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The role of sleep difficulties in the vasomotor menopausal symptoms and depressed mood relationships: an international pooled analysis of eight studies in the InterLACE consortium

Published online by Cambridge University Press:  12 February 2018

Hsin-Fang Chung*
School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
Nirmala Pandeya
School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
Annette J. Dobson
School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
Diana Kuh
Medical Research Council Unit for Lifelong Health and Ageing at University College London, London, UK
Eric J. Brunner
Department of Epidemiology and Public Health, University College London, London, UK
Sybil L. Crawford
Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
Nancy E. Avis
Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC, USA
Ellen B. Gold
Department of Public Health Sciences, University of California, Davis, CA, USA
Ellen S. Mitchell
Family and Child Nursing, School of Nursing, University of Washington, Seattle, WA, USA
Nancy F. Woods
Biobehavioral Nursing and Health Systems, School of Nursing, University of Washington, Seattle, WA, USA
Joyce T. Bromberger
Departments of Epidemiology and Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
Rebecca C. Thurston
Departments of Epidemiology and Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
Hadine Joffe
Connors Center for Women's Health and Department of Psychiatry, Brigham and Women's Hospital and Dana Farber Cancer Institute/Harvard Medical School, Boston, MA, USA
Toyoko Yoshizawa
Department of Women's Health Nursing, Tohoku University Graduate School of Medicine, Sendai, Japan
Debra Anderson
Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
Gita D. Mishra
School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
Author for correspondence: Dr Hsin-Fang Chung, E-mail:



Many women experience both vasomotor menopausal symptoms (VMS) and depressed mood at midlife, but little is known regarding the prospective bi-directional relationships between VMS and depressed mood and the role of sleep difficulties in both directions.


A pooled analysis was conducted using data from 21 312 women (median: 50 years, interquartile range 49−51) in eight studies from the InterLACE consortium. The degree of VMS, sleep difficulties, and depressed mood was self-reported and categorised as never, rarely, sometimes, and often (if reporting frequency) or never, mild, moderate, and severe (if reporting severity). Multivariable logistic regression models were used to examine the bi-directional associations adjusted for within-study correlation.


At baseline, the prevalence of VMS (40%, range 13–62%) and depressed mood (26%, 8–41%) varied substantially across studies, and a strong dose-dependent association between VMS and likelihood of depressed mood was found. Over 3 years of follow-up, women with often/severe VMS at baseline were more likely to have subsequent depressed mood compared with those without VMS (odds ratios (OR) 1.56, 1.27–1.92). Women with often/severe depressed mood at baseline were also more likely to have subsequent VMS than those without depressed mood (OR 1.89, 1.47–2.44). With further adjustment for the degree of sleep difficulties at baseline, the OR of having a subsequent depressed mood associated with often/severe VMS was attenuated and no longer significant (OR 1.13, 0.90–1.40). Conversely, often/severe depressed mood remained significantly associated with subsequent VMS (OR 1.80, 1.38–2.34).


Difficulty in sleeping largely explained the relationship between VMS and subsequent depressed mood, but it had little impact on the relationship between depressed mood and subsequent VMS.

Original Articles
Copyright © Cambridge University Press 2018 

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