Psychological Medicine

Original Articles

Major depression during and after the menopausal transition: Study of Women's Health Across the Nation (SWAN)

J. T. Brombergera1 c1, H. M. Kravitza2, Y.-F. Changa3, J. M. Cyranowskia4, C. Browna4 and K. A. Matthewsa5

a1 Departments of Epidemiology and Psychiatry, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA

a2 Departments of Psychiatry and Preventive Medicine, Rush University Medical Center, Chicago, IL, USA

a3 Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA

a4 Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA

a5 Departments of Psychiatry, Epidemiology, and Psychology, University of Pittsburgh, Pittsburgh, PA, USA


Background It is unclear whether risk for major depression during the menopausal transition or immediately thereafter is increased relative to pre-menopause. We aimed to examine whether the odds of experiencing major depression were greater when women were peri- or post-menopausal compared to when they were pre-menopausal, independent of a history of major depression at study entry and annual measures of vasomotor symptoms (VMS), serum levels of, or changes in, estradiol (E2), follicular stimulating hormone (FSH) or testosterone (T) and relevant confounders.

Method Participants included the 221 African American and Caucasian women, aged 42–52 years, who were pre-menopausal at entry into the Pittsburgh site of a community-based study of menopause, the Study of Women's Health Across the Nation (SWAN). We conducted the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID) to assess diagnoses of lifetime, annual and current major depression at baseline and at annual follow-ups. Psychosocial and health factors, and blood samples for assay of reproductive hormones, were obtained annually.

Results Women were two to four times more likely to experience a major depressive episode (MDE) when they were peri-menopausal or early post-menopausal. Repeated-measures logistic regression analyses showed that the effect of menopausal status was independent of history of major depression and annually measured upsetting life events, psychotropic medication use, VMS and serum levels of or changes in reproductive hormones. History of major depression was a strong predictor of major depression throughout the study.

Conclusions The risk of major depression is greater for women during and immediately after the menopausal transition than when they are pre-menopausal.

(Received September 17 2010)

(Revised December 16 2010)

(Accepted December 18 2010)

(Online publication February 09 2011)


c1 Address for correspondence: Dr J. T. Bromberger, Ph.D., University of Pittsburgh, 3811 O'Hara Street, Pittsburgh, PA 15213, USA. (Email: