American journal of obstetrics and gynecology · 2024
Association of premature natural and surgical menopause with incidence of depression requiring hospitalization: a prospective cohort study.
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Xu Minzhi, Yin Xiaoxv, Gong Yanhong
Аннотация
BACKGROUND: Premature menopause is associated with depression in postmenopausal women. However, current evidence ignores the differences between premature natural and surgical menopause, and there is a lack of exploration of the mechanisms underlying the association between premature menopause and depression.
OBJECTIVE: To examine the association of premature natural and surgical menopause with incidence of depression requiring hospitalization, and to evaluate whether frailty and menopausal hormone therapy are significant factors contributing to a higher incidence of depression requiring hospitalization associated with premature natural and surgical menopause, in comparison to women who experience menopause after age 40.
STUDY DESIGN: This cohort included 139,691 postmenopausal women from the UK Biobank, 44,734 of whom participated the 7-year online mental health survey. Reproductive histories were obtained at enrollment. Depression requiring hospitalization was identified based on electronic health records and the Patient Health Questionnaire-9. Cox proportional hazard models and Poisson regression models were fitted.
RESULTS: During a median (interquartile range) follow-up of 12.53 (11.71-13.25) years, 7563 participants (5.41%) developed depression requiring hospitalization. In the fully adjusted model, compared with women who experienced menopause >40, the hazard ratios (95% confidence intervals) of those with premature natural and surgical menopause for depression requiring hospitalization were 1.27 (1.17-1.38) and 1.76 (1.43-2.16), respectively. Similar findings were observed in the association of premature natural (risk ratio=1.17, 95% confidence interval: 1.00-1.39) and surgical menopause (risk ratio=1.62, 95% confidence interval: 1.05-2.51) with depression as measured by the Patient Health Questionnaire-9 score. An inverse dose-response relationship was observed in the analysis of alternate age thresholds and depression requiring hospitalization. When premature natural menopause was compared with women who experienced menopause >40, the proportion of the mediating effect of frailty and menopausal hormone therapy on depression requiring hospitalization was 27.43% (9.53%-229.00%) and 65.15% (45.57%-136.00%), respectively. When premature surgical menopause was compared with women who experienced menopause >40, the proportion of the mediating effect of frailty and menopausal hormone therapy on depression requiring hospitalization was 8.30% (2.59%-34.00%), 42.90% (27.96%-81.00%), respectively.
CONCLUSION: Premature menopause, especially surgical premature menopause, is significantly associated with depression requiring hospitalization in women. Frailty and adjustment of hormone therapy strategies during menopause may be potential targets for intervention.
OBJECTIVE: To examine the association of premature natural and surgical menopause with incidence of depression requiring hospitalization, and to evaluate whether frailty and menopausal hormone therapy are significant factors contributing to a higher incidence of depression requiring hospitalization associated with premature natural and surgical menopause, in comparison to women who experience menopause after age 40.
STUDY DESIGN: This cohort included 139,691 postmenopausal women from the UK Biobank, 44,734 of whom participated the 7-year online mental health survey. Reproductive histories were obtained at enrollment. Depression requiring hospitalization was identified based on electronic health records and the Patient Health Questionnaire-9. Cox proportional hazard models and Poisson regression models were fitted.
RESULTS: During a median (interquartile range) follow-up of 12.53 (11.71-13.25) years, 7563 participants (5.41%) developed depression requiring hospitalization. In the fully adjusted model, compared with women who experienced menopause >40, the hazard ratios (95% confidence intervals) of those with premature natural and surgical menopause for depression requiring hospitalization were 1.27 (1.17-1.38) and 1.76 (1.43-2.16), respectively. Similar findings were observed in the association of premature natural (risk ratio=1.17, 95% confidence interval: 1.00-1.39) and surgical menopause (risk ratio=1.62, 95% confidence interval: 1.05-2.51) with depression as measured by the Patient Health Questionnaire-9 score. An inverse dose-response relationship was observed in the analysis of alternate age thresholds and depression requiring hospitalization. When premature natural menopause was compared with women who experienced menopause >40, the proportion of the mediating effect of frailty and menopausal hormone therapy on depression requiring hospitalization was 27.43% (9.53%-229.00%) and 65.15% (45.57%-136.00%), respectively. When premature surgical menopause was compared with women who experienced menopause >40, the proportion of the mediating effect of frailty and menopausal hormone therapy on depression requiring hospitalization was 8.30% (2.59%-34.00%), 42.90% (27.96%-81.00%), respectively.
CONCLUSION: Premature menopause, especially surgical premature menopause, is significantly associated with depression requiring hospitalization in women. Frailty and adjustment of hormone therapy strategies during menopause may be potential targets for intervention.