| BackgroundOvary aging strides across female’s decades of life, therefore, it has important meaning for women. Three stages and10substages are divided during women’s life from puberty and the end of life according to the criteria of the Stages of Reproductive Aging Workshop+10. Among them, menopausal transition and early postmenopause are more important stages which were characterized by not only the fluctuation of hormone level, but also the physical, psychological and social changes. Therefore, both menopausal transition and early postmenopause are presumed to be vulnerable period of depression and anxiety. However, the direct reason of depression and anxiety during menopausal stages has been controversial for many years. Therefore, there is lack of clear guidelines for doctors to execute the best diagnosis and therapy plan for depression and anxiety in climacteric clinic.For the association of depression with menopausal transition, a lot of studies were conducted including both the cross-section study with large samples and prospecitive cohort study with long follow-up year. Most of these studies were located in European or the United States. The main results support the negative effect of menopausal transition on depression, although most women do not suffer from depression in this period. The neurobiological theory posits that the hypoestrogenic state or the fluctuation of hormone levle derives the onset or worsening of pre-existing mood symptoms in perimenopausal women at risk of depression. The domina theory attributes the occurrence of depression to sleep disturbance which is caused by vasomotor symptoms correlated with decreased estrogen levels. In contrast, the psychological theory focused on the psychosocial factors, such as the burden of caring for aging patients or the changes of family roles. For anxiety, less study is conducted to explore its association with menopausal transition, especially for the longitudinal study. Some study showed that anxiety symptoms increased in early menopausal transition, then decreased. While the other studies attribute anxiety during menopausal transition to life style, menopause related symptoms and psychosocial factors or the confounding of hot flashes, rather than menopausal stages. Therefore, measurements without physical symptoms in items were suggested to be used for the screening of depression and anxiety in order to avoid the confounding of other menopause related symptoms. But among the measurements used currently, only the Hospital Anxiety and Depresison Scale(HADS) does not including physical symptoms in items. In contrast, in China, it is lack of studies which were the longitudinal study design and used standard staging system to divide ovary aging process. Besides, measuremens in most study were limited to the scales of SDS and SAS which were not suggested to be the right measures to screen depression and anxiety of menopausal women because of the physical symptoms items.Our study is part of the "health related problem study in community women during ovary aging process". Studies were once conducted to compare the psychosocial symptoms among different stages of ovary aging. The result showed that women in early menopausal transiton and early postmenopause were more likely to have higher scores of psychosocial symptoms.Based on our previous study, the aim of this dissertation was to investigate and compare the prevalence of depression and anxiety among different stages of the ovary aging process and to explore the possible influencing factors, by using of the new revised STRAW+10system, main measurements such as Hospital Anxiety and Depression Scale (HADS) with higher specificity for the screening of anxiety and depression in menopausal women, Menopause-specific Quality of Life Questionnaire(MENQOL) for the investigatin of menopausal related symptoms and Life Events Scale(LES) for the measure of stress life events..This dissertation contains three sections:Section I The prevalence and related factors of depression and anxiety symptoms during diferent stages of ovary aging processSection II Changes and new-onset incidence of depression and anxiety symptoms during ovary aging process in one year follow-upSectionⅢ Self-control study of incidence of depression and anxiety in4years’follow-up and influencing factors for premenopausal women Section I The prevalence and related factors of depression and anxiety symptoms during different stages of ovary aging processObjective To analyze the prevalence and related factors of depression and anxiety symptoms in different stages of ovary aging process.Specific aims1. To compare the differences of depression or anxiety scores and prevalence among different stages of ovary aging2. To explore the association of depression and anxiety symptoms with serum hormone level, menopausal symptoms, life events, social support, the attitude to menopause or aging, reproductive events related mood problems, and life behavior, respectively.Methods1. Study design:cross-sectional study2. Sample source:A prospective cohort study about health problem during ovary aging which was conducted in one community in west district in Beijing since2005. Women who were followed up or recruited between October in2011and April in2012were regarded as the participants of this study.4. Participants:Voluntary women aged30to64years old, with intact uterus and at least one ovary, having last10months’menstrual cycle diary or the record of final menstruation, with the ability of understanding the content of questionnaire were recruited from the ovary aging study cohort. But those women who got hormone therapy or took antipsychotic medicine, or got pregnant or lactation during the past10months, had uterus or ovarian organic disease, severe liver or kidney disease or cancer, were excluded.5. Measurements:The changes of gynecological endocrinology and related health problem follow-up questionnaire, Hospital Anxiety and Depression Scale, Menopause-specific Quality of Life Questionnaire, Social Support Scale and Life Events Scale.6. Examination:weight and height measureand serum FSH and E2level assay7. Statistical analysis:All data were entered into database Epidata3.02and were analyzed by SPSS13.0. χ2test was use to compare the differences of depression or anxiety prevalence。Mann-Whitney U test and Kruskal-Wallis H test were use to compare the differences of depression or anxiety scores in different groups. Binary logistic regression model was used to explore the possible factors of depression or anxiety.Results 1. A total of330women were included the final analysis with an average age of49.52±7.09years.77women (23.3%)were in reproductive stage,78women(23.6%) were in early menopausal transition(EMT),65women(19.7%) were in late menopausal transition(LMT),60women(18.2%)were in early postmenopause(EPM) and50(15.2%) women were in late postmenopause(15.2%).2. The prevalence of depression and anxiety were20.6%(65women) and7.6%(25women)respectively, and the combination prevalence of both symptoms was6.1%(20women). The prevalence of depression in EMT(20women,25.6%), LMT(14women,21.5%) and EPM(17women,28.3%) were higher than reproductive stage(7women,9.1%), and the prevalence of anxiety in EMT(10women,12.8%) and EPM(10women16.7%) were higher than reproductive stage (0)(P<0.05). Women who were in menopausal transition or postmenopause had the risk of3.18times to suffer from depression than premenopausal women.3. In reproductive stage, serum FSH level was positively correlated with depression score (r=0.238,P=0.037), and the FSH level was higher in those women who were depressive [10.95(5.30) IU/Lvs7.59(2.75) IU/L, P=0.019]. But no significant correlation was found between serum FSH level and depression or anxiety in any other stages of ovary aging process(P>0.05).4. There was no significant difference of E2level between women with depression or anxiety and women without it(P>0.05).5. Depression and anxiety symptoms were correlated with different menopausal symptoms in different stages of ovary aging. In EMT, night sweat (P=0.000,OR=18.67), muscle and joint pain(P=0.042,OR=4.77)and sleep problem(P=0.025,OR=6.88) were correlated with anxiety. In LMT, muscle and joint pain(P=0.005, OR=5.77) and waist pain(P=0.005,OR=10.68)were correlated with depression. In EPM, bloating or swelling to ache(P=0.005,OR=6.48),sleep problem(P=0.003,OR=13.91), bad body spirit(P=0.003,OR=7.14), tiredness(P=0.005,OR=7.86) and the appearance or skin changes(P=0.016,OR=4.51) were correlated with depression.5. Logistic regression model showed that the risk factors of depression for women during the ovary aging process included menopausal transition and postmenopause(P=0.032), sleep problem(P=0.023, OR=2.09) and life stress(P=0.009, OR=2.63), while the protective factors of depression included subjective social support (P=0.025, OR=0.91)and attention to a balanced diet (P=0.000, OR=0.25)6. Logistic regression model showed that the risk factors of anxiety for women during the ovary aging process included night sweat(P=0.008,OR=4.52), life stress(P=0.001,OR=5.73), the occurrence of severe disease or seriously injured for family members(P=0.026,OR=5.57), the death of family members (P=0.018,OR=6.57), and unemployment or retired (P<0.05,OR>1).Conclusions1. During the main stages of ovary aging process including EMT, LMT and EPM, the average prevalence of depression symptoms was25.1%and anxiety symptoms was10.8%.2. Menopausal transition and postmenopasue can increase the risk of depression symptoms.3. There was no any correlation between serum E2level and depression or anxiety. More attention should be paid on the associatin of depression symptoms in reproductive stage with the function of hypothalamus and pituitary.4. Menopausal transition and postmenopause, sleep problem, life stress can increase the risk of depression, while subjective support and attention to a diet balance were protective factors of depression.5. Night sweat, life stress and negative life events from family members can increase the risk of anxiety. Section II The changes and new-onset incidence of depression and anxiety symptoms during ovary aging process in one year follow-up syudyObjective:To analyze the changes and incidence of depression and anxiety during ovary aging process, and to explore the possible influencing factors.Specific aims1. To compare the difference of depression and anxiety score or prevalence during different transition stages of ovary aging process.2. To compare the difference of variables between baseline and follow-up grouped by the changes pattern of depression and anxiety symptoms.3. To analyze the incidence of new-onset of depression and anxiety in one year follow-up.4. To compare the baseline characteristics or some variables’changes during the follow-up between women with depression or anxiety and women without the symptom.Methods1. Study design:Retrospective cohort study2. Participants:Among annually assessment of the ovary aging study cohort, those who were assessed between October in2010and June in2011, with completed demographic information, HADS AND MENQOL investigation data and included in section I study were selected to offer the baseline data. The data from section I study were used as the follow-up one.3. Questionnaire and examination:the same with section I except Social Support Scale and Life Events Scale4. Statistical analysisAll data were entered into database Epidata3.02and were analyzed by SPSS13.0. The Wilcoxon test was used to compare the changes of depression or anxiey score and other variables between baseline and follow-up among different changes stages of ovary aging process, x2test or Mann-Whitney U test/Kruskal-Wallis H test was used to compare the baseline characteristics between women with symptoms and asymptomatic women. Binary logistic regression model was used for multiple factors analysis of depression or anxietyResults1. A total of296participants were included at baseline, with an average age of48.81±7.09year and an average follow-up time of0.97±0.16year.2. During the transition stages from reproductive stage to EMT, and from EPM to EPM, the scores of depression at follow-up was significantly higher than baseline(4.59±2.95 vs3.09±2.64, P=0.018;5.76±4.27vs3.98±3.92,P=0.013), the scores of anxiety at follow-up was significantly higher than baseline(3.16±2.48vs2.25±1.81, P=0.028;4.48±4.10vs2.67±3.99,P=0.001), and so did the prevalence of depression during the transition from reproductive stage to EMT(21.9%vs3.1%,P=0.023).3. For women without depression or anxiety symptoms at both baseline and follow up, serum E2level at follow-up was significantly lower than baseline(31.78(69.50)pg/ml vs26.95(54.50)pg/ml,P=0.001;30.86(67.40) pg/ml vs26.71(52.40)pg/ml,P=0.001); For women with new onset depression at follow-up, the score of physical symptoms was significantly higher than baseline(2.54±1.28vs2.12±0.98, P=0.002); For women with depression both at baseline and follow-up, the serum FSH level was higher at follow-up[25.13(51.60)IU/L vs34.13(47.20)IU/L,P=0.046]4. The incidence of new-onset depression was15.6%(35women)after one year follow-up for258women without depression at baseline, with the incidience in EMT, LMT and EPM were17.2%(lOwomen),14.6%(7women), and24.4%(11women), respectively. Multiple factors analysis showed that baseline depression score(P=0.001,OR=1.39), BMI(P=0.031,OR=1.13) and the increase of physical symptoms score(P=0.001,OR=2.60) were independent risk factors of new onset of depression.5. The incidence of anxiety was5.4%(15women) after one year follow-up for280women without anxiety at baseline, with the incidence in EMT, LMT and EPM were9.7%(6women),3.8%(2women) and7.8(4women), respectively. Multiple factors analysis showed that the higher anxiety symptom score at baseline(P=0.049,OR=1.35) and the occurrence of severe disease/seriously injured/death for family members in the last year (P=0.006, OR=6.91)were independent risk factors of anxiety.Conclusions1. The vulnerable stages of new onset of depression and anxiety were EMT and EPM. During the main stages of ovary aging process including EMT, LMT and EPM, the average new onset incidence of depression symptoms in one year follow-up was18.5%and anxiety symptoms was7.3%.2. The risk of depression was higher for those women who had higher level of depression score and BMI, and the increase of physical symptoms score. While the risk of anxiety was higher for those women who experienced negative life events in the last year and and the higher level of anxiety score.3. The decrease of serum E2was not correlated with depression, but the depression might be related to the function changes of hypothalamus and pituitary. SectionⅢ Self-control study of incidence of depression and anxiety in4years’ follow-up and its influencing factors for premenopasual womenObjective To investigate the incidence of depression and anxiety in4years’follow-up in premenopausal women and to explore within-women influencing factor.Specific aims1. To compare the differences of depression and anxiety scores among different follow-up year grouped by the different transition stages of ovary aging.2. To calculate the incidence of depression and anxiety in4year’s follow-up.3. To compare the risk factors within women before and after the occurrence of depression.4. To compare the risk factors within women before and after the occurrence of anxietyMethods1. Study design:Prospective cohort study1. Sample resource:Ovary aging study cohort in Gynecological endocrinology and women health center in PUMCH3. Participants:women without depression(HADS-D<8)or anxiety (HADS-A<8), aged30-54years, having regular menstrual cycle during the age of20to30years, having intact uterus and at least one ovary, with at least one independent menstruation in the past10months and at least6months’menstrual diary were recruited. The exclusion criteria were the same with Section I.4. Study procedure:The baseline data were collected between October in2007and May in2008. Then annually assessment was conducted for4times. Each assessment included the screening of depression and anxiety symptoms, investigation of menopausal symptoms, serum hormonal assay and height and weight measure. And so does the menstrual diary recycling.5. Measurements:The changes of gynecological endocrinology and related health problem follow-up questionnaire, HADS, MENQOL, and menstruation diary card.6. Statistical analysisAll data were entered into database Epidata3.02and were analyzed by SPSS13.0. χ2test or Mann-Whitney U test/Kruskal-Wallis H test was used to compare the baseline characteristics between women with symptoms and asymptomatic women. Repeated measure was used to analyse the changes of ovary aging stages and follow-up year on the scores of depression and anxiety. Conditional logistic regression model was used to estimate the within women risk of depression and anxiety symptoms.Results 1. For228women without depression symptoms at baseline, with an average age of48.42±4.47year, the incidence of new onset of depression in4years’ follow-up was22.4%.39.2%depression women were in EMT which was higher than other stages.2. The scores of depression(4.12±2.08vs2.62±2.14,P=0.000) and physical symptoms(2.08±0.89vs1.77±0.73.P=0.000) at baseline in women with depression symptoms at follow-up were higher than women without depression.3. Conditional logistic regression analysis showed that, the increase of serum FSH level(P=0.008,OR=1.10), vasomotor symptoms(P=0.008,OR=1.10) and physical symptoms(P=0.008,OR=1.10) were within-women risk factors of depression.4. For271women without anxiety symptoms at baseline, with an average age of47.81±3.82year, the incidence of new onset of anxiety in4years’ follow-up was10.7%.51.7%women were in EMT which was higer than other stages.5. The scores of anxiety(3.45±2.34vs2.03±1.87,P=0.000), depression(6.14±3.38vs3.72±3.03,P=0.000), BMI(25.85±3.34kg/m2vs24.42±3.10kg/m2, P=0.021) and physical symptoms(2.39±1.06vs1.85±0.79kg/m2,P=0.001) at baseline for women with anxiety symptoms at follow-up were higher than women without anxiety.6. Conditional logistic regression analysis showed that, the increase of physical symptoms(P=0.007, OR=35.56) were within-women risk factors of anxiety.7. Repeated meausure showed that the scores of both depression(F=3.486, P=0.018;F=25.413,P=0.000) and anxiety(F=5.307,P=0.003;F=3.257,P=0.023)were influenced by the changes of ovary aging and the follow-up year.The scores of depression and anxiety were significantly higher in MT-MT(P=0.002,0.043)and MT-EPM(P=0.003,0.034)than in reproductive stages, and were significantly higher in the fourth follow-up year than baseline(P=0.000).Conclusions1. The new onset incidence of depression and anxiety for premenopausal women were22.4%and10.7%, respectively. EMT was the vulnerable stages for women to suffer from depression and anxiety.2. Menopausal symptoms such as physical symptoms and vasomotor symptoms, and the changes of pituitary-ovarian axis characterized by the increase of FSH were independent within-women risk factors of depression. And the physical symptoms were also the within-women risk factors of anxiety.3. Stay in MT and transition to EMP could increase the scores of depression and anxiety. |
PDF Full Text Request