Hostname: page-component-8448b6f56d-gtxcr Total loading time: 0 Render date: 2024-04-15T23:42:22.936Z Has data issue: false hasContentIssue false
  • English
  • Français

Do anxiety symptoms predict major depressive disorder in midlife women? The Study of Women's Health Across the Nation (SWAN) Mental Health Study (MHS)

Published online by Cambridge University Press:  27 January 2014

H. M. Kravitz ,
L. L. Schott ,
H. Joffe ,
J. M. Cyranowski  and
J. T. Bromberger
H. M. Kravitz*
Affiliation:
Departments of Psychiatry and Preventive Medicine, Rush University Medical Center, Chicago, IL, USA
L. L. Schott
Affiliation:
Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
H. Joffe
Affiliation:
Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
J. M. Cyranowski
Affiliation:
Departments of Psychology and Psychiatry, University of Pittsburgh and University of Pittsburgh Medical Center, Pittsburgh, PA, USA
J. T. Bromberger
Affiliation:
Departments of Epidemiology and Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
*
*Address for correspondence: Dr H. M. Kravitz, Rush University Medical Center, Department of Psychiatry, Rush West Campus, 2150 West Harrison Street, Chicago, IL 60612, USA. (Email: hkravitz@rush.edu)
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

In women, anxiety symptoms are common and increase during midlife, but little is known about whether these symptoms predict onsets of major depressive disorder (MDD) episodes. We examined whether anxiety symptoms are associated with subsequent episodes of MDD in midlife African-American and Caucasian women, and whether they confer a different risk for first versus recurrent MDD episodes.

Method

A longitudinal analysis was conducted using 12 years of data from the Study of Women's Health Across the Nation (SWAN) Mental Health Study (MHS). The baseline sample comprised 425 Caucasian (n = 278) and African American (n = 147) community-dwelling women, aged 46.1 ± 2.5 years. Anxiety symptoms measured annually using a self-report questionnaire were examined in relation to MDD episodes in the subsequent year, assessed with the SCID. Multivariable models were estimated with random effects logistic regression.

Results

Higher anxiety symptoms scores were associated with a significantly higher adjusted odds of developing an episode of MDD at the subsequent annual visit [odds ratio (OR) 1.47, p = 0.01], specifically for a recurrent episode (OR 1.49, p = 0.03) but non-significant for a first episode (OR 1.32, p = 0.27). There were no significant racial effects in the association between anxiety symptoms and subsequent MDD episodes.

Conclusions

Anxiety symptoms often precede MDD and may increase the vulnerability of midlife women to depressive episodes, particularly recurrences. Women with anxiety symptoms should be monitored clinically during the ensuing year for the development of an MDD episode.

Keywords

Anxietylongitudinalmajor depressive disordermidlife womenrace
Type
Original Articles
Information
Psychological Medicine , Volume 44 , Issue 12 , September 2014 , pp. 2593 - 2602
Copyright
Copyright © Cambridge University Press 2014 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Accortt, EE, Freeman, MP, Allen, JJ (2008). Women and major depressive disorder: clinical perspectives on causal pathways. Journal of Women's Health 17, 1583–1590.Google Scholar
Alloy, LB, Kelly, KA, Mineka, S, Clements, CM (1990). Comorbidity of anxiety and depressive disorders: a helplessness-hopelessness perspective. In Comorbidity of Mood and Anxiety Disorders (ed. Maser, J. D. and Cloninger, R. C.), pp. 499–543. American Psychiatric Press: Washington, DC.Google Scholar
Bijl, RV, De Graaf, R, Ravelli, A, Smit, F, Vollebergh, WA (2002). Gender and age-specific first incidence of DSM-III-R psychiatric disorders in the general population. Results from the Netherlands Mental Health Survey and Incidence Study (NEMESIS). Social Psychiatry and Psychiatric Epidemiology 37, 372–379.Google Scholar
Breslau, N, Schultz, L, Peterson, E (1995). Sex differences in depression: a role for preexisting anxiety. Psychiatry Research 58, 1–12.Google Scholar
Bromberger, JT, Kravitz, HM, Chang, Y, Randolph, JF Jr., Avis, NE, Gold, EB, Matthews, KA (2013). Does risk for anxiety increase during the menopausal transition? Study of Women's Health Across the Nation (SWAN). Menopause 20, 488–495.Google Scholar
Bromberger, JT, Kravitz, HM, Chang, Y-F, Cyranowski, JM, Brown, C, Matthews, KA (2011). Major depression during and after the menopausal transition: Study of Women's Health Across the Nation (SWAN). Psychological Medicine 41, 1879–1888. Erratum in: Psychological Medicine (2011), 41, 2238.Google Scholar
Bromberger, JT, Kravitz, HM, Matthews, K, Youk, A, Brown, C, Feng, W (2009). Predictors of first lifetime episode of major depression in midlife women. Psychological Medicine 39, 55–64.Google Scholar
Bromberger, JT, Matthews, KA, Schott, LL, Brockwell, S, Avis, NE, Kravitz, HM, Everson-Rose, SA, Gold, EB, Sowers, MF, Randolph, JF Jr. (2007). Depressive symptoms during the menopausal transition: the Study of Women's Health Across the Nation (SWAN). Journal of Affective Disorders 103, 267–272.Google Scholar
Bromberger, JT, Schott, LL, Kravitz, HM, Sowers, M, Avis, NE, Gold, EB, Randolph, JF Jr., Matthews, KA (2010). Longitudinal change in reproductive hormones and depressive symptoms across the menopausal transition: results from the Study of Women's Health Across the Nation (SWAN). Archives of General Psychiatry 67, 598–607.Google Scholar
Clark, LA, Watson, D, Mineka, S (1994). Temperament, personality, and the mood and anxiety disorders. Journal of Abnormal Psychology 103, 103–116.Google Scholar
Cohen, LS, Soares, CN, Vitonis, AF, Otto, MW, Harlow, B (2006). Risk for new onset of depression during the menopausal transition. The Harvard Study of Moods and Cycles. Archives of General Psychiatry 63, 385–390.Google Scholar
Coryell, W, Fiedorowicz, JG, Solomon, D, Leon, AC, Rice, JP, Keller, MB (2012). Effects of anxiety on the long-term course of depressive disorders. British Journal of Psychiatry 200, 210–215.Google Scholar
Fawcett, J (2013). Similarities and differences in psychiatry and medicine. Psychiatric Annals 43, 50–51.CrossRefGoogle Scholar
Fawcett, JF, Kravitz, HM (1983). Anxiety syndromes and their relationship to depressive illness. Journal of Clinical Psychiatry 44, 8–11.Google Scholar
Freeman, EW, Sammel, MD, Lin, H, Gracia, CR, Kapoor, S, Ferdousi, T (2005). The role of anxiety and hormonal changes in menopausal hot flashes. Menopause 12, 258–266.Google Scholar
Freeman, EW, Sammel, MD, Lin, H, Nelson, DB (2006). Associations of hormones and menopausal status with depressed mood in women with no history of depression. Archives of General Psychiatry 63, 375–382.Google Scholar
Gold, EB, Colvin, A, Avis, N, Bromberger, J, Greendale, GA, Powell, L, Sternfeld, B, Matthews, K (2006). Longitudinal analysis of vasomotor symptoms and race/ethnicity across the menopausal transition: Study of Women's Health Across the Nation (SWAN). American Journal of Public Health 96, 1226–1235.Google Scholar
Goldberg, D, Fawcett, J (2012). The importance of anxiety in both major depression and bipolar disorder. Depression and Anxiety 29, 471–478.CrossRefGoogle ScholarPubMed
Johnson, RA, Wichern, DW (1982). Applied Multivariate Statistical Analysis. Prentice-Hall: Englewood Cliffs, NJ.Google Scholar
Kessler, RC, Berglund, P, Demler, O, Jin, R, Walters, EE (2005 a). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry 62, 593–602.CrossRefGoogle ScholarPubMed
Kessler, RC, Chiu, WT, Demler, O, Merikangas, KR, Walters, EE (2005 b). Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry 62, 617–627. Erratum in: Archives of General Psychiatry (2005), 62, 709.Google Scholar
Kessler, RC, McGonagle, KA, Zhao, S, Nelson, CB, Hughes, M, Eshleman, S, Wittchen, H-U, Kendler, KS (1994). Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Results from the National Comorbidity Study. Archives of General Psychiatry 51, 8–19.Google Scholar
Löwe, B, Decker, O, Müller, S, Brähler, E, Herzog, W, Schellberg, D, Herzberg, Y (2008). Validation and standardization of the Generalized Anxiety Disorder Screener (GAD-7) in the general population. Medical Care 4, 266–274.CrossRefGoogle Scholar
Martin, LA, Neighbors, HW, Griffith, DM (2013). The experience of symptoms of depression in men vs women: analysis of the National Comorbidity Survey Replication. Journal of the American Medical Association Psychiatry 70, 1100–1106.Google Scholar
Mineka, S, Watson, D, Clark, LA (1998). Comorbidity of anxiety and unipolar mood disorders. Annual Review of Psychology 49, 377–412.Google Scholar
Neugarten, BL, Kraines, RJ (1965). ‘Menopausal symptoms’ in women of various ages. Psychosomatic Medicine 27, 266–273.Google Scholar
Radloff, LS (1977). The CES-D scale: a self-report depression scale for research in the general population. Applied Psychological Measurement 1, 385–401.Google Scholar
Sherbourne, CD, Stewart, AL (1991). The MOS social support survey. Social Science and Medicine 32, 705–714.Google Scholar
Sowers, MF, Crawford, SL, Sternfeld, B, Morganstein, D, Gold, EB, Greendale, GA, Evans, D, Neer, R, Matthews, K, Sherman, S, Lo, A, Weiss, G, Kelsey, J (2000). SWAN: a multicenter, multiethnic, community-based cohort study of women and the menopausal transition. In Menopause: Biology and Pathobiology (ed. Lobo, R., Marcus, R. and Kelsey, J.), pp. 175–188. Academic Press: San Diego, CA.Google Scholar
Spielberger, CD (1979). Preliminary Manual for the State-Trait Personality Inventory (STPI). University of South Tampa: Tampa, FL.Google Scholar
Spielberger, CD, Reheiser, EC (2009). Assessment of emotions: anxiety, anger, depression, and curiosity. Applied Psychology: Health and Well-Being 1, 271–302.Google Scholar
Spitzer, RL, Kroenke, K, Williams, JB, Löwe, B (2006). A brief measure for assessing generalized anxiety disorder: the GAD-7. Archives of Internal Medicine 166, 1092–1097.Google Scholar
Spitzer, RL, William, JBW, Gibbon, M, First, MB (1992). The Structured Clinical Interview for DSM-III-R (SCID). I: History, rationale, and description. Archives of General Psychiatry 49, 624–629.CrossRefGoogle ScholarPubMed
Weinstock, LM, Whisman, MA (2006). Neuroticism as a common feature of the depressive and anxiety disorders: a test of the revised integrative hierarchical model in a national sample. Journal of Abnormal Psychology 115, 68–74.Google Scholar
WHO (1996). Research on the menopause in the 1990s. Report of a WHO Scientific Group. World Health Organization Technical Report Series 866, 1–107.Google Scholar
Wittchen, H-U, Kessler, RC, Pfister, H, Lieb, M (2000). Why do people with anxiety disorders become depressed? A prospective-longitudinal community study. Acta Psychiatrica Scandinavica 102 (Suppl. 406), 14–23.Google Scholar