Psychological Medicine

Original Articles

Predictors of first lifetime episodes of major depression in midlife women

J. T. Brombergera1 c1, H. M. Kravitza2, K. Matthewsa3, A. Youka4, C. Browna5 and W. Fenga4

a1 Departments of Epidemiology and Psychiatry, and 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 Departments of Psychiatry, Epidemiology and Psychology, University of Pittsburgh, Pittsburgh, PA, USA

a4 Graduate School of Public Health and Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA, USA

a5 Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA


Background Little is known about factors that predict first lifetime episodes of major depression in middle-aged women. It is not known whether health-related factors and life stress pose more or less of a risk to the onset of clinical depression than does the menopausal transition.

Method The Structured Clinical Interview for DSM-IV Axis I Disorders (SCID) was used to assess diagnoses of lifetime, annual and current major depression in a community-based sample of premenopausal or early perimenopausal African American and White women. Menstrual cycle characteristics, psychosocial and health-related factors, and blood samples for assay of reproductive hormones were obtained annually. Two hundred and sixty-six women without a history of major depression at baseline constituted the cohort for the current analyses.

Results Over 7 years of follow-up, 42 (15.8%) women met criteria for a diagnosis of major depression. Frequent vasomotor symptoms (VMS; hot flashes and/or night sweats) (HR 2.14, p=0.03) were a significant predictor of major depression in univariate analyses. After simultaneous adjustment for multiple predictors in Cox proportional hazards analyses, frequent VMS were no longer significant; lifetime history of an anxiety disorder (HR 2.20, p=0.02) and role limitations due to physical health (HR 1.88, p=0.07) at baseline and a very stressful life event (HR 2.25, p=0.04) prior to depression onset predicted a first episode of major depression.

Conclusions Both earlier (e.g. history of anxiety disorders) and more proximal factors (e.g. life stress) may be more important than VMS in contributing to a first episode of major depression during midlife.

(Received August 06 2007)

(Revised February 07 2008)

(Accepted February 12 2008)

(Online publication April 01 2008)