time; and the specific age group limits the generalizability of results. CONCLUSION:These results confirm that PMS is independent from depression, rather than a variant of depression, and can be used to resolve the controversy regarding the relationship between PMS and depression. The current findings highlight the need for identifying women at high risk for PMS and depression, and promoting interventions individually tailored to their symptom presentations.
Symptom profiles of women at risk of mood disorders: A latent class analysis.
Weiss Sandra J,Flynn Heather,Christian Lisa,Hantsoo Liisa,di Scalea Teresa Lanza,Kornfield Sara L,Muzik Maria,Simeonova Diana I,Cooper Bruce A,Strahm Anna,Deligiannidis Kristina M
Journal of affective disorders
BACKGROUND:Depression is the leading cause of disease burden among women worldwide. However, an understanding of symptom profiles among women at risk of mood disorders is limited. We determined distinct profiles of affective symptoms among high risk women, along with their distinguishing characteristics. METHODS:Women were recruited from 17 clinical sites affiliated with the National Network of Depression Centers. They completed measures of depression (Patient Health Questionnaire - 9) and anxiety (Generalized Anxiety Disorder - 7) as well as questions regarding demographics, reproductive status, behavioral/mental health history, and life stress/adversity. Latent class analysis and multinomial logistic regression were used to identify and characterize symptom profiles. RESULTS:5792 women participated, ages 18 to 90 (M = 38). Three latent classes were identified: generally asymptomatic (48%), elevated symptoms of comorbid anxiety and depression (16%), and somatic symptoms (36%). Financial security and greater social support were protective factors that distinguished asymptomatic women. The profile of the class with elevated anxiety/depressive symptoms constituted a complex mix of adverse social determinants and potentially heritable clinical features, including a diagnosis of Bipolar Disorder. Women in the 3rd latent class were characterized by menstrual irregularity and a stronger expression of neurovegetative symptoms, especially sleep disturbance and fatigue. LIMITATIONS:Limitations included less than optimal racial diversity of our sample and reliance on self-report. CONCLUSIONS:Different symptom profiles may reflect distinct subtypes of women at risk of mood disorders. Understanding the etiology and mechanisms underlying clinical and psychosocial features of these profiles can inform more precisely targeted interventions to address women's diverse needs.
Burden of illness, metabolic control, and complications in relation to depressive symptoms in IDDM patients.
Karlson B,Agardh C D
Diabetic medicine : a journal of the British Diabetic Association
Relationships between demographic-, treatment-, and sickness-related factors, metabolic control (HbA1c), perceived burden of illness, and degree of depressive symptoms were examined in a group of 155 insulin-dependent diabetic patients, aged 35.3 +/- 8.9 years. The patients completed a questionnaire measuring depressive symptoms and three aspects of perceived burden of illness. No gender differences in HbA1c level or occurrence of late diabetic complications were found. Both men and women showed a modestly elevated degree of depression compared with norm groups. Self-reported burden of illness was strongly related to depression but was largely unrelated to objective disease-related measures. Level of depression was correlated neither with degree of metabolic control nor with the presence of such late diabetic complications as retinopathy and nephropathy. Some 44% of the variance in depression could be explained by worries about complications in those patients with the lowest HbA1c levels, by perceived restrictions in everyday life in patients with intermediate metabolic control, and by problems of glycaemic regulation in patients with poor metabolic control. Degree of depression was largely unrelated to disease severity, but was found to be related to the perceived daily burden of living with the disease, the specific worries and concerns associated with a depressed mood varying with degree of metabolic control.
Diagnosis and management of mood disorders during the menopausal transition.
Cohen Lee S,Soares Claudio N,Joffe Hadine
The American journal of medicine
Recent census data indicate that, in the United States, an increasing number of women--almost 1.5 million each year--are reaching menopause. The menopausal transition is marked by intense hormonal fluctuations, and may be accompanied by vasomotor complaints, sleep disturbances, changes in sexual function, and increased risk for osteoporosis and cardiovascular disease. In addition, there is evidence of increased risk for developing depression, even among women who never experienced depressive symptoms before. Thus depression during the perimenopause may have a substantial impact on personal, family, and professional spheres of life. A challenge to clinicians and health professionals lies in the identification of the most tolerable treatments to manage depression and improve quality of life in an aging population. Any treatment strategy should take into account not only the spectrum of side effects that may complicate treatment but also other menopause-related factors (e.g., vasomotor symptoms, psychosocial stressors) that may modulate risk for the development of mood disturbance. This article reviews the current literature on the prevalence and risk factors associated with depression during the menopausal transition. The benefits and risks of using hormonal and nonhormonal strategies for the management of depression and other menopause-related somatic symptoms are critically reviewed.
What are the determinants of quality of life in people with cervical dystonia?
Ben-Shlomo Y,Camfield L,Warner T,
Journal of neurology, neurosurgery, and psychiatry
BACKGROUND:Little is known about the quality of life in patients with cervical dystonia, although pain and depression are relatively common. OBJECTIVE:To test the hypothesis that an individual's ability to cope with the disease will modify the association of intrinsic, extrinsic, and disease related factors with quality of life. METHODS:Patients with cervical dystonia diagnosed by a movement disorder specialist were recruited from seven European countries. Data on quality of life (SF-36), measures of coping, and intrinsic, extrinsic, and disease related factors were collected by a self completed postal questionnaire. RESULTS:289 patients (101 men and 188 women), mean age 55 years, completed the questionnaire. Both physical and mental quality of life scores were predicted by self esteem and self deprecation, educational level, employment status, social support, response to botulinum toxin, disease severity, social participation, stigma, acceptance of illness, anxiety, and depression. In multivariable analyses, the strongest predictors were anxiety and depression. Severe depression was associated with a 19.1 point decrement in the physical summary score (95% confidence interval, -31.7 to -6.6; p = 0.003); however, disease duration and severity remained predictors. CONCLUSIONS:Care for patients with cervical dystonia must not only focus on reducing the severity of the dystonia but also on the psychological wellbeing of the patient. Interventions aimed at treating depression or anxiety, especially of a cognitive nature, may have a large impact on improving quality of life.
Strategies and issues for managing menopause-related symptoms in diverse populations: ethnic and racial diversity.
Rice Valerie Montgomery
The American journal of medicine
Menopause is a naturally occurring "equal opportunity" event that every woman who lives beyond the age of approximately 52 years will experience. During the next 20 years, approximately 3.5 million African American women, 2 million Latinas, and 1 million Asian American women will enter the menopause. How a woman approaches the menopausal transition depends on a number of factors, from educational level to socioeconomic status; health-related factors, including stress; and marital status. Increasingly, the roles of race and ethnicity, as they relate to menopausal symptoms, are being explored. Understanding similarities and differences among women of color in perceptions, attitudes, and expectations surrounding the menopause can help provide culturally appropriate care and promote lifestyles that may decrease symptoms and increase quality of life. For example, minority women are usually the gatekeepers for healthcare for themselves and their families and have a highly developed social support network, often including extended family, a church community, and involvement in sororal or social organizations. In the future, research on menopausal symptoms among women of different racial/ethnic groups should focus on exploring in greater detail the effect of dietary factors and body mass index, additional evaluation of pituitary sensitivity, and use of complementary and alternative medicines in symptom management, with a better understanding of the risks and benefits of such therapies.
Smoking prevalence and factors associated with smoking status among Vietnamese in California.
Tong E K,Gildengorin G,Nguyen T,Tsoh J,Modayil M,Wong C,McPhee S J
Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco
INTRODUCTION:Vietnamese American men have smoking prevalence rates higher than the general population. We analyzed Vietnamese American smoking behavior by demographic and health-related factors, including some specific to Vietnamese, in the largest tobacco-specific survey yet targeting the Vietnamese population. METHODS:Using a statewide surname probability sample and computer-assisted telephone interviewing, we surveyed 1,101 Vietnamese men and 1,078 Vietnamese women in California (63.5% participation among successfully contacted eligible individuals) in 2007-2008. We conducted multivariate regression models to analyze the association between Vietnamese male smoking status and demographic and health-related factors. RESULTS:Among women, <1% were current smokers and <2% were former smokers. Among men, 25% were current and 24% were former smokers. Regression models for Vietnamese men delineated factors associated with both current and former smoking (vs. never smoking): being married, being employed, having lower educational attainment, and consuming alcohol. Other factors associated with current smoking (vs. never smoking) were having no health insurance, having seen a Vietnamese doctor or no doctor visit in the past year, having Vietnamese military or Vietnamese reeducation camp experience, having less knowledge about the harms of smoking, and reporting higher depression symptoms. Increasing age and not being Buddhist were associated with former (vs. never) smoking. DISCUSSION:Smoking patterns of Vietnamese women and Vietnamese men are significantly different from the general California population. Tobacco control efforts targeting Vietnamese men should include community outreach since current smokers have low health care access, utilization, and knowledge.
Mediators of the relationship between race and allostatic load in African and White Americans.
Tomfohr Lianne M,Pung Meredith A,Dimsdale Joel E
Health psychology : official journal of the Division of Health Psychology, American Psychological Association
OBJECTIVE:Allostatic load (AL) is a cumulative index of physiological dysregulation, which has been shown to predict cardiovascular events and all-cause mortality. On average, African Americans (AA) have higher AL than their White American (WA) counterparts. This study investigated whether differences in discrimination, negative affect-related variables (e.g., experience and expression of anger, depression), and health practices (e.g., exercise, alcohol use, smoking, subjective sleep quality) mediate racial differences in AL. METHOD:Participants included healthy, AA (n = 76) and WA (n = 100), middle-aged (Mage = 35.2 years) men (n = 98) and women (n = 78). Questionnaires assessed demographics, psychosocial variables, and health practices. Biological data were collected as part of an overnight hospital stay-AL score was composed of 11 biomarkers. The covariates age, gender, and socioeconomic status were held constant in each analysis. RESULTS:Findings showed significant racial differences in AL, such that AA had higher AL than their WA counterparts. Results of serial mediation indicated a pathway whereby racial group was associated with discrimination, which was then associated with increased experience of anger and decreased subjective sleep quality, which were associated with AL (e.g., race → discrimination → experience of anger → subjective sleep quality → AL); in combination, these variables fully mediated the relationship between race and AL (p < .05). CONCLUSION:These results suggest that discrimination plays an important role in explaining racial differences in an important indictor of early disease through its relationship with negative affect-related factors and health practices. (PsycINFO Database Record
Factors associated with cessation of smoking among Swiss adults between 1991 and 2011: results from the SAPALDIA cohort.
Ayala-Bernal Diana,Probst-Hensch Nicole,Rochat Thierry,Bettschart Robert,Brändli Otto,Bridevaux Pierre-Olivier,Burdet Luc,Frey Martin,Gerbase Margaret,Pons Marco,Rothe Thomas,Stolz Daiana,Tschopp Jean-Marie,Turk Alexander,Künzli Nino,Schindler Christian
Swiss medical weekly
INTRODUCTION:Smoking is still the most preventable cause of disease and premature death in Switzerland, as elsewhere. We aimed to assess the main determinants of smoking cessation in the population-based cohort of SAPALDIA (Swiss Cohort Study on Air Pollution and Lung and Heart Diseases in Adults). METHODS:The SAPALDIA study was initiated in 1991 with 9651 participants aged 18 to 60 years from eight areas (S1). Follow-up assessments were conducted in 2002 (S2; 8047 participants) and 2010/11 (S3; 6088 participants). At each survey, detailed information on health and potential health-related factors was collected and lung function measured. Using logistic regression, we assessed predictors of smoking cessation between S1 and S2 and between S2 and S3. RESULTS:In both periods, highest educational level (summary odds ratio [OR] 1.49, 95% confidence interval [CI] 1.08-2.06; ref. lowest level), FEV1/FVC <0.5 (OR 6.19, 95% CI 2.44-15.7, ref. FEV1/FVC ≥0.7), higher age in men (OR 1.02, 95% CI 1.01-1.03, per year) and overweight (OR 1.38, 95% CI 1.16-1.64) were significant predictors of smoking cessation. Nicotine dependence (OR 0.97, 95% CI 0.96-0.98, per cigarette smoked a day) and female sex between age 45 and 60 (e.g., OR 0.74, 95% CI 0.61-0.91, at age 50) were negatively associated with smoking cessation. Moreover, smokers at S2 reporting a diagnosis of depression were less likely to quit smoking by S3 (OR 0.53, 95% CI 0.30-0.93). CONCLUSIONS:Prospective tobacco control policies in Switzerland should be addressed to women, younger persons and persons of lower education.
Depressive symptoms in middle-aged women are more strongly associated with physical health and social support than with socioeconomic factors.
Aro A R,Nyberg N,Absetz P,Henriksson M,Lönnqvist J
Nordic journal of psychiatry
The association of socioeconomic factors, health-related factors, and social support with depressive symptoms has been extensively studied. However, most epidemiological studies have focused on a few factors such as marital status, social class, and employment. In this study of middle-aged women we analyzed both univariate and multivariate associations of socioeconomic factors, perceived physical health factors, and social support with self-rated depressive symptoms measured with the Beck Depression Inventory. A nationwide sample (n = 1851) of Finnish women aged 48-50 years was analyzed. Socioeconomic, health-related, and social support factors were all measured with single items. All variables, except level of urbanization, were significantly associated with depressive symptoms in univariate analyses. Multivariate associations were examined with standard multiple regression analyses in three stages: first with the socioeconomic factors, then with socioeconomic and health factors, and finally entering the social support factors into the regression model. In the first model, being either on a sick leave or at home as working status, being divorced, and having low income reached significance. In the second model, being divorced and having poor perceived physical health were the most powerful among the five significant variables. In the last model, explaining 32% of the variance, the most powerful predictors of depressive symptoms were perceived current physical health, satisfaction with received social support, and quality of intimate relationships. For the prevention or intervention of depressive symptoms among middle-aged women in the population subjects with concurrent subjective or objective health problems and poor social support seem to comprise a particularly important target group.
Body fat and blood lipids in postmenopausal women are related to resting autonomic nervous system activity.
Kimura Tetsuya,Matsumoto Tamaki,Akiyoshi Mihoko,Owa Yoko,Miyasaka Naoyuki,Aso Takeshi,Moritani Toshio
European journal of applied physiology
The present study investigated the activity of the autonomic nervous system (ANS), a major influence in normal physiological function, and its association with unfavorable postmenopausal states in body composition, lipid and/or glucose metabolism, or cardiovascular profiles. Body composition, blood pressure, and blood profiles of lipid and glucose of 175 postmenopausal women were measured. Resting ANS activity was assessed by heart rate variability (HRV) power spectral analysis. To scrutinize the influence of ANS activity levels on postmenopausal obesity-related factors, we divided the subjects into a low group ( < 220 ms(2)) and a high group ( > 220 ms(2)), based on the total power of HRV. Low-frequency (P < 0.01) and high-frequency power (P < 0.01) were both significantly lower in the low group. No significant difference was found in age, age at menopause, or years after menopause between the two groups. In contrast, body mass index (P < 0.05), percentages of body fat (P < 0.01), and systolic (P < 0.01) and diastolic (P < 0.01) blood pressure were significantly greater in the low group. As to blood lipid profiles, triglycerides (P < 0.05), total cholesterol (P < 0.05), and low-density lipoprotein cholesterol (P < 0.05) were significantly higher in the low group. Our findings indicate that reduced sympatho-vagal activity is associated with higher postmenopausal body fat content, blood pressure, and blood lipid concentrations. This study further implies that such autonomic depression could be a crucial risk factor in undermining the health and, ultimately, the quality of life, of postmenopausal women.
Depressed mood during the menopausal transition: is it reproductive aging or is it life?
Mitchell Ellen Sullivan,Woods Nancy Fugate
Women's midlife health
BACKGROUND:Although there has been noteworthy attention to both depressed mood symptoms and majordepressive disorder during the menopausal transition (MT), recently investigators have questioned whether there is an over-pathologizing of the MT by emphasizing hormonal effects on depression and deflecting attention from the everyday conditions of women's lives as they relate to depressed mood. In addition, fluctuation of mood over short periods of time may not be captured by measures of depressed mood symptoms such as the CESD, especially when administered using a reference period such as a week or more. The purpose of this study was to examine the association of menopausal transition factors, health-related factors, stress factors, social factors and symptoms with repeated measures of depressed mood reported for a 24 h period. METHODS:Seattle Midlife Women's Health Study participants ( = 291, 6977 observations) provided data from 1990 to 2013 including annual questionnaires, symptom diaries and urine specimens assayed for hormones several times per year. Multilevel modeling was used to test bivariate and multivariable models accounting for depressed mood severity. RESULTS:In individual models with age as the measure of time, being in early postmenopause, exercising more, and being partnered were associated with less severe depressed mood; greater perceived stress, having a history of sexual abuse, difficulty getting to sleep, early awakening, and awakening at night were each associated with higher depressed mood severity. In a multivariable model ( = 234, 6766 observations), being older, being in the early postmenopause, exercising more, being partnered, were associated with less severe depressed mood; reporting greater perceived stress, history of sexual abuse, difficulty getting to sleep and early awakening were associated with more severe depressed mood. CONCLUSIONS:Clinicians need to consider the context in which midlife women experience the menopausal transition and mood symptoms as well as hormonal transitions during this part of the lifespan.
The association between sleep chronotype and obesity among black and white participants of the Bogalusa Heart Study.
Sun Xunming,Gustat Jeanette,Bertisch Suzanne M,Redline Susan,Bazzano Lydia
Research indicates that sleep duration and quality are inter-related factors that contribute to obesity, but few studies have focused on sleep chronotype, representing an individual's circadian proclivity, nor assessed these factors in racially diverse middle-aged samples. We examined the associations between chronotype and obesity among black and white men and women participating in the Bogalusa Heart Study (BHS).Body mass index (BMI) and sleep data were available for 1,197 middle-aged men and women (mean age 48.2 ± 5.3 years) who participated in the BHS 2013-2016. Based on the reduced Morningness-Eveningness Questionnaire's cutoff values for chronotypes, we combined 'definitely morning' and 'moderately morning' types into 'morning' type, 'definitely evening' and 'moderately evening' types into 'evening' type and kept those who were "neither" type in a separate group. We used 'morning' type as the referent group. Obesity was defined as a BMI ≥ 30. Multivariable logistic regression models were used to examine associations adjusting for sex, age, education, smoking, alcohol use and drug use, depression, shift work, physical activity and sleep duration.Evening chronotype, reported by 11.1% of participants, was associated with obesity after multi-variable adjustment, including shift work, physical activity and sleep duration (OR 1.67, 95% CI: 1.08-2.56). However, once stratified by race (black/white), this association was found only among white participants (OR = 1.91, 95% CI = 1.12-3.25) after full adjustment.In our biracial, community-based population, evening chronotype was independently associated with obesity, specifically among white participants. Further research is needed to identify behavioral, endocrine, nutritional and genetic pathways which underlie these associations.
The impact of the COVID-19 pandemic on mental health: early quarantine-related anxiety and its correlates among Jordanians.
Eastern Mediterranean health journal = La revue de sante de la Mediterranee orientale = al-Majallah al-sihhiyah li-sharq al-mutawassit
BACKGROUND:Jordan implemented a nationwide lockdown and recommended self-quarantine in response to the COVID-19 pandemic. Such measures are expected to have consequences on mental health. AIMS:In this study, we aimed to estimate the prevalence of quarantine-related anxiety and its socioeconomic correlates. METHODS:An online questionnaire was utilized to collect information about quarantine-related anxiety and related factors from a non-representative sample of Jordanian population in March 2020. The Beck Anxiety Inventory (BAI) was used to ascertain the level of stress. Using STATA 16, multivariable ordinal logistic regression was done to estimate beta-coefficient (β) and corresponding 95% CI of the anxiety level. RESULTS:Overall, 5274 participants returned the survey. The prevalence of mild, moderate, and severe anxiety was 21.5%, 10.9%, and 6%, respectively. Female gender (β= 0.47, 95% CI: 0.34 to 0.59) and more members of the household (β= 0.04, 95% CI: 0.00 to 0.07) were correlated with a higher degree of anxiety, while older age (β= -0.27, 95% CI: -0.33 to -0.20), having larger social network (β= -0.17, 95% CI -0.22 to -0.13), social support (β= -0.28, 95% CI: -0.32 to -0.23), and higher income (>2000 Jordanian Dinars vs reference, β= -0.52, 95% CI: -0.71 to -0.33) were correlated with lower BAI scores. CONCLUSION:Our findings showed that approximately four out of every ten participants experienced quarantine-related anxiety. Younger participants, women, and people with poor social support were more likely to experience quarantine-related anxiety. These findings highlight the importance of targeting these groups to mitigate the consequence of home quarantine on public health.
Early Psychological Impact of the COVID-19 Pandemic in Brazil: A National Survey.
Campos Juliana Alvares Duarte Bonini,Martins Bianca Gonzalez,Campos Lucas Arrais,Marôco João,Saadiq Rayya Ahmed,Ruano Rodrigo
Journal of clinical medicine
BACKGROUND:Isolation measures used to contain epidemics generate social interaction restrictions and impose changes in routines of the public that increase negative psychological outcomes. Anxiety and depression are the most common symptoms. OBJECTIVE:To evaluate the mental health of the Brazilian population during the SARs-CoV-2 pandemic and its relationship with demographic and health characteristics. METHODS:Adults from all Brazilian States participated ( = 12,196; women: 69.8%, mean age = 35.2 years). The Depression, Anxiety and Stress Scale, and the Impact of Event Scale-revised were used (online survey). Data validity and reliability were verified by confirmatory factor analysis and ordinal alpha coefficient. The probability of presenting psychological symptoms was calculated by multiple logistic regression and odds ratio (OR) (0 = without symptoms, 1 = with mild, moderate, and severe levels of symptoms). RESULTS:High prevalence of depression (61.3%), anxiety (44.2%), stress (50.8%), and psychological impact (54.9%) due to the isolation experienced from the pandemic was found. Younger individuals (OR = 1.58-3.58), those that felt unsafe (OR = 1.75-2.92), with a previous diagnosis of mental health (OR = 1.72-2.64) and/or had general health problems before the pandemic (OR = 1.17-1.51), who noticed changes in their mental state due to the pandemic context (OR = 2.53-9.07), and excessively exposed to the news (OR = 1.19-2.18) were at increased risk of developing symptoms. Women (OR = 1.35-1.65) and those with lower economic status (OR = 1.38-2.69) were more likely to develop psychological symptoms. Lower educational levels increased the likelihood of depressive (OR = 1.03-1.34) and intrusive symptoms (OR = 1.09-1.51). : The pandemic and related factors can have a high impact on the mental health of the population. Demographic characteristics can influence the occurrence of psychological symptoms.
Body Mass Index and Waist Circumference in Patients with HIV in South Africa and Associated Socio-demographic, Health Related and Psychosocial Factors.
Huis In 't Veld Diana,Pengpid Supa,Colebunders Robert,Peltzer Karl
AIDS and behavior
A high body mass index (BMI) and high waist circumference are important health risk factors predisposing for cardiovascular and metabolic diseases and certain cancers. Historically, underweight was a diagnostic criterion of HIV-infection. In a cross-sectional study the prevalence of BMI-categories and high waist circumference and its associated factors in patients visiting three outpatient HIV clinics in South Africa were measured with anthropometric measurements and structured questionnaires regarding socio-demographic information, quality of life (QoL), AIDS-related stigma, symptoms of depression, alcohol use, HIV related information and level of adherence to ART. The median age of the 2230 included patients was 37 years, 66.5% were women and 88.6% received antiretroviral therapy. The prevalences of overweight, obesity and high waist circumference were 29.2, 21.9 and 44.6% respectively in women and 12.4, 4.0 and 3.9% respectively in men. Underweight was found in 18.2% of men and 6.3% of women. In multinomial regression analysis compared to a normal BMI, both overweight and obesity were associated with female gender, with being married or cohabiting and with a higher QoL score. Underweight was associated with male gender and tobacco use and negatively associated with being married or cohabiting and the physical domain of the QoL measure. A high waist circumference in men was associated with higher age and negatively associated with tobacco use and stigma score. In women it was negatively associated with never being married. A high prevalence of overweight and obesity was observed in HIV-clinics in South Africa, mainly in women. Since overweight and obesity are important health risk factors, effective weight reduction interventions are desirable.
Inadequate nutrient intakes among homebound elderly and their correlation with individual characteristics and health-related factors.
Sharkey Joseph R,Branch Laurence G,Zohoori Namvar,Giuliani Carol,Busby-Whitehead Jan,Haines Pamela S
The American journal of clinical nutrition
BACKGROUND:The prevalence of inadequate nutrient intakes among the homebound elderly and their correlation with individual characteristics and health-related factors remain poorly understood. OBJECTIVE:We assessed the extent of inadequate dietary intakes of key nutrients among the homebound elderly by using the newly released dietary reference intakes and examined the associations of individual characteristics and health-related factors with low nutrient intakes. DESIGN:This was a cross-sectional examination of data collected during the baseline assessment of a prospective study of nutrition and function among a randomly recruited sample of cognitively eligible recipients of home-delivered meals who completed a home visit and three 24-h dietary recalls (n = 345). Nutrient analysis was performed with the NUTRITION DATA SYSTEM software, and associations were identified through multiple regression models. RESULTS:In multiple regression models, lower intakes of specific nutrients were associated with subjects who were women, who were black, who reported a low income and limited education, and who did not usually eat breakfast. On the basis of the estimated average requirement standard for nutrient inadequacy, the intake of >/= 6 nutrients was inadequate in 27% of subjects, of 3-5 nutrients in 40% of subjects, and of 1-2 nutrients in 29% of subjects. On the basis of the adequate intake standard, a less than adequate intake of calcium was reported by 96% of subjects and of vitamin D by 99% of subjects. CONCLUSIONS:The findings suggest that home-delivered meals programs should target specific subgroups of participants with interventions, such as a breakfast meal or more-nutrient-dense meals, tailored to increase nutrient intakes and reduce the prevalence of nutrient inadequacy.
Depressed mood during the menopausal transition and early postmenopause: observations from the Seattle Midlife Women's Health Study.
Woods Nancy Fugate,Smith-DiJulio Kathleen,Percival Donald B,Tao Eunice Y,Mariella Anne,Mitchell Sullivan
Menopause (New York, N.Y.)
OBJECTIVE:To characterize patterns of depressed mood during the menopausal transition (MT) in relation to age and MT-related factors and to assess the contribution of factors related to depressed mood at earlier points in the life span. DESIGN:Women (N = 508) were recruited from 1990 to 1992 from multiethnic neighborhoods and followed annually through 2005: 302 met the eligibility criteria for analyses reported here. The Center for Epidemiologic Studies Depression scale (CES-D) and a menstrual calendar were completed annually throughout the study. A subset of women provided a first morning voided urine specimen from 1997 through 2005. Urine samples were assayed for estrone glucuronide, follicle-stimulating hormone, testosterone, and cortisol. Mixed effects modeling was used to identify changes in CES-D scores over time, including the relationship to age, MT-related factors, and factors related to depression at other points in the life span (postpartum depression/blues, life stress, or family history of clinical depression). RESULTS:Age was modestly and negatively related to CES-D scores, but MT stage alone was not, except that the late MT stage was significantly related to depressed mood. Hot flash activity, life stress, family history of depression, history of "postpartum blues," sexual abuse history, body mass index, and use of antidepressants were also individually related to depressed mood; the hormonal assays and age of entry into and duration of late MT stage were unrelated. CONCLUSIONS:Although women in the late MT stage are vulnerable to depressed mood, factors that account for depressed mood earlier in the life span continue to have an important influence and should be considered in studies of etiology and therapeutics.
A prospective study of predictors of successful weight maintenance by women enrolled in community-based weight-loss programs.
Collings A S,Saules K K,Saad L R
Eating and weight disorders : EWD
OBJECTIVE:Research is limited on the psychological predictors of successful long-term weight maintenance after weight loss. Therefore, the present study examined the individual contributions of body image, depression, and self-esteem to successful weight maintenance after a significant weight loss. METHOD:Measures of depression, self-esteem, and body image were administered at baseline, three-, and twelve-months to 73 women enrolled in community- based weight loss programs. RESULTS:Significant predictors of weight maintenance included baseline self-classified weight, early (3 months) weight maintenance, later (12 months) change in perceptual body image, and the interaction between early and late change in body image avoidance. Classifying oneself as more overweight at baseline predicted less weight maintenance, while later discrepancies between current and realistic body size were positively associated with weight maintenance. Those who showed steady improvements in body image avoidance behavior were more likely to maintain weight loss. Baseline BMI, self-esteem, and depression did not predict 12-month weight maintenance. DISCUSSION:Further understanding how body image and related factors contribute to weight maintenance may inform development of more effective interventions to promote long-term weight maintenance.
Maternal age and number of children are risk factors for depressive disorders in non-perinatal women of reproductive age.
Aras Neriman,Oral Elif,Aydin Nazan,Gulec Mustafa
International journal of psychiatry in clinical practice
OBJECTIVE:It remains unclear whether or not the vulnerability of depression in women of reproductive age is related with pregnancy or perinatal period. The aim of the study was to determine the prevalence of depressive disorders and related factors in a large sample of non-perinatal women of reproductive age. METHOD:This study involved 589 women of reproductive age. At baseline, sociodemographic data and premenstrual assessment forms were completed, and screening tests for the assessment of the severity of depressive symptoms were administered to all of the participants. Participants who had over scale scores of the cut-off point in the screening instruments were assessed with module A of the Structured Clinical Interview for DSM Disorders (SCID-I) to determine DSM IV Axis I disorders. RESULTS:The prevalence of depressive disorders was 32.8%. Depressive disorders had high rates in women who were married at younger ages and who had three or more children. Although the prevalence of depressive disorders was 32.8%, only 10.4% of the women had follow-up and treatment in a psychiatric outpatient clinic. CONCLUSION:Low education levels, early maternal age, and having more than three children and higher premenstrual symptom scores were risk factors for depressive disorders in non-perinatal reproductive age.
Cross-sectional community survey of menopause symptoms among Japanese women.
Ishizuka Bunpei,Kudo Yoshiko,Tango Toshiro
OBJECTIVES:To determine the prevalence and characteristics of climacteric symptoms and related factors among 50-year-old Japanese women. METHODS:A self-administered questionnaire was mailed to all 50-year-old women (n=3166) in three northern wards of Kawasaki City regarding 10 menopausal symptoms (hot flashes, sweats, insomnia, depression, palpitation, chills, irritation, headache, fatigue, and stiff shoulders) as well as demographic, lifestyle, psychological, socio-economic and physical factors. The questionnaire included closed-ended questions about symptoms over a 1-year recall time frame. The response rate was 55%, and women with current illness, a history of gynecological or endocrinological disorders and those on HRT were eliminated. We finally analyzed data from 1169 (37%) women. RESULTS:The prevalence of hot flashes was 36.9%. These, together with sweats, insomnia and depression, were associated with menstrual status. All four symptoms were also associated with lifestyle and socio-psychological factors. Psychological stress (unease or anxiety) was associated with all 10 symptoms investigated. The two most prevalent symptoms, namely, fatigue (64.7%) and stiff shoulders (75.4%) were associated with psychological and lifestyle factors. CONCLUSIONS:Hot flashes were experienced by more women in the present community-based study than in most previous studies of Japanese women. We found that hot flashes ('hoteri' in Japanese) are related to menstrual status. Symptoms both related and unrelated to menstrual status were associated with lifestyle, psychological factors and BMI.
Factors associated with sexual function in Iranian women with type 2 diabetes mellitus: partner relationship as the most important predictor.
Shadman Zhaleh,Akhoundan Mahdieh,Poorsoltan Nooshin,Larijani Bagher,Arzaghi Seyed Masoud,Khoshniat Mohsen
Iranian Red Crescent medical journal
BACKGROUND:No comprehensive study has been conducted on risk factors of sexual dysfunction in women with diabetes mellitus. OBJECTIVES:The aim of this study was to consider all possible influencing variables including hormonal, physical and, psychological status, socioeconomic status, and dietary intake to get more accurate and reliable results. PATIENTS AND METHODS:Sexual function was assessed by Iranian validated female sexual function index (FSFI).The variables of the study were demographic and diabetes-related factors, stress-depression, physical activity, blood pressure, anthropometric measurements, lipid profile, cortisol, sex and thyroid hormones, 25-hydroxy vitamin D, and dietary intake. RESULTS:Among all investigated variables, partner relationship showed a strong positive association with FSFI (β = 1.93 ± 0.41, P < 0.0001). In addition, not considering partner relationship, FSFI showed a significant negative association with age (β = -0.19 ± 0.20, P = 0.04), stress-depression score (β = -0.08 ± 0.04, P = 0.04), DD (β = -0.03 ± 0.01, P = 0.04), and systolic blood pressure (β = -0.14 ± 0.06, P = 0.03). Significant associations between FSFI and serum sex hormones and other biochemical were found in neither postmenopausal nor non-menopausal women. The means of SFSI in postmenopausal women were greater than non-menopausal (P = 0.02). CONCLUSIONS:It seems that in our population, female sexual function was much more than just a hormonal or physical problem and psychological factors, especially partner relationship and stress-depression, are the most determinants. In addition, age, duration of challenging with disease, and the lack of controlling systolic blood pressure were common factors that decreased sexual function.
The correlations of sexual activity, sleep problems, emotional distress, attachment styles with quality of life: comparison between gynaecological cancer survivors and noncancer women.
Hsieh Chia-Chen,Chen Chi-An,Hsiao Fei-Hsiu,Shun Shiow-Ching
Journal of clinical nursing
AIMS AND OBJECTIVES:To compare quality of life and its related factors, which include sexual activity, sleep problems, depression, anxiety and attachment styles in close relationships, between gynaecological cancer survivors and noncancer women. BACKGROUND:The majority of studies focus on examining the relationships between the late-treatment side effects and quality of life in gynaecological cancer survivors. As a result, there is insufficient information about what are the correlations between psychosocial factors and quality of life in gynaecological cancer survivors. DESIGN:Cross-sectional study. METHODS:The quality of life of the 85 gynaecological cancer patients who had completed active treatments for at least six months was compared with the 85 age-matched women without cancer history. Measures included SF-12 Health Surveys, Medical Outcomes Study Sleep Scale, Beck Depression Inventory-II, State-Trait Anxiety Inventory, Sexual Activity Questionnaire and Experiences in Close Relationships-Revised. RESULTS:There were no significant differences in the quality of life between gynaecological cancer survivors and noncancer women. However, higher attachment-related anxiety in close relationship was the main factor associated with the lower physical quality of life in the gynaecological cancer survivor group. In contrast, older ages were correlated with lower physical quality of life in noncancer women. Anxiety level was the main factor associated with lower mental quality of life for both groups. CONCLUSIONS:Different from noncancer women, the psychosocial factor of insecure attachment in close relationships was the main factor associated with physical quality of life for gynaecological cancer survivors. Anxiety status was the common factor correlated with mental quality of life for cancer and noncancer women. RELEVANCE TO CLINICAL PRACTICE:Developing psychosocial interventions focusing on secure attachment in close relationships and anxiety management could improve physical and mental components of quality of life among gynaecological cancer survivors.
Symptoms of depression and related factors among Spanish university students.
Vázquez Fernando L,Blanco Vanessa
A 554-member stratified random sample of students at a Spanish university (65.9% women; aged 18-34 years) was screened for symptoms of depression using a new Castilian Spanish translation of the Center for Epidemiologic Studies Depression Scale (CES-D) that had been validated by back-translation. Mean CES-D score was 14.2 (SD = 10.3, range 0-54), with a significant difference between the scores of women (M = 15.5; SD = 10.9) and men (M = 11.8; SD = 8.4; t552 = 4.06, p < .0005). Some 33%, of the sample screened positive with the usual CES-D screening threshold of 16, and 16% with the threshold of 24 recommended by Clarke and coworkers. The symptoms most commonly experienced all or most of the time were hopelessness, given the maximum rating by 18.8% of students, difficulty in concentration (17.7%), fatigue (13.9%), inadequacy (13.0%), and disturbance of sleep (12.4%).
Influence of depressive mood on quality of life ratings of women with epilepsy of childbearing age.
Todorova Koraliya S,Kaprelyan Ara G
UNLABELLED:Depressive disorders are the most frequent psychiatric comorbidity in epilepsy. Depressive mood affects negatively quality of life (QOL) ratings, sometimes having greater impact than seizure-related variables. Women with epilepsy are a specific subgroup at risk of comorbid depression in consequence of certain biopsychosocial demands. The AIM of this study was to assess the relative contribution of mood, seizure-related and demographic variables on QOL scores in women with epilepsy of childbearing age. SUBJECTS AND METHODS:A psychiatric assessment was carried out of 65 women with epilepsy (aged 18-55, mean 37.23 +/- 11.83 yrs). Comorbid depressive disorder was diagnosed according to ICD-10 criteria. Its severity was evaluated on the Hamilton Depression Rating Scale (HAMD-17). A questionnaire for demographic and seizure-related variables was completed. Two self-assessment questionnaires were administered: the Seizure Severity Questionnaire (SSQ) and the Quality of Life in Epilepsy Inventory-31 (QOLIE-31). The data were analysed using SPSS for Windows (version 17.0). Univariate correlation and multiple stepwise regression analyses were performed to explore the association between possible prognostic variables (independent variables) and QOLIE-31 overall and subscale scores (dependent variables). RESULTS:Analysis showed that demographic factors: employment and education; seizure-related factors: seizure severity, seizure frequency, antiepileptic drug therapy and comorbid depressive disorder were the variables significantly associated with QOLIE-31 overall score (p < 0.01). A three variable model accounted for 64.8% of the variance in QOLIE-31 overall score including seizure severity, comorbid depression and seizure frequency. CONCLUSIONS:Clinical factors are the strongest predictors of QOL of women with epilepsy in our study, seizure severity and comorbid depression being the main contributors. Paying attention to the psychological needs of women with epilepsy will have a positive effect on their QOL.
Understanding Multiple Behavioral Risk Factors for Cancer in Rural Women.
Noonan Devon,Dardas Latefa,Bice-Wigington Tiffany,Sloane Richard,Benjamin Rebecca,Choi Seung Hee,Simmons Leigh Ann
Public health nursing (Boston, Mass.)
OBJECTIVES:To examine the demographic and health-related factors associated with risk behaviors that have been linked to cancer including smoking, high BMI, and low physical activity. DESIGN AND SAMPLE:A secondary analysis was conducted using data from Rural Families Speak about Health, a multistate, epidemiologic study of rural American women and their families (N = 444). MEASURES:Validated measures for various demographic and health-related items including tobacco use, BMI, physical activity, and depression were used. RESULTS:Of the total sample with complete data (n = 399), the mean age was 32 years and the majority were White (64%), married (67%), had a high school education or higher (73%), and had an annual household income of less than $40,000 (90%). Regarding cancer risk behaviors, 36% of the sample were smokers, 39% reported low levels of physical activity, and 45% had a calculated BMI over 30. Thirty-five percent of participants reported engaging in two or more risk behaviors. There were significant differences in income, perceived health status, and depression depending on the number of risk behaviors reported. CONCLUSIONS:Understanding combinations of risk behaviors can assist nurses and other health professionals in tailoring multiple health behavior change interventions to prevent cancer among rural women.
Association between depression and vascular disease in systemic lupus erythematosus.
Greco Carol M,Li Tracy,Sattar Abdus,Kao Amy H,Danchenko Natalya,Edmundowicz Daniel,Sutton-Tyrrell Kim,Tracy Russell P,Kuller Lewis H,Manzi Susan
The Journal of rheumatology
OBJECTIVE:Systemic lupus erythematosus (SLE) is a chronic inflammatory autoimmune disease with increased prevalence of cardiovascular disease (CVD) and depression. Although depression may contribute to CVD risk in population-based studies, its influence on cardiovascular morbidity in SLE has not been evaluated. We evaluated the association between depression and vascular disease in SLE. METHODS:A cross-sectional study was conducted from 2002-2005 in 161 women with SLE and without CVD. The primary outcome measure was a composite vascular disease marker consisting of the presence of coronary artery calcium and/or carotid artery plaque. RESULTS:In total, 101 women met criteria for vascular disease. In unadjusted analyses, several traditional cardiovascular risk factors, inflammatory markers, adiposity, SLE disease-related factors, and depression were associated with vascular disease. In the final multivariable model, the psychological variable depression was associated with nearly 4-fold higher odds for vascular disease (OR 3.85, 95% CI 1.37, 10.87) when adjusted for other risk factors of age, lower education level, hypertensive status, waist-hip ratio, and C-reactive protein. CONCLUSION:In SLE, depression is independently associated with vascular disease, along with physical factors.
Psychological Symptoms in Obesity and Related Factors.
Değirmenci Taner,Kalkan-Oğuzhanoğlu Nalan,Sözeri-Varma Gülfizar,Özdel Osman,Fenkçi Semin
Noro psikiyatri arsivi
INTRODUCTION:This study aimed to investigate the relationship between levels of depression and anxiety symptoms and quality of life, self-esteem in obesity. METHODS:Fifty-two subjects whose Body Mass Index (BMI) is 30 kg/m and over and 43 control whose BMI is normal were recruited for this study. The socio demographic data form, Hamilton Depression Rating Scale (HAM-D17), Hamilton Anxiety Rating Scale (HAM-A), Quality of Life Scale Short Form (WHOQOL-Brief-TR), Coopersmith Self Esteem Scale (CSES), The Eating Attitudes (EAT), were applied to the participants. RESULTS:In this study most of the patients are women, married, postgraduated and live in urban areas. It was determined to scores of HAM-D17, HAM-A and EAT are higher in obese group than control group; WHOQOL-Brief-TR physical field scores was lower in obese group than control group. CSES scores wasn't difference between obese and control group. In obese group, there was HAM-D17 and HAM-A scores a negative correlation between quality of life physical field score, negative correlation between CSES score, positive correlation between EAT scale score. There is no correlation between scores of HAM-D17 and HAM-A and BMI. CONCLUSION:Our results suggest that depressive and anxiety levels are high in induvidual with obesity. They have problems in eating attitudes and their quality of life especially physical field is poor. The psychological symptoms have negative effects on the quality of life, self-esteem, and eating attitudes. Our results suggest that psychiatric support to improving positive effects quality of life and self-esteem in individual with obesity.
Work-related factors associated with age at natural menopause in a generation of French gainfully employed women.
Cassou B,Mandereau L,Aegerter P,Touranchet A,Derriennic F
American journal of epidemiology
This study's purpose was to identify occupational factors that may influence the age at natural menopause in a random sample of gainfully employed French women born in 1938 (n=1,594). Occupational physicians selected the subjects from their files and interviewed them during their annual visits in 1990 and 1995. The authors used Kaplan-Meier survival curves to estimate median age at menopause (52 years) and multiple Cox models to estimate associations among women's characteristics, occupational factors, and age at menopause separately within two strata distinguished by a self-reported history of depression. Among women without such a history, earlier menopause was associated with smoking more than 10 cigarettes per day in 1990 (p<0.001), a high-strain job (p=0.01) in 1990, and difficult schedules before 1990 (p=0.03). Later menopause was associated with higher educational status (p=0.003) and repetitive work in 1990 (p=0.005). Among women with a history of depression, a later menopause was associated with having at least one child (p<0.001) and menarche later than the age of 13 years (p=0.004). Earlier menopause was associated with a high job control in 1990 (p=0.03) and high school education (p<0.01). These results suggest that certain physical job stressors may be related to age at menopause.
Prevalence of Metabolic Syndrome and Associated Factors in a Cohort of Individuals With Treatment-Resistant Depression: Results From the FACE-DR Study.
Godin Ophélia,Bennabi Djamila,Yrondi Antoine,Richieri Raphaelle,D'Amato Thierry,Bellivier Franck,Bougerol Thierry,Horn Mathilde,Camus Vincent,Courtet Philippe,Doumy Olivier,Genty Jean Baptiste,El-Hage Wissam,Haesebaert Frederic,Holtzmann Jerôme,Lancon Christophe,Leboyer Marion,Llorca Pierre Michel,Maruani Julia,Molière Fanny,Samalin Ludovic,Schmitt Laurent,Stephan Florian,Vaiva Guillaume,Aouizerate Michel Walter Bruno,Haffen Emmanuel,
The Journal of clinical psychiatry
BACKGROUND:The aim of this study was to estimate the prevalence of metabolic syndrome (MetS) and its components in a cohort of French patients with treatment-resistant depression (TRD) and to determine correlations with sociodemographic, clinical, and treatment-related factors. METHODS:From 2012 to 2018, 205 patients who met DSM-IV criteria for major depressive episode with moderate-to-severe symptoms (Montgomery-Asberg Depression Rating Scale score ≥ 20), and at least Stage II resistance according to Thase and Rush criteria were enrolled in the FondaMental Advanced Centers of Expertise in Resistant Depression (FACE-DR) cohort. Data on sociodemographic and clinical characteristics, lifestyle information, and treatment and comorbidities were collected, and a blood sample was drawn. MetS was defined according to the criteria of the International Diabetes Federation. RESULTS:Overall, 38% of individuals with TRD met criteria for MetS. The frequency of MetS was significantly higher in men than in women only for patients aged 40 years or older (46.3% vs 35.2%, P = .0427). Moreover, whereas the management for diabetes was good, less than one-third of the patients with high blood pressure or dyslipidemia were treated for these conditions. Multivariate analysis showed that individuals with abnormal plasma c-reactive protein levels had a 3-fold increased risk (95% CI, 1.5-5.2) of having MetS, independent of other potential confounders. CONCLUSION:The prevalence of MetS is higher in patients with TRD than in those with other psychiatric disorders and characterized by a considerable undertreatment of some components of MetS in this population. Diagnosis and treatment of the components of MetS should be systematically performed to prevent the occurrence of cardiovascular diseases in patients with TRD. These findings highlight the need for integrated care, with more interaction and coordination between psychiatrists and primary care providers.
Correlates of depressive symptoms in late middle-aged Taiwanese women: findings from the 2009 Taiwan National Health Interview Survey.
Tsai Kun-Wei,Lin Shih-Chun,Koo Malcolm
BMC women's health
BACKGROUND:Previous studies have shown that depressive symptoms in middle-aged women were associated with a number of factors such as climacteric symptoms. Nevertheless, studies based on population-based data with a wide range of potential correlates are still scarce. Therefore, the aim of this study was to investigate the correlates of depressive symptoms in late middle-aged Taiwanese women using data from a nationally-representative, population-based survey. METHODS:Women aged 50.0-65.0 years were identified from the dataset of the 2009 Taiwan National Health Interview Survey. The outcome measure was depressive symptoms in the past week, evaluated using the Center for Epidemiologic Studies Short Depression Scale (CES-D 10) with a cut-off score of 10 or greater. Univariate and multiple logistic regression analyses were used to evaluate the correlates of depressive symptoms. RESULTS:The mean age of the 533 respondents was 56.7 years. Depressive symptoms were present in 53 respondents (9.9%). Multiple logistic regression analysis revealed that an education level of elementary school or below (adjusted odds ratio [AOR] = 3.19, P = 0.003), nulliparity (AOR = 8.10, P = 0.001), living alone (AOR = 5.47, P = 0.003), never having worked (AOR = 4.14, P = 0.008), lack of regular exercise (AOR = 3.01, P = 0.003), a perceived health status of fair or bad (AOR = 4.34, P < 0.001), and somatic climacteric symptoms (AOR = 2.32, P = 0.012) were independent and significant factors of depressive symptoms in late middle-aged Taiwanese women. CONCLUSIONS:Findings from this secondary analysis of a population-based survey suggested independent associations of somatic climacteric symptoms, and a number of socio-demographic and health-related factors with depressive symptoms in late middle-aged Taiwanese women.
Predictors of first lifetime episodes of major depression in midlife women.
Bromberger J T,Kravitz H M,Matthews K,Youk A,Brown C,Feng W
BACKGROUND:Little is known about factors that predict first lifetime episodes of major depression in middle-aged women. It is not known whether health-related factors and life stress pose more or less of a risk to the onset of clinical depression than does the menopausal transition. METHOD:The Structured Clinical Interview for DSM-IV Axis I Disorders (SCID) was used to assess diagnoses of lifetime, annual and current major depression in a community-based sample of premenopausal or early perimenopausal African American and White women. Menstrual cycle characteristics, psychosocial and health-related factors, and blood samples for assay of reproductive hormones were obtained annually. Two hundred and sixty-six women without a history of major depression at baseline constituted the cohort for the current analyses. RESULTS:Over 7 years of follow-up, 42 (15.8%) women met criteria for a diagnosis of major depression. Frequent vasomotor symptoms (VMS; hot flashes and/or night sweats) (HR 2.14, p=0.03) were a significant predictor of major depression in univariate analyses. After simultaneous adjustment for multiple predictors in Cox proportional hazards analyses, frequent VMS were no longer significant; lifetime history of an anxiety disorder (HR 2.20, p=0.02) and role limitations due to physical health (HR 1.88, p=0.07) at baseline and a very stressful life event (HR 2.25, p=0.04) prior to depression onset predicted a first episode of major depression. CONCLUSIONS:Both earlier (e.g. history of anxiety disorders) and more proximal factors (e.g. life stress) may be more important than VMS in contributing to a first episode of major depression during midlife.
Prevalence of sexual dysfunction and related factors among diabetes mellitus patients in Southwest Ethiopia.
Asefa Adane,Nigussie Tadesse,Henok Andualem,Mamo Yitagesu
BMC endocrine disorders
BACKGROUND:Diabetes mellitus causes multiple medical, psychological and sexual problems in both men and women. Sexual dysfunction is one of those problems that lead to a strong social and psychological problem which adversely affect marital relation and treatment outcome. The issue has not been well studied in Ethiopia; therefore, this study aimed to evaluate the prevalence and factors related to sexual dysfunction in adult patients with diabetes mellitus. METHODS:Facility-based cross-sectional study was conducted among adults with diabetes mellitus on follow-up at diabetic clinics of Mizan-Tepi University Teaching Hospital and Tepi General Hospital. A consecutive sampling technique was employed to select 423 study participants, and data were collected through interviewer-administered questionnaire and patients' medical chart review. Changes in Sexual Functioning Questionnaire-fourteen items (CSFQ-14) was used to measure sexual dysfunction. Descriptive statistics and binary logistic regression analyses were performed. Two tail tests at α of less 0.05 were used as a level of significance. RESULTS:A total of 398 diabetic patients were interviewed, with a 94% response rate. The prevalence of sexual dysfunction was 53.3%. Age of above 41 years (AOR: 3.98, 95% CI 2.32-6.85), lack of formal education (AOR: 3.20, 95% CI 1.60-6.39), divorced or widowed (AOR: 5.28, 95% CI 2.35-11.86), type 2 DM (AOR: 4.52, 95% CI 2.17-9.42), depression (AOR: 4.05, 95% CI 2.32-7.10), complications or co-morbidity (AOR: 2.05, 95% CI 1.18-3.58), and not doing physical activity (AOR: 1.62, 95% CI; 1.47-1.77) were significantly associated with sexual dysfunction among diabetes patients. CONCLUSIONS:The prevalence of sexual dysfunction was as high as reports from other studies. Therefore, health care providers should include the issue of sexual health in their routine discussions with adult diabetes mellitus patients. Presence of depression, not doing physical activity and having complications or co-morbidity are modifiable factors associated with sexual dysfunction; therefore, they should be attended during care addressing sexual dysfunction.
Exploring quality of sleep and its related factors among menopausal women.
Hsu Hsiu-Chin,Lin Mei-Hsiang
The journal of nursing research : JNR
Sleep, a basic physiological need of all humans, appears to be both integrative and restorative. However, studies have reported that 33-51% of women show a dramatic increase in sleep disturbance in the mid-life years, a time when they enter menopause. The purposes of this study were to (1) explore the prevalence of poor sleep quality in menopausal women; (2) identify the relationship between sleep quality of menopausal women and its related factors; (3) predict the possible explanations of how the related variables affect sleep quality of menopausal women; and (4) provide recommendations for future strategies that aim to improve sleep quality of menopausal women. A cross-sectional, correlation coefficient design was used. Purposive sampling was employed to recruit 197 menopause women from a small town in central Taiwan. T-test, one-way ANOVA, and multiple regression were used for data analysis. The results were as follows: (1) overall, the total score for sleep quality was 5.55 +/- 3.47; 57.9% of subjects were identified as good sleepers and 42.1% as poor sleepers; (2) there were significant differences in quality of sleep related to occupational situation, history of chronic disease, menopausal status, number of chronic diseases, and number of menopausal symptoms (t = - 3.49, - 3.37, p < .01; F = 3.62, p < .05, F = 4.95, 5.35, p < .01); (3) depression and aging were strongly related to quality of sleep (r = .57; .22, p < .01); (4) 36% of variance in quality of sleep can be explained by depression and aging.
Depression among Low-Income Female Muslim Uyghur and Kazakh Informal Caregivers of Disabled Elders in Far Western China: Influence on the Caregivers' Burden and the Disabled Elders' Quality of Life.
Wang Meiyan,He Bin,Wang Yuhuan,Wu Fuchen,Chen Xuefeng,Wang Wenting,Yang Xue
BACKGROUND:Paying attention to and improving the mental health of the informal caregivers of disabled elders has become a global public health priority. This study focused on low-income female Uyghur and Kazakh informal caregivers of disabled elders residing in China's far west. It investigated the prevalence of and the major related factors of depressive emotion. METHODS:A cross-sectional study was performed from September 2013 to January 2014 in Shawan Prefectures, Tuokexun Prefectures, Bole Prefecture and Urumchi city. Shawan Prefecture has the highest proportion of Kazakhs, whereas Tuokexun Prefectures, Bole Prefecture and Urumchi city have the highest proportion of Uyghurs in Muslim ethnic Uygur and Kazakh communities. Xinjiang Uyghur Autonomous Region is located in remote western China; this area is approximately 3,105 km (1,929 miles) away from Beijing. A total of 444 female Uyghur and Kazakh informal caregivers of disabled elders participated in this study. The self-rating depression scale, the Zarit burden interview, and the SF-36 questionnaire were used to evaluate the state of caregiver depression, caregiver burden, and quality of life (QOL), respectively. Statistical analyses were performed using multivariate logistic regression analyses, correlation with Spearman's rho and independent-sample t-tests; a P-value of <0.05 was considered statistically significant. RESULTS:Up to 38.5% (n = 217) of informal caregivers reported having depression, whereas 61.5% (n = 273) of them reported a lack of depression. Age of disabled elders more than 60 years old, total hours spent on caring daily≥8h, duration of caring≥5 years, negative self-evaluation of health condition, having caregiver burden, elders' medium degree of disability and elders' heavy degree of disability had a higher risk of caregiver depression. By contrast, daughter/daughter-in-law of disabled elders; unemployed carers, family's per capita income >US$235.48(1500 yuan), high social support, and high QOL of disabled elders were each associated with a lower risk of depressive emotion. Moreover, informal caregivers with depression obtained high care burden scores; at the same time, disabled elders who were looked after by caregivers with depression obtained low QOL scores. CONCLUSIONS:Our findings suggest that the demographics characteristics of informal caregivers, and caregiver burden, and the disabled elders' degree of disability and QOL had the most significant correlation with depressive emotion among women informal caregivers. The results had a enlighten that these variables should be considered while planning interventions to improve depression of informal caregivers.
Fear of cancer recurrence in haematological cancer patients: exploring socio-demographic, psychological, existential and disease-related factors.
Borreani C,Alfieri S,Farina L,Bianchi E,Corradini P
Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer
PURPOSE:This study aims to explore the relation between the dimension of fear of cancer recurrence (FCR) in haematological cancer patients relapse-free for at least 2 years and socio-demographic, related to the disease, psychological and existential factors. METHODS:A sample of 75 haematological cancer patients agreed to participate in the study through a self-reported online questionnaire (51.9% males). A total of 70.1% had a low recurrence risk. The questionnaire included socio-demographic (gender, age, civil status, level of education and number of children), related to the disease (diagnosis, therapeutic line and years since diagnosis), psychological (anxiety and depression), existential (purpose in life; PIL) factors and Fear of Cancer Recurrence Concerns Inventory (FCRI). Simple and multiple linear regressions were conducted for the analyses, and we performed some preliminary analysis on the reliability of the FCRI. FINDINGS:A total of 53.3% of participants showed clinical levels of FCR on the severity dimension, which was higher than found in previous research in other cancer patients. The coping strategies, triggers, severity and psychological distress dimensions showed higher mean values. Women, patients with indolent non-Hodgkin lymphomas, years since diagnosis, anxiety and purpose in life are significantly related to one or more dimensions of FCRI. IMPLICATIONS:It is important that the clinicians have at their disposal multiple possibilities to help patients cope with haematological cancer. If future research will confirm the results of this study, the negative correlation between FCR and PIL can suggest indications for planning interventions based on a salutogenic approach.
Depression in Swedish women: relationship to factors at birth.
Gudmundsson Pia,Andersson Susan,Gustafson Deborah,Waern Margda,Ostling Svante,Hällström Tore,Palsson Sigurdur,Skoog Ingmar,Hulthen Lena
European journal of epidemiology
Depression is a common and serious disorder that may have developmental origins. Birth-related factors have been related to childhood and adult occurrence of somatic as well as psychiatric disorders, but studies on the relationship between birth-related factors and depression are few and show mixed results. In addition, varying methods have been used to assess depression. Standardized clinical criteria to diagnose depression, combined with birth data collected from midwife records have not been used in most studies. Participants in the Prospective Population Study of Women in Sweden (803 women), born 1914, 1918, 1922 and 1930, provide information on birth factors and depression. Women participated from 1968 at mid-life ages of 38-60 years, to 2000, when they were age 78-92 years. Original birth records containing birth weight, length, head circumference, and gestational time, as well as social factors were obtained. Lifetime depression was diagnosed via multiple information sources. Symptoms were assessed using the Comprehensive Psychopathological Rating Scale and diagnoses were based on DSM-III-R criteria. Over their lifetime, 44.6% of women in this sample experienced depression. Birth weights ≤ 3500 g [odds ratio (OR), age-adjusted = 1.72; 95% CI 1.29-2.28, P < 0.001] and shorter gestational time (OR, age-adjusted = 1.13; 95% CI 1.04-1.24, P = 0.005) were independently associated with a higher odds of lifetime depression in a logistic regression model adjusted for age. Lower than median birth weights and shorter gestational time were related to lifetime depression in women. Both neurodevelopmental and environmental contributions to lifetime depression may be considered.
Prevalence and influencing factors of depressive symptoms among women of reproductive age in the rural areas of Hubei, China.
Cao B,Jiang H,Xiang H,Lin B,Qin Q,Zhang F,Kong W,Wei S,Liu L,Yan W,Nie S
OBJECTIVES:Depression is one of the most common mental disorders and a major public health problem in the Chinese population, especially among women. The current study aims to understand prevalence of depression symptoms and provide detailed epidemiological factors associated with depression among reproductive women in rural areas which was paid less attention in previous surveys. STUDY DESIGN:Cross-sectional study. METHODS:Face-to-face household interviews were conducted on 1058 women (age: 15-49 years) in rural areas from July 2012 to August 2012. Questionnaires were used to investigate the influencing factors of depression among women. Pearson's χ(2), logistic regression analysis and structural equation modelling (SEM) were applied to analyze the related factors. RESULTS:The prevalence of depression among women was 30.7% [95% confidence interval (CI): 27.9%-33.5%]. Compared with non-depressed individuals, those with depression were more likely to be short of social support [odd ratio (OR): 0.940, P < 0.001) and have no one to talk with (OR: 0.366, P < 0.001), to be dissatisfied with the house (OR: 2.673, P < 0.001) and economy (OR: 2.268, P < 0.01) of their family, and to have great pressure (OR: 2.099, P < 0.01), negative life events (OR: 1.485, P < 0.05) and physical diseases (OR: 1.364, P < 0.05). Pressure status, social support assessment, and socio-economic status were negatively related to depression (correlation coefficient: -0.57, -0.27 and 0.17). CONCLUSIONS:The high prevalence of depression among reproductive women in rural areas is of particular concern. Factors associated with depression may assist health care administrations to identify and assess high-risk women and target strategies accordingly.
Subjective cognitive decline in diabetes: Associations with psychological, sleep, and diabetes-related factors.
Kim Min Jung,Park Chang,Zhu Bingqian,Fritschi Cynthia
Journal of advanced nursing
AIMS:To determine whether psychological, sleep, and diabetes-related factors were associated with subjective cognitive decline (SCD) in adults with type 2 diabetes (T2D). DESIGN:A secondary analysis with a cross-sectional, correlational design. METHODS:Data from two parent studies were combined. A total of 105 adults with diabetes were recruited from a Midwestern city in the United States from September 2013-March 2014 and September 2016-September 2017. Subjective cognitive decline was measured with the psychological-cognitive symptom subscale of the Diabetes Symptom Checklist-Revised. Psychological factors (diabetes distress, fatigue, and depressive symptoms) and sleep were measured using the Diabetes Distress Scale and Patient-Reported Outcomes Measurement Information System. Diabetes-related factors were measured with body mass index and glycaemia control. Quantile regression was used to examine the associations. RESULTS/FINDINGS:The mean age of the participants was 58.10 (SD 7.92) years and 58.1% were women. The participants' mean psychological-cognitive symptom score was 1.41 (SD 1.13). After controlling for age and gender, sleep disturbance, sleep-related impairment, and body mass index were associated with SCD in lower cognitive symptom quantile groups (5th to 30th percentiles). In contrast, fatigue and depressive symptoms were more strongly associated with SCD in higher quantile groups (70th to 95th percentiles). CONCLUSION:In adults with T2D, SCD was differentially associated with psychological, sleep, and diabetes-related factors depending on cognitive symptom percentiles. Adults with T2D require regular screening for SCD. If they complain of cognitive symptoms at clinical visits, different underlying factors should be assessed according to their symptom severity. IMPACT:Findings from this study provided evidence for early identification of SCD and its influencing factors, which may help to develop nursing interventions to recognize and/or delay the onset of cognitive impairment in adults with T2D.
Depressive Symptom and Related Factors: A Cross-Sectional Study of Korean Female Workers Working at Traditional Markets.
Hwang Won Ju,Kim Jin Ah,Rankin Sally H
International journal of environmental research and public health
BACKGROUND:Depression is one of the psychiatric diseases with a high prevalence rate, globally, and reportedly more prevalent among women than among men. Especially, women workers working at traditional markets are in depressive conditions without occupational health services. The purpose of this study is to investigate factors having a significant effect on the depressive symptoms of women workers at traditional markets in South Korea. METHODS:A cross-sectional study was used and subjects for the present study were 500 female workers in three selected representative traditional marketplaces in South Korea. RESULTS:The results of hierarchical regression analysis indicated that increased BMI (β = 0.297, = 0.017), poor nutritional status (β = 0.596, < 0.001), street vendor status (β = 2.589, = 0.001), job stress (β = 0.491, < 0.001), lower back pain (β = 0.377, = 0.011), lower self-efficacy (β = -0.368, = 0.002) and diminished family function (β = -0.633, = 0.001) affected workers' depressive symptoms. The explanatory power of these variables was 38.5%. CONCLUSIONS:Based on these results, future research should focus on incorporating theses significant factors into effective interventions designed to decrease depressive symptoms in this population. Moreover, this study will increase interest in occupational health nursing, particularly in relation to vulnerable social groups, and expand the scope of practice in the field.
A study of postpartum depression in a fast developing country: prevalence and related factors.
Bener Abdulbari,Burgut F Tuna,Ghuloum Suheila,Sheikh Javaid
International journal of psychiatry in medicine
BACKGROUND:Depression is a common and disabling complication of postpartum women. There is a paucity of research on postpartum depressive disorders and their predictors in women from Arab countries. AIM:The aim of this study was to determine the prevalence and identify risk factors of postpartum depression among Arab women in Qatar using Edinburgh Postnatal Depression Scale Score (EPDS). DESIGN:This is a prospective cross-sectional study conducted during the period from January 2010 to May 2011. SETTING:Primary healthcare centers of the Supreme Council of Health, State of Qatar. SUBJECTS:A representative sample of 1669 mothers within 6 months after delivery were approached and 1379 (82.6%) mothers participated in this study. METHODS:The study was based on a face-to-face interview with a designed diagnostic screening questionnaire. Occurrence of postpartum depressive symptoms was assessed by the EPDS. Also, socio-demographic characteristics, medical and family history, and obstetric variables of patients were collected through a designed questionnaire. The diagnostic screening questionnaire was reviewed and calculated the final score which identified the risk cases. RESULTS:The prevalence of postpartum depression among the study sample was 17.6%. Mothers of age above 35 years (49.9% vs. 39.2%; p < 0 .001), low education below intermediate level (51% vs. 35.8%; p < 0.001), housewives (38.7% vs. 29%; p = 0.03), with low monthly income (QR 5000-9999) (43.2% vs. 32.2%; p < 0.001) were significantly at high risk for postpartum depression. Maternal complications (38.7% vs. 26.1%; p < 0.001) and caesarean section (36.2% vs. 28.8%; p = 0.022) were significantly higher among depressed mothers compared to non-depressed women. Financial difficulties (OR = 2.04; p < 0.001), prematurity (OR = 1.64; p = 0.025), poor family support (OR = 1.52; p = 0.016), dissatisfaction in marital life (OR = 1.26; p = 0.005), poor marital relationship (OR = 1.13; p = 0.05) were the main predictors of postpartum depression. CONCLUSION:This prevalence of postpartum depression in women living in Qatar was comparable to previous epidemiological research done in developing countries. Financial difficulties, prematurity, lack of family support, and poor marital relationships have been identified as main risk factors for developing postpartum depression.
Do health-related factors predict major depression? A longitudinal epidemiologic study.
Zhang Xiao Chi,Woud Marcella L,Becker Eni S,Margraf Jürgen
Clinical psychology & psychotherapy
Major depressive disorder (MDD) is a leading cause of global disease burden. Hence, examining the role of risk and protective factors for MDD is an important target in psychological research. Various studies showed that obesity, smoking, and alcohol consumption are related to depressive symptoms. In contrast, physical activity has been found to be a protective factor. The present population-based study tested whether these health-related factors are prospectively associated with incidence of MDD. Data were taken from the Dresden Predictor Study, which was designed to investigate risk and protective factors of mental health in young women. It included two assessments approximately 17 months apart. Results of single logistic regression analyses showed that being overweight, being a smoker, and being in a high-risk drinking group at baseline were predictive of developing MDD at follow-up. Engaging in regular physical activity and having good physical health were found to be protective factors of MDD. However, being in a medium-risk drinking group was not predictive of incidence of MDD, and irregular physical activity was not a protective factor. This is the first prospective, longitudinal study to show that obesity, smoking, and high-risk drinking are predictive of new onsets of MDD and that physical health is a protective factor. These data provide promising avenues for future research.
Comparison of depression between primary and secondary infertile couples.
Yoldemir Tevfik,Yassa Mahmut,Atasayan Kemal
Gynecological endocrinology : the official journal of the International Society of Gynecological Endocrinology
OBJECTIVE:We aimed to compare the depression levels between primary and secondary infertile couples and to investigate the related factors that may affect depression. STUDY DESIGN:Two hundred and fifty primary and secondary infertile couples, who admitted to Gynecology and Infertility Clinics of Pendik Teaching and Research Hospital affiliated with Marmara University were enrolled in this study. Sixty-four BMI-matched fertile female patients who applied to the General Gynecology Clinic and their husbands were taken as the control group. Beck Depression Inventory (BDI) form was filled by the infertile couples to evaluate the depression status before they started their cycles. RESULTS:The mean total BDI scores were alike between groups among women. Mild depression was found to be higher in the primary infertile women and moderate depression was higher in women of the control group. Women had statistically higher depression scores than male partners. Primary infertile, secondary infertile, and fertile women had higher depression scores than their male partners in the corresponding groups. There was no significant difference in mean total BDI scores among males between the groups. The percentage of distribution of male partners in each level of depression was similar between the groups. CONCLUSIONS:Only a weak positive correlation between the mean total BDI score and the number of previous treatment cycles was found. Psychiatric support before and during the upcoming fertility treatment might reduce the perception of the probable treatment failure.
Sleep quality and related factors in postmenopausal women.
Valiensi Stella Maris,Belardo María Alejandra,Pilnik Susana,Izbizky Gustavo,Starvaggi Agustina Paula,Castelo Branco Camil
Sleep disorders, resulting from hormonal changes and vasomotor symptoms, are common in both peri- and postmenopausal women. Poor sleep quality is associated with increased metabolic and cardiovascular risk, depression and a global impairment in health status. OBJECTIVES:Our study aimed to assess sleep quality in a sample of postmenopausal women and to identify the factors associated with poor sleep quality. It also considered the negative impact of sleep disorders such as insomnia, hypersomnia and breathing disturbances. SUBJECTS & METHODS:Data came from a cross-sectional study of 195 postmenopausal women conducted at the Italian Hospital of Buenos Aires, Argentina. Their sociodemographic, gynecological and clinical characteristics were recorded and sleep was assessed using the Pittsburgh Sleep Quality Index (PSQI), the Epworth Sleepiness Scale (ESS), and the Oviedo Sleep Questionnaire (Cuestionario Oviedo de Sueño, COS). RESULTS:The mean PSQI score was 6.90 ± 4.43. Sleep problems were common, with 46.7% of participants scoring over 5 on the PSQI. Snoring was reported by 13% of the patients (PSQI item 10 A). While 10% of the poor sleepers reported episodes of apnea during rest (PSQI item 10B), 7.1% reported leg spasm (PSQ I item 10C). The mean total COS score was 17.57 ± 7. According to COS item 1, all the subjects reported some dissatisfaction with the quality of their sleep. According to the COS, the prevalence of insomnia was 3.6% using ICD-10 criteria and 15.4% using DSM-IV criteria. The mean ESS score was 6.12 ± 4.09. CONCLUSION:Postmenopausal women are likely to complain of disturbed sleep. Almost half of the women in this survey said their sleep quality was impaired, and most of that group would benefit from medical attention.
New onset of depression in aging women and men: contributions of social, psychological, behavioral, and somatic predictors in the community.
Beutel Manfred E,Brähler Elmar,Wiltink Joerg,Kerahrodi Jasmin Ghaemi,Burghardt Juliane,Michal Matthias,Schulz Andreas,Wild Phillipp S,Münzel Thomas,Schmidtmann Irene,Lackner Karl J,Pfeiffer Norbert,Borta Andreas,Tibubos Ana N
BACKGROUND:Based on the vulnerability-stress model, we aimed to (1) determine new onset of depression in individuals who had not shown evidence of depression at baseline (5 years earlier) and (2) identify social, psychological, behavioral, and somatic predictors. METHODS:Longitudinal data of N = 10 036 participants (40-79 years) were evaluated who had no evidence of depression at baseline based on Patient Health Questionnaire (PHQ-9), no history of depression, or intake of antidepressants. Multivariate logistic regression models were used to predict the onset of depression. RESULTS:Prevalence of new cases of depression was 4.4%. Higher rates of women (5.1%) than men (3.8%) were due to their excess incidence <60 years of age. Regression analyses revealed significant social, psychological, behavioral, and somatic predictors: loneliness [odds ratio (OR) 2.01; 95% confidence interval (CI) 1.48-2.71], generalized anxiety (OR 2.65; 1.79-3.85), social phobia (OR 1.87; 1.34-2.57), panic (OR 1.67; 1.01-2.64), type D personality (OR 1.85; 1.47-2.32), smoking (OR 1.35; 1.05-1.71), and comorbid cancer (OR 1.58; 1.09-2.24). Protective factors were age (OR 0.88; 0.83-0.93) and social support (OR 0.93; 0.90-0.95). Stratified by sex, cancer was predictive for women; for men smoking and life events. Entered additionally, the PHQ-9 baseline score was strongly predictive (OR 1.40; 1.34-1.47), generalized anxiety became only marginally, and panic was no longer predictive. Other predictors remained significant, albeit weaker. CONCLUSIONS:Psychobiological vulnerability, stress, and illness-related factors were predictive of new onset of depression, whereas social support was protective. Baseline subclinical depression was an additional risk weakening the relationship between anxiety and depression by taking their overlap into account. Vulnerability factors differed between men and women.
Exploring Sleep Quality and Related Factors in Chinese Midlife Women.
Xu Qunyan,Zhao Yue,Chen Hui,Jing Jianling
Health care for women international
We investigated the percentage of women with poor sleep quality and its related factors among mainland Chinese women. Sleep quality and menopausal status were self-reported. We explored the contribution of possible risk factors, including sociodemographic characteristics, comorbidities, lifestyle, psychological status, stressful life events, and vasomotor symptoms. We found that 38.6% of midlife Chinese women were poor sleepers. This percentage was higher in comparison with women from other Asian countries. Our multiple logistic regression showed that anxiety, comorbidities, perceived stress, and vasomotor symptoms were risk factors for poor sleep quality.
Use of Clinical Preventive Service and Related Factors in Middle-Aged Postmenopausal Women in Korea.
Healthcare (Basel, Switzerland)
Postmenopausal women experiencing health transitions can improve health-related quality of life through clinical health service use. The aim of this study was to investigate the factors affecting clinical preventive service use, focusing on a multi-dimensional approach among middle-aged postmenopausal women. This descriptive study is a secondary analysis of the seventh Korea National Health and Nutrition Examination Survey (KNHANESⅦ-1) in 2016. Among the 8150 participants, our analysis included 771 naturally menopausal women aged 40-65. National health insurance (OR = 1.659, 95% CI = 1.080-2.550), private health insurance (OR = 2.877, 95% CI = 1.665-4.971), needs for health service (OR = 2.363, 95% CI = 1.332-4.195), cardiovascular disease (OR = 1.570, 95% CI = 1.009-2.445), hospital admission (OR = 3.054, 95% CI = 1.298-7.184), smoking (OR = 0.262, 95% CI = 0.144-0.477), drinking (OR = 0.573, 95% CI = 0.335-0.979), and depression (OR = 0.535, 95% CI = 0.340-0.841) were associated with clinical preventive service use among middle-aged postmenopausal women. To promote clinical preventive service use among postmenopausal women, policies promoting health behavior expansion should be introduced and should consider the predictive variables revealed by this study.
Prevalence and related factors of irregular menstrual cycles in Korean women: the 5th Korean National Health and Nutrition Examination Survey (KNHANES-V, 2010-2012).
Jung Eun-Kyung,Kim Seok-Won,Ock Sun-Myeong,Jung Kyu-In,Song Chan-Hee
Journal of psychosomatic obstetrics and gynaecology
INTRODUCTION:There have been few population-based studies reporting medical, lifestyle and psychological factors associated with irregular menstrual cycles. This study aimed to elucidate the prevalence and related factors of irregular menstrual cycles in Korean women. METHODS:Cross-sectional data from the 5th Korean National Health and Nutrition Examination Survey were used. Eligible women were 19-40 years old, not currently taking oral contraceptives or using intrauterine devices, and not currently pregnant or breast feeding, and had no medical history of hysterectomy, thyroid diseases, cancers or renal failure. Finally, 3194 premenopausal women were recruited in this study. The prevalence and related factors of irregular cycles were obtained using a general linear model and logistic regression analyses in a complex sampling design. RESULTS:The prevalence of irregular cycles was 14.3%. Age and high-education level were associated with lower odds ratios (ORs) for irregular cycles (OR 0.91, 95% confidence interval (95% CI) 0.87-0.96, and OR 0.58, 95% CI 0.38-0.88, respectively). The ORs of body mass index, perceived stress and depressive mood were 1.05 (95% CI 1.01-1.10), 1.46 (95% CI 1.11-1.92) and 2.07 (95% CI 1.18-3.63), respectively. CONCLUSIONS:Age, perceived stress, body mass index, depressive mood and education level, rather than obstetric factors or metabolic diseases were significant factors associated with irregular menstrual cycles in Korean women. Of these factors, perceived stress is the most significant factor associated with increased irregular menstrual cycles.
Factors related to depression symptoms among working women in Menoufia, Egypt.
Kasemy Zeinab A,Salama Amal A,Abo Salem Mahmoud E,Negm Noha
The Journal of the Egyptian Public Health Association
BACKGROUND:Lifetime prevalence rates for any psychological disorder are higher than previously thought. Depression in the workplace may lower work productivity and increase maladjustment in daily professional life. AIM OF THE STUDY:The study aimed to investigate the prevalence of depression symptoms and the work-related risk factors in Egyptian working women. PATIENTS AND METHODS:A cross-sectional study was carried out on 600 working women in family health facilities in Tala district, Menoufia governorate in 2015. Two questionnaires were used: one of them was an Arabic translated form of the questionnaire found in the Egyptian Practice Guidelines established by the Ministry of Health and population for family physicians to use in assessing the prevalence of depression symptoms. The second one was a predesigned questionnaire used to assess risk factors concerning demographic characteristics and the work environment related to depression symptoms. RESULTS:The prevalence rate of depression symptoms among working women was 37.5%. Multiple logistic regression analyses reveal that the following work-related factors were associated with an increased likelihood of exhibiting positive depression symptoms: work-related activities continued during home time, such as telephone calls or messages [odds ratio (OR)=5.10; 95% confidence interval (CI): 1.69-15.39], when work problems affect concentration and interactions with family (OR=148.67; 95% CI: 50.04-441.71), and difficulty with household chores (OR=6.63; 95% CI: 1.64-26.73). In addition, the following sociodemographic factors were significant: being divorced or widowed (OR=4.10; 95% CI: 2.28-7.36), no enough income (OR=2.59; 95% CI: 1.68-3.97), and rural residence (OR=1.74; 95% CI: 1.08-2.78). CONCLUSION:Reported depression symptoms were high among working women in Menoufia. Both unfavorable employment conditions and background characteristics such as being divorced/widow, low income, and rural residence were factors determining depression symptoms. It is necessary to establish preventive strategies for female workers to control the negative effect of depression in the workplace.
Body constitution of traditional Chinese medicine caused a significant effect on depression in adult women.
Chen Shih-Lin,Liu Yun-Ting,Hsueh Kuang-Chieh,Tang Pei-Ling
Complementary therapies in clinical practice
BACKGROUND:and purpose: Depression is a common mental disorder and reduces quality of life. As traditional Chinese medicine constitution (TCMC) has become an increasingly popular complementary and alternative approach for early detection and treatment of disease, this study investigated the relationship of female-related factors and constitution with depression. MATERIALS AND METHODS:This cross-sectional study included 1423 women from the Taiwan Biobank. A questionnaire of 44 items was used covering a variety of factors and the Body Constitution Questionnaire. The constitution types were divided into Yang-deficiency, Yin-deficiency, and Phlegm stasis. RESULTS:Yang (p = 0.022) or Yin (p = 0.017) deficiencies, being single (p = 0.027-0.033), previous use of women's health supplements (p = 0.005-0.008), and smoking (p = 0.033-0.036) were associated with a higher risk of depression. CONCLUSION:Integration of TCMC with Western medicine may be an alternative option towards depression prevention and alleviation.
Prevalence of depression and its related factors among Chinese women with breast cancer.
Chen Xiaoli,Zheng Ying,Zheng Wei,Gu Kai,Chen Zhi,Lu Wei,Shu Xiao Ou
Acta oncologica (Stockholm, Sweden)
BACKGROUND. Little information is available regarding depression among Asian breast cancer survivors. METHODS. We estimated the prevalence of depression and its correlates among 1400 participants of a population-based cohort study of women with stage 0-IV breast cancer in Shanghai, China. Through in-person interviews conducted at 6 months and 18 months post-diagnosis and review of medical charts, information on sociodemographic and clinical factors and quality of life (QOL) was collected. Depression was measured by the 20-item Center for Epidemiologic Studies Depression Scale at 18 months post-diagnosis. RESULTS. Approximately 26% of participants had mild to severe depression and 13% fulfilled the criteria of clinical depression at 18 months post-diagnosis. Women with lower income were more likely to have depression than women with higher income (prevalence: 16.6% vs. 6.9% for mild depression and 17.1% vs. 5.5% for clinical depression, respectively). Depression was more common among women who were widowed (18.9%) or divorced/separated/single (16.4%) than among women who were married (11.8%). Women with comorbidity were more likely to have clinical depression (17.3% vs 11.2%). Multivariate analysis showed that low income, marital status, comorbidity, and low QOL scores were independent predictors for depression. We did not find that prevalence of depression differed by menopausal status, estrogen or progesterone receptor status, disease stage, or cancer-related treatments. CONCLUSION. Depression is common among Asian women with breast cancer. Routine screening and prevention of depression are warranted among women with breast cancer.
Association between depression and metabolic syndrome in korean women: Results from the korean national health and nutrition examination survey (2007-2013).
Park Se Jin,Roh Sungwon,Hwang Jaemin,Kim Hyoung Ah,Kim Sohye,Lee Tae Kyung,Kang Shi Hyun,Ha Yu Jeong,Jang Jung Won,Park Subin
Journal of affective disorders
BACKGROUND:A considerable amount of research suggests that depression may be associated with cardiovascular disease (CVD) and the risk factors for the development of CVD such as metabolic syndrome (MetS). This study aimed to investigate the associations between depression, MetS, and combinations of the individual MetS components in Korean women. METHODS:Cross-sectional data for 23,385 women who aged 19 years and older were obtained from the nationally representative Korean National Health and Nutrition Examination Survey (2007-2013). Associations between prior diagnosis of depression and MetS were estimated after adjusting for related factors using multivariable logistic regression analysis. RESULTS:MetS was more prevalent in women with a prior diagnosis of depression than those without diagnosed depression (26.20% vs. 19.07%, p<.001). Depression was significantly associated with MetS (odds ratio, 1.20; 95% confidence interval, 1.01-1.43) after adjusting for age, education, monthly household income, smoking status, alcohol use, physical activity, and postmenopausal status. There was a higher prevalence of most MetS combinations among women with depression than women without depression. Specifically, significant differences between the two groups were found for MetS combinations including high triglycerides. LIMITATIONS:A cross-sectional study design and lack of a standardized objective measure for depression. CONCLUSIONS:Diagnosed depression is associated with MetS in Korean women. Specifically, women with diagnosed depression have significantly elevated levels of several combinations of MetS components including high triglycerides. Addressing these MetS combinations could help reduce CVD events and mortality among women with depression.
Physical activity and depression symptoms in women with chronic illness and the mediating role of health-related quality of life.
McIntyre Erica,Lauche Romy,Frawley Jane,Sibbritt David,Reddy Prasuna,Adams Jon
Journal of affective disorders
BACKGROUND:The aim of this study was to determine the impact of physical activity on depression symptom severity in women 45 years and older with a chronic illness diagnosis, and explore relations between physical activity and psychological and health-related characteristics predicting depression symptoms. METHODS:1932 women diagnosed with one of five chronic illnesses: asthma, depression, diabetes, osteoarthritis, or osteoporosis participated in a sub-study of the 45 and Up Study-a cross-sectional study of people aged 45 years and older. The survey included items measuring demographics, depression symptoms, health-related quality of life (HRQoL), health-related hardiness, sleep quality, and health behaviours, such as physical activity. RESULTS:A multiple regression model explained 43% of the variance in depression symptoms (R = 0.43, F (18) = 61.72, p < .001); intensity of physical activity was a significant predictor of depression symptoms (p < .001), and HRQoL was found to explain the most variance (B = -10.00) in depression symptoms. Mediation analysis confirmed that HRQoL partially mediated the relation between physical activity and depression symptoms; however, the effect was very small. LIMITATIONS:Cross-sectional data and self-report measures limit the implications of the findings. CONCLUSION:Women with chronic illness engaging in more vigorous physical activity had less severe depression symptoms. Findings suggest that improving HRQoL is critical to the prevention and management of depression symptoms in women with chronic illness. Psychological and health-related factors that influence HRQoL, such as sleep quality and health-related hardiness, are important clinical considerations for health practitioners.
Hormone-related factors and post-menopausal onset depression: results from KNHANES (2010-2012).
Jung Sun Jae,Shin Aesun,Kang Daehee
Journal of affective disorders
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.
The Prevalence and Factors Associated With Anxiety-Like and Depression-Like Behaviors in Women With Polycystic Ovary Syndrome.
Lin Han,Liu Mingxing,Zhong Dongmei,Ng Ernest Hung Yu,Liu Jianping,Li Juan,Shi Yu,Zhang Chunren,Wen Xiaohui,Mai Zhefen,Ou Miaoxian,Ma Hongxia
Frontiers in psychiatry
Increasing evidence shows that polycystic ovary syndrome (PCOS) patients are particularly vulnerable to anxiety/depression-like behaviors. This study sought to determine the prevalence of anxiety/depression-like behaviors among women with PCOS and to identify factors associated with these behaviors. This study was a secondary analysis of three studies performed on Chinese women who were aged 18 to 40 and diagnosed with PCOS according to the modified Rotterdam criteria. We obtained 802 useable responses for the self-rating anxiety scale and 798 responses for the self-rating depression scale. The prevalence of anxiety-like and depression-like behaviors among women with PCOS was 26.1% (209/802) and 52.0% (415/798), respectively. Anxiety-like behaviors were associated with age, body image-related factors (including body mass index and waist-to-hip ratio), and hyperandrogenism-related factors (including free androgen index and hirsutism). Depression-like behaviors were associated with age, body image-related factors, hyperandrogenism-related factors, and metabolic factors (including fasting insulin, fasting plasma glucose, and homeostatic model assessment of insulin resistance). Body image-related factors and hyperandrogenism-related factors were related to both anxiety-like behaviors and depression-like behaviors in both infertile and fertile PCOS patients.