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Depressed mood during the menopausal transition and early postmenopause: observations from the Seattle Midlife Women's Health Study

Woods, Nancy Fugate PhD, RN, FAAN1; Smith-DiJulio, Kathleen RN, MA, PhD1; Percival, Donald B. PhD2; Tao, Eunice Y. MD1; Mariella, Anne PhD, RN, CNM3; Mitchell, Ellen Sullivan PhD, RN1

doi: 10.1097/gme.0b013e3181450fc2

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.

In this longitudinal study of the menopausal transition and early postmenopause, depressed mood was significantly and positively associated with late transition stage, hot flashes, life event stress, high body mass index, family history of depression, history of postpartum blues, sexual abuse, and antidepressant use.

From the 1Department of Family and Child Nursing and 2Applied Physics Laboratory, University of Washington, Seattle, WA; and 3The Center for Midwifery, University of Colorado, Aurora, CO.

Received May 4, 2007; revised and accepted June 14, 2007.

Funding/support: This work was supported by National Institute of Nursing research grants NINR R01NR004141 and NINR P30NR04001.

Financial disclosure: None reported.

Address correspondence to: Nancy Fugate Woods, PhD, RN, FAAN, Department of Family and Child Nursing, University of Washington School of Nursing, T318, Health Sciences Bldg, Box 357260, Seattle, WA 98195-7260. E-mail:

©2008The North American Menopause Society