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Does risk for anxiety increase during the menopausal transition? Study of Women’s Health Across the Nation

Bromberger, Joyce T. PhD1,2; Kravitz, Howard M. DO, MPH3,4; Chang, Yuefang PhD5; Randolph, John F. Jr MD6; Avis, Nancy E. PhD7; Gold, Ellen B. PhD8; Matthews, Karen A. PhD1,2

doi: 10.1097/gme.0b013e3182730599
Original Articles

Objective Little is known about the risk of anxiety in women during midlife and the menopausal transition. We examined anxiety as a cluster of four symptoms and determined the association between menopausal stage and high anxiety during 10 years of follow-up of 2,956 women of multiple race/ethnicities.

Methods This study was a longitudinal analysis of data from the multisite Study of Women’s Health Across the Nation, a study of menopause and aging. Women were aged 42 to 52 at study entry. The outcome was high anxiety, with a score of 4 or greater on the sum of four anxiety symptoms rated according to frequency in the previous 2 weeks from 0 (none) to 4 (daily; upper 20%). Covariates included sociodemographics, health factors, stressors, and vasomotor symptoms.

Results Women with low anxiety at baseline were more likely to report high-anxiety symptoms at early or late perimenopause or postmenopause than at premenopause (odds ratio, 1.56-1.61), independent of multiple risk factors, including upsetting life events, financial strain, fair/poor perceived health, and vasomotor symptoms. Women with high anxiety at baseline continued to have high rates of high anxiety throughout follow-up, but odds ratios did not differ by menopausal stage.

Conclusions Women with high anxiety at premenopause may be more often anxious and are not at increased risk for high anxiety at specific stages of the menopausal transition. In contrast, women with low anxiety at premenopause may be more susceptible to high anxiety during and after the menopausal transition than before the menopausal transition.

From the 1Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA; 2Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA; Departments of 3Psychiatry and 4Preventive Medicine, Rush University Medical Center, Chicago, IL; 5Department of Neurosurgery, University of Pittsburgh, Pittsburgh, PA; 6Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI; 7Public Health Sciences Division, School of Medicine, Wake Forest University, Winston-Salem, NC; and 8Department of Public Health Sciences, University of California Davis School of Medicine, Davis, CA.

Received July 6, 2012; revised and accepted September 5, 2012.

The content of this article is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute on Aging, National Institute of Nursing Research, Office of Research on Women’s Health, or National Institutes of Health.

Funding/support: The Study of Women’s Health Across the Nation received grant support from the National Institutes of Health, Department of Health and Human Services, through the National Institute on Aging, National Institute of Nursing Research, and National Institutes of Health Office of Research on Women’s Health (grants NR004061, AG012505, AG012535, AG012531, AG012539, AG012546, AG012553, AG012554, and AG012495).

Financial disclosure/conflicts of interest: None reported.

Address correspondence to: Joyce T. Bromberger, PhD, 3811 O’Hara Street, Pittsburgh, PA 15213. E-mail:

© 2013 by The North American Menopause Society.