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Association of sex hormones and sex hormone–binding globulin with depressive symptoms in postmenopausal women: the Multiethnic Study of Atherosclerosis

Colangelo, Laura A. MS1; Craft, Lynette L. PhD1; Ouyang, Pamela MBBS2; Liu, Kiang PhD1; Schreiner, Pamela J. PhD3; Michos, Erin D. MD2; Gapstur, Susan M. PhD4

doi: 10.1097/gme.0b013e3182432de6
Original Articles

Objective Sex hormones are thought to play an important role in the pathophysiology of depressive disorders in women. This study assessed the associations of total testosterone (T), bioavailable T, estradiol, dehydroepiandrosterone, and sex hormone–binding globulin (SHBG) with depressive symptoms stratified on postmenopausal stage to determine whether the associations were strongest for early postmenopausal women.

Methods Women (N = 1,824) free of depressive symptoms at baseline (2000-2002) in the Multiethnic Study of Atherosclerosis were categorized into tertiles of years postmenopause: T1, 0 to 10 years; T2, 11 to 20 years; and T3, 21 to 58 years. Multivariable-adjusted relative risks (RRs) and 95% CIs were computed for the incidence of depressive symptoms, as defined by a score of 16 or higher on the Center for Epidemiologic Studies Depression scale at examination 3 (2004-2005).

Results In analysis including all sex hormones, the RR for incident depressive symptoms associated with 1 unit higher log total T was 0.57 (P = 0.13), with log estradiol was 0.78 (P = 0.04), with log SHBG was 1.84 (P = 0.003), and with log dehydroepiandrosterone was 1.45 (P = 0.08) in T1. Without adjustment for SHBG, the RR for log bioavailable T was 0.16 (P = 0.04). However, in T2 and T3, there were no meaningful associations of hormone or SHBG levels with incident depressive symptoms. When stratified by HT use, results were consistent for HT users but attenuated for HT nonusers.

Conclusions In early postmenopausal women, sex hormones were associated with incident depressive symptoms.

From the 1Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL; 2Department of Medicine, Johns Hopkins University, Baltimore, MD; 3Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN; and 4Epidemiology Research Program, American Cancer Society, Atlanta, GA.

Received September 10, 2011; revised and accepted November 21, 2011.

Funding/support: This work was supported by R01 HL074406, R01 HL074338 and contracts N01-HC-95159 through N01-HC-95165 and N01-HC-95169 from the National Heart, Lung, and Blood Institute.

Financial disclosure/conflicts of interest: None reported.

Address correspondence to: Laura A. Colangelo, MS, Department of Preventive Medicine, 680 North Lake Shore Drive, Suite 1400, Chicago, IL 60611. E-mail:

©2012The North American Menopause Society