Objective: This study aims to identify reproductive factors associated with severe depressive symptoms (SDS) in postmenopausal women and to determine whether a past psychological disorder (PPD) and the timing of first-onset PPD in relation to menopause modify associations.
Methods: Lifetime reproductive characteristics and PPD were obtained from 51,088 postmenopausal women of the E3N cohort study. The Center for Epidemiologic Studies—Depression Scale (CES-D) was used to assess SDS. Multivariate logistic regression models were performed to estimate the risk of SDS overall and according to the presence and timing of first-onset PPD (before the final menstrual period, in early postmenopause, or in late postmenopause).
Results: Women with irregular cycles were at increased risk for SDS (odds ratio [OR], 1.35; 95% CI, 1.19-1.53), except when PPD occurred in early postmenopause (OR, 1.08; 95% CI, 0.74-1.57). Parity was inversely associated with the risk of SDS (P < 0.001), whereas decreasing age at first full-term pregnancy increased the risk of SDS with PPD (P < 0.001) and increasing age at last full-term pregnancy increased the risk of SDS without PPD (P = 0.012). Age at final menstrual period (per 2-y increment) was associated with a decreased risk of SDS with postmenopausal (especially late postmenopausal) PPD (OR, 0.82; 95% CI, 0.80-0.85) but with an increased risk of SDS when PPD occurred before the final menstrual period (OR, 1.15; 95% CI, 1.12-1.19). Artificial menopause increased the risk of SDS with PPD before the final menstrual period (OR, 1.40; 95% CI, 1.18-1.66), whereas menopausal symptoms were associated with SDS across all categories.
Conclusions: Associations between endogenous reproductive factors and SDS may vary according to the presence of PPD and the timing of first-onset PPD. Further studies are warranted.
From the 1U1018, Institut National de la Santé et de la Recherche Médicale, Center for Research in Epidemiology and Population Health, Villejuif Cedex, France; 2U1018, Université Paris-Sud, Villejuif Cedex, France; 3Gustave Roussy, Villejuif Cedex, France; 4U1061, Institut National de la Santé et de la Recherche Médicale, Université Montpellier, Montpellier, France; and 5Cancer and Disease Epigenetics, Murdoch Children’s Research Institute, Parkville, Australia.
Received June 24, 2013; revised and accepted August 15, 2013.
Funding/support: The E3N study was supported by the Ligue nationale contre le cancer, the Mutuelle Générale de l’Education Nationale, Gustave Roussy, and the Institut National de la Santé et de la Recherche Médicale. F.P. was financially supported by a doctoral grant from the French Research Ministry.
Financial disclosure/conflicts of interest: None reported.
Address correspondence to: Françoise Clavel-Chapelon, PhD, U1018, Institut National de la Santé et de la Recherche Médicale, Center for Research in Epidemiology and Population Health, Team 9, Nutrition, Hormones, and Women’s Health, Institut Gustave Roussy, 114, rue Edouard Vaillant, Villejuif Cedex 94805, France. E-mail: firstname.lastname@example.org