Badawy, Y., Spector, A., Li, Z., & Desai, R. (2024). The risk of depression in the menopausal stages: A systematic review and meta-analysis. Journal of affective disorders, 357, 126-133. https://doi.org/10.1016/j.jad.2024.04.041
Badawy Y, Spector A, Li Z, Desai R. The risk of depression in the menopausal stages: A systematic review and meta-analysis. Journal of affective disorders. 2024;357:126-133. doi:10.1016/j.jad.2024.04.041
Badawy, Y., et al. "The risk of depression in the menopausal stages: A systematic review and meta-analysis." Journal of affective disorders, vol. 357, 2024, pp. 126-133.
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Institute of Statistical Science, Academia Sinica, Taipei, Taiwan02jv2qv86
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RRM Academy Synopsis
Perimenopause is linked to higher odds of depression in women
A meta-analysis found that women in perimenopause had higher odds of depression than women in premenopause (odds ratio 1.40). Women after menopause had no significant rise in odds of depression (odds ratio 1.18). Both odds ratios compare with premenopause. Seven cohort studies of 9141 women supplied the data.
Key Findings
Perimenopausal women had higher odds of elevated depressive symptoms or a depression diagnosis than in the premenopausal stage (OR = 1.40, 95% CI 1.21 to 1.61, p < .001).
Pooling five studies, postmenopausal women showed no significant increase in odds of depressive symptoms or diagnosis versus premenopausal women (OR = 1.18, 95% CI 0.74 to 1.86; p = .48).
Separate postmenopausal models stayed non-significant: symptoms alone OR = 1.25 (95% CI 0.69 to 2.26), diagnosis alone OR = 0.77 (95% CI 0.31 to 1.93), three studies each.
Variation between studies (heterogeneity) was low in the seven-study perimenopause model (I2 = 0.01 %) and significant in the five-study postmenopause model (I2 = 74.59 %).
The 17 prospective cohort studies covered 16061 women in total. Fourteen had low risk of bias and three had moderate risk on the QUIPS tool.
Interpretation
A meta-analysis pools the results of several studies. This one pooled prospective cohort studies that followed women over time. In each study, women served as their own comparison across stages, from before menopause onward. Mean age at the start ranged from 35 to 50 years, with follow-up of three to thirty years. Where studies reported ethnicity, the samples included White, African American, Asian and Hispanic women. The review left out studies of surgical menopause and psychiatric populations. The authors note that studies defined stages and measured depression in different ways. The authors suggest more research on the years after menopause, where findings differ.
RRM Context
Thirteen of the 17 studies used the STRAW criteria, which are based on bleeding patterns that women report. Women's own bleeding reports therefore shape the stages in those studies. RRM sees cycle changes as health information. RRM also views hormones, mood and body as one picture. The authors describe the menopause transition as a time of fluctuating and eventually lower estrogen and progesterone.
Our editorial summary of this paper, not the article's abstract.
Abstract
Introduction
For many women, menopause transition can be a period of emotional and physical changes, with different menopausal stages associated with varied risk for depressive symptoms and diagnosis. This review aimed to conduct a systematic review and meta-analyses to provide an estimate for the risk of developing a) clinical depression and b) depressive symptoms at different menopausal stages.
Methods
We searched Medline, PsycInfo, Embase and Web of Science from inception to July 2023. Seventeen prospective cohort studies with a total of 16061 women were included in the review, and risk of bias was assessed using the Quality in Prognosis Studies tool (QUIPS). Seven papers with a total of 9141 participants were included in meta-analyses, using random effects models and pooled odds ratios (OR) calculated for depressive symptoms and diagnoses.
Results
Perimenopausal women were found to be at a significantly higher risk for depressive symptoms and diagnoses, compared to premenopausal women (OR = 1.40; 95 % CI: 1.21; 1.61, p < .001). We did not find a significantly increased risk for depressive symptoms or diagnoses in post-menopausal, compared to pre-menopausal women.
Limitations
Studies used different criteria to classify the menopausal stages and different measures for depression, which may have contributed to the heterogeneity seen in some models. We were unable to include a model that compared peri to post-menopause, due to a lack of longitudinal studies comparing the two stages.
Conclusions
The risk of depression in perimenopause, shown in an ethnically diverse sample; highlights the clinical need for screening and support in this potentially vulnerable group.
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