Predictors of first lifetime episodes of major depression in midlife women.
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.


METHODS
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.
Bromberger
J T
JT
Departments of Epidemiology and Psychiatry, and Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA. brombergerjt@upmc.edu
Kravitz
H M
HM
Matthews
K
K
Youk
A
A
Brown
C
C
Feng
W
W
D000328:Adult; D001741:Black or African American / Q000523:psychology / Q000706:statistics & numerical data; D000375:Aging / Q000523:psychology*; D001008:Anxiety Disorders / Q000453:epidemiology / Q000523:psychology; D015992:Body Mass Index; D015331:Cohort Studies; D003865:Major Depressive Disorder / Q000453:epidemiology* / Q000523:psychology*; D005260:Female; D005640:Follicle Stimulating Hormone / Q000097:blood; D005500:Follow-Up Studies; D006304:Health Status; D006801:Humans; D007406:Interview, Psychological / Q000379:methods; D008137:Longitudinal Studies; D008593:Menopause / Q000097:blood / Q000523:psychology; D008875:Middle Aged; D010414:Pennsylvania / Q000453:epidemiology; D011237:Predictive Value of Tests; D012307:Risk Factors; D013315:Stress, Psychological / Q000453:epidemiology / Q000523:psychology; D019966:Substance-Related Disorders / Q000453:epidemiology / Q000523:psychology; D044465:White People / Q000523:psychology / Q000706:statistics & numerical data; D016387:Women's Health
D005640:Follicle Stimulating Hormone