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Depressive symptoms are increased in the early perimenopausal stage in ethnically diverse human immunodeficiency virus–infected and human immunodeficiency virus–uninfected women

Maki, Pauline M. PhD1,2; Rubin, Leah H. PhD1; Cohen, Mardge MD3,4; Golub, Elizabeth T. PhD, MPH5; Greenblatt, Ruth M. MD6; Young, Mary MD7; Schwartz, Rebecca M. PhD8; Anastos, Kathryn MD9; Cook, Judith A. PhD1

doi: 10.1097/gme.0b013e318255434d
Original Articles

Objective The risk of clinically significant depressive symptoms increases during perimenopause. With highly active antiretroviral treatment (HAART), more human immunodeficiency virus (HIV)–infected women survive to transition through menopause. In a cross-sectional analysis, we evaluated the association of menopausal stage and vasomotor symptoms with depressive symptoms in an ethnically diverse cohort of women with a high prevalence of HIV.

Methods Participants included 835 HIV-infected women and 335 HIV-uninfected controls from the Women’s Interagency HIV Study (63% African American). The Center for Epidemiologic Studies Depression Scale was used to screen for elevated depressive symptoms. Menopausal stages were defined according to standard definitions. Logistic regression analysis was used to identify predictors of elevated depressive symptoms.

Results Compared with premenopausal women, early perimenopausal women (OR [odds ratio], 1.74; 95% CI, 1.17-2.60), but not late perimenopausal or postmenopausal women, were more likely to show elevated depressive symptoms in adjusted analyses. The odds were similar in HIV-infected and HIV-uninfected women. Persistent vasomotor symptoms also predicted elevated depressive symptoms in HIV-infected and HIV-uninfected women (OR, 1.45; 95% CI, 1.02-2.06). In HIV-infected women, menopausal stage interacted with antiretroviral use (P = 0.02); the likelihood of elevated depressive symptoms in early perimenopause compared with premenopause was especially high in HAART-untreated women (OR, 3.87; 95% CI, 1.57-9.55).

Conclusions In HIV-infected and HIV-uninfected women, the odds of elevated depressive symptoms were significantly higher during early perimenopause. Elevated depressive symptoms were associated with nonadherence to HAART, underscoring the importance of screening and treating depressive symptoms in HIV-infected women who have experienced a change in the regularity of their menstrual cycles.

From the Departments of 1Psychiatry and 2Psychology, University of Illinois at Chicago, Chicago, IL; 3The Core Center, Bureau of Health Services of Cook County, Chicago, IL; 4Departments of Medicine, Stroger Hospital and Rush University, Chicago IL; 5Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD; 6Departments of Clinical Pharmacy, Medicine, Epidemiology, and Biostatistics, University of California, San Francisco, CA; 7Georgetown University School of Medicine, Washington, DC; 8Department of Community Health Sciences, School of Public Health, State University of New York Downstate Medical Center, Brooklyn, NY; and 9Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY.

Received January 6, 2012; revised and accepted March 12, 2012.

Funding/support: The Women’s Interagency HIV Study was funded by the National Institute of Allergy and Infectious Diseases (UO1-AI-35004, UO1-AI-31834, UO1-AI-34994, UO1-AI-34989, UO1-AI-34993, and UO1-AI-42590) and by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (UO1-HD-32632). This study was cofunded by the National Cancer Institute, the National Institute on Drug Abuse, and the National Institute on Deafness and Other Communication Disorders. Funding was also provided by the National Center for Research Resources (University of California San Francisco Clinical and Translational Science Institute grant UL1 RR024131). L. Rubin’s participation was funded by grant number K12HD055892 from the National Institute of Child Health and Human Development (NICHD), and the National Institutes of Health Office of Research on Women’s Health (ORWH). The contents of this publication are solely the responsibility of the authors and do not necessarily represent the official views of the National Institutes of Health.

Financial disclosure/conflicts of interest: P.M.M. has served as a consultant for Noven Pharmaceuticals. The contents of this publication are solely the responsibility of the authors and do not necessarily represent the official views of the National Institutes of Health.

Preliminary data were presented at The North American Menopause Society, San Diego, CA, October 1 to 3, 2009.

Data were collected by the Women’s Interagency HIV Study Collaborative Study Group, with centers (principal investigators) at New York City/Bronx Consortium (Kathryn Anastos); Brooklyn, NY (Howard Minkoff); Washington, DC, Metropolitan Consortium (Mary Young); The Connie Wofsy Study Consortium of Northern California (Ruth Greenblatt); Los Angeles County/Southern California Consortium (Alexandra Levine); Chicago Consortium (Mardge Cohen); and Data Coordinating Center (Stephen Gange).

Address correspondence to: Pauline M. Maki, PhD, Department of Psychiatry (MC 913), University of Illinois at Chicago, Chicago, IL 60612. E-mail:

©2012The North American Menopause Society