Statistical mediation by sleep quality in the association between menopausal symptoms and depressive symptoms in peri- and postmenopausal women: a multicenter cross-sectional study.

OBJECTIVE

This study aimed to examine the associations among menopausal symptoms, depressive symptoms, and sleep quality in peri- and postmenopausal women, with particular attention to the indirect statistical association through sleep quality.

METHODS

A multicenter cross-sectional study including 2,330 peri- and postmenopausal women was conducted. Menopausal symptoms were assessed using the Kupperman Menopausal Index (KMI), depressive symptoms using the Patient Health Questionnaire-9 (PHQ-9), and sleep quality using the Pittsburgh Sleep Quality Index (PSQI). Multivariable logistic regression and bootstrap-based statistical mediation models were applied to quantify associations and indirect effects.

RESULTS

Depressive symptoms (PHQ-9 ≥5) were observed in 34.0% of participants. Increasing severity of menopausal symptoms was significantly associated with both depressive symptoms and poor sleep quality (P<0.001). Poor sleep quality (PSQI >5) was strongly associated with depressive symptoms (odds ratio [OR]=4.48, 95% confidence interval [CI]: 3.72-5.40). Statistical mediation analysis indicated significant indirect associations through sleep quality, with proportions statistically mediated ranging from 17.08% to 63.39% and the largest proportion observed for hot flashes and sweating.

CONCLUSION

Sleep quality statistically accounted for part of the observed association between menopausal symptoms and depressive symptoms. These findings support incorporating sleep assessment into menopause care and provide a rationale for prospective studies evaluating temporal relationships and the potential value of sleep-focused interventions.