title: Depressive symptoms and risk of uterine leiomyomata.
abstract: OBJECTIVE
  Uterine leiomyomata (UL) are a major source of gynecologic morbidity and the primary indication for hysterectomy. Depression can cause dysregulation of the hypothalamic-pituitary-adrenal axis, which may affect the synthesis of reproductive hormones involved in UL pathogenesis. We assessed the association between depressive symptoms and UL among 15,963 premenopausal women.
  
  
  METHODS
  Data were derived from the Black Women's Health Study, a prospective cohort study. In 1999 and 2005, the Center for Epidemiologic Studies Depression Scale (CES-D) was used to ascertain depressive symptoms. On biennial follow-up questionnaires from 1999 through 2011, women reported physician-diagnosed depression, antidepressant use, and UL diagnoses. Incidence rate ratios (IRRs) and 95% confidence intervals (CIs) were estimated using multivariable Cox regression.
  
  
  RESULTS
  There were 4722 incident UL cases diagnosed by ultrasound (n=3793) or surgery (n=929) during 131,262 person-years of follow-up. Relative to baseline CES-D scores<16, IRRs were 1.05 (95% CI, 0.98-1.13) for CES-D scores 16-24 and 1.16 (95% CI, 1.06-1.27) for CES-D scores≥25 (P-trend=.001). IRRs for current and past physician-diagnosed depression relative to no depression were 1.15 (95% CI, 0.98-1.34) and 1.25 (95% CI, 1.13-1.39), respectively. Results persisted after further control for antidepressant use. IRRs for current and past use of antidepressants (any indication) relative to never use were 1.11 (95% CI, 0.97-1.28) and 1.32 (95% CI, 1.14-1.52), respectively.
  
  
  CONCLUSIONS
  In this cohort of black women, greater depressive symptoms were associated with UL, independent of antidepressant use, supporting the hypothesis that dysregulation of the hypothalamic-pituitary-adrenal axis increases UL risk.
authors.affiliation: Slone Epidemiology Center, Boston University, Boston, MA. Electronic address: lwise@bu.edu.
authors.forename: Lauren A
authors.initials: LA
authors.lastname: Wise
authors.affiliation: Slone Epidemiology Center, Boston University, Boston, MA.
authors.forename: Se
authors.initials: S
authors.lastname: Li
authors.affiliation: Slone Epidemiology Center, Boston University, Boston, MA.
authors.forename: Julie R
authors.initials: JR
authors.lastname: Palmer
authors.affiliation: Slone Epidemiology Center, Boston University, Boston, MA.
authors.forename: Lynn
authors.initials: L
authors.lastname: Rosenberg
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data*; D000928:Antidepressive Agents / Q000627:therapeutic use; D015331:Cohort Studies; D003863:Depression / Q000188:drug therapy / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007030:Hypothalamo-Hypophyseal System; D007889:Leiomyoma / Q000453:epidemiology*; D015999:Multivariate Analysis; D010913:Pituitary-Adrenal System; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D014594:Uterine Neoplasms / Q000453:epidemiology*
chemical_list: D000928:Antidepressive Agents
keywords: African Americans; antidepressants; depressive symptoms; prospective studies; uterine neoplasms