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Predictors of first lifetime episodes of major depression in midlife women

Published online by Cambridge University Press:  01 April 2008

J. T. Bromberger ,
H. M. Kravitz ,
K. Matthews ,
A. Youk ,
C. Brown  and
W. Feng
J. T. Bromberger*
Affiliation:
Departments of Epidemiology and Psychiatry, and Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
H. M. Kravitz
Affiliation:
Departments of Psychiatry and Preventive Medicine, Rush University Medical Center, Chicago, IL, USA
K. Matthews
Affiliation:
Departments of Psychiatry, Epidemiology and Psychology, University of Pittsburgh, Pittsburgh, PA, USA
A. Youk
Affiliation:
Graduate School of Public Health and Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA, USA
C. Brown
Affiliation:
Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
W. Feng
Affiliation:
Graduate School of Public Health and Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA, USA
*
*Address for correspondence: J. T. Bromberger, Ph.D., Departments of Epidemiology and Psychiatry, University of Pittsburgh, 3811 O'Hara Street, Pittsburgh, PA 15213, USA. (Email: brombergerjt@upmc.edu)
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Abstract

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.

Keywords

Incident major depressionlongitudinal studymenopausemidlife women
Type
Original Articles
Information
Psychological Medicine , Volume 39 , Issue 1 , January 2009 , pp. 55 - 64
Copyright
Copyright © 2008 Cambridge University Press

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