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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 ,
Nirmala Pandeya ,
Annette J. Dobson ,
Diana Kuh ,
Eric J. Brunner ,
Sybil L. Crawford ,
Nancy E. Avis ,
Ellen B. Gold ,
Ellen S. Mitchell  and
Nancy F. Woods
...Show all authors
Hsin-Fang Chung*
Affiliation:
School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
Nirmala Pandeya
Affiliation:
School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
Annette J. Dobson
Affiliation:
School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
Diana Kuh
Affiliation:
Medical Research Council Unit for Lifelong Health and Ageing at University College London, London, UK
Eric J. Brunner
Affiliation:
Department of Epidemiology and Public Health, University College London, London, UK
Sybil L. Crawford
Affiliation:
Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
Nancy E. Avis
Affiliation:
Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC, USA
Ellen B. Gold
Affiliation:
Department of Public Health Sciences, University of California, Davis, CA, USA
Ellen S. Mitchell
Affiliation:
Family and Child Nursing, School of Nursing, University of Washington, Seattle, WA, USA
Nancy F. Woods
Affiliation:
Biobehavioral Nursing and Health Systems, School of Nursing, University of Washington, Seattle, WA, USA
Joyce T. Bromberger
Affiliation:
Departments of Epidemiology and Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
Rebecca C. Thurston
Affiliation:
Departments of Epidemiology and Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
Hadine Joffe
Affiliation:
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
Affiliation:
Department of Women's Health Nursing, Tohoku University Graduate School of Medicine, Sendai, Japan
Debra Anderson
Affiliation:
Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
Gita D. Mishra
Affiliation:
School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
*
Author for correspondence: Dr Hsin-Fang Chung, E-mail: h.chung1@uq.edu.au
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Abstract

Background

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.

Methods

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.

Results

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).

Conclusions

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.

Keywords

Depressed moodhot flushesmenopausal transitionnight sweatssleep difficultiesvasomotor menopausal symptoms

Information

Type
Original Articles
Information
Psychological Medicine , Volume 48 , Issue 15 , November 2018 , pp. 2550 - 2561
Copyright
Copyright © Cambridge University Press 2018 

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References

Alvaro, PK, Roberts, RM and Harris, JK (2013) A systematic review assessing bidirectionality between sleep disturbances, anxiety, and depression. Sleep 36, 1059–1068.Google Scholar
Anderson, D, Yoshizawa, T, Gollschewski, S, Atogami, F and Courtney, M (2004) Menopause in Australia and Japan: effects of country of residence on menopausal status and menopausal symptoms. Climacteric 7, 165–174.Google Scholar
Aronson, KR, Barrett, LF and Quigley, K (2006) Emotional reactivity and the overreport of somatic symptoms: somatic sensitivity or negative reporting style? Journal of Psychosomatic Research 60, 521–530.Google Scholar
Asnis, GM, Thomas, M and Henderson, MA (2015) Pharmacotherapy treatment options for insomnia: a primer for clinicians. International Journal of Molecular Sciences 17, E50.Google Scholar
Avis, NE, Crawford, S, Stellato, R and Longcope, C (2001) Longitudinal study of hormone levels and depression among women transitioning through menopause. Climacteric 4, 243–249.Google Scholar
Avis, NE, Crawford, SL, Greendale, G, Bromberger, JT, Everson-Rose, SA, Gold, EB et al. (2015) Duration of menopausal vasomotor symptoms over the menopause transition. JAMA Internal Medicine 175, 531–539.Google Scholar
Ayers, B, Forshaw, M and Hunter, MS (2010) The impact of attitudes towards the menopause on women's symptom experience: a systematic review. Maturitas 65, 28–36.Google Scholar
Bromberger, JT, Schott, LL, Kravitz, HM, Sowers, M, Avis, NE, Gold, EB et al. (2010) Longitudinal change in reproductive hormones and depressive symptoms across the menopausal transition: results from the Study of Women's Health Across the Nation (SWAN). Archives of General Psychiatry 67, 598–607.Google Scholar
Burleson, MH, Todd, M and Trevathan, WR (2010) Daily vasomotor symptoms, sleep problems, and mood: using daily data to evaluate the domino hypothesis in middle-aged women. Menopause 17, 87–95.Google Scholar
Christensen, H, Batterham, PJ, Gosling, JA, Ritterband, LM, Griffiths, KM, Thorndike, FP et al. (2016) Effectiveness of an online insomnia program (SHUTi) for prevention of depressive episodes (the GoodNight study): a randomised controlled trial. Lancet Psychiatry 3, 333–341.Google Scholar
Cohen, LS, Soares, CN, Vitonis, AF, Otto, MW and Harlow, BL (2006) Risk for new onset of depression during the menopausal transition: the Harvard study of moods and cycles. Archives of General Psychiatry 63, 385–390.Google Scholar
Dobson, AJ, Hockey, R, Brown, WJ, Byles, JE, Loxton, DJ, McLaughlin, D et al. (2015) Cohort profile update: Australian longitudinal study on women's health. International Journal of Epidemiology 44, 1547a–1547f.Google Scholar
Duffy, J, Rolph, R, Gale, C, Hirsch, M, Khan, KS, Ziebland, S et al. International Collaboration to Harmonise Outcomes in Pre-eclampsia (2017) Core outcome sets in women's and newborn health: a systematic review. BJOG 124, 1481–1489.Google Scholar
Eichling, PS and Sahni, J (2005) Menopause related sleep disorders. Journal of Clinical Sleep Medicine 1, 291–300.Google Scholar
Elison, S, Ward, J, Williams, C, Espie, C, Davies, G, Dugdale, S et al. (2017) Feasibility of a UK community-based, eTherapy mental health service in Greater Manchester: repeated-measures and between-groups study of ‘living life to the full interactive’, ‘sleepio’ and ‘breaking free online’ at ‘self help services’. BMJ Open 7, e016392.Google Scholar
Freeman, EW and Sammel, MD (2016) Anxiety as a risk factor for menopausal hot flashes: evidence from the Penn ovarian aging cohort. Menopause 23, 942–949.Google Scholar
Freeman, EW, Sammel, MD and Lin, H (2009) Temporal associations of hot flashes and depression in the transition to menopause. Menopause 16, 728–734.Google Scholar
Freeman, EW, Sammel, MD, Lin, H and Nelson, DB (2006) Associations of hormones and menopausal status with depressed mood in women with no history of depression. Archives of General Psychiatry 63, 375–382.Google Scholar
Gibson, CJ, Thurston, RC, Bromberger, JT, Kamarck, T and Matthews, KA (2011) Negative affect and vasomotor symptoms in the study of women's health across the nation daily hormone study. Menopause 18, 1270–1277.Google Scholar
Gold, EB, Colvin, A, Avis, N, Bromberger, J, Greendale, GA, Powell, L et al. (2006) Longitudinal analysis of the association between vasomotor symptoms and race/ethnicity across the menopausal transition: study of women's health across the nation. American Journal of Public Health 96, 1226–1235.Google Scholar
Harlow, BL, Cohen, LS, Otto, MW, Spiegelman, D and Cramer, DW (1999) Prevalence and predictors of depressive symptoms in older premenopausal women: the Harvard study of moods and cycles. Archives of General Psychiatry 56, 418–424.Google Scholar
Hunter, MS and Liao, KL (1995) A psychological analysis of menopausal hot flushes. British Journal of Clinical Psychology 34, 589–599.Google Scholar
Institute of Medicine (2006) Sleep Disorders and Sleep Deprivation: An Unmet Public Health Problem. Washington, DC: The National Academies Press.Google Scholar
Joffe, H, Crawford, SL, Freeman, MP, White, DP, Bianchi, MT, Kim, S et al. (2016) Independent contributions of nocturnal hot flashes and sleep disturbance to depression in estrogen-deprived women. The Journal of Clinical Endocrinology and Metabolism 101, 3847–3855.Google Scholar
Joffe, H, Partridge, A, Giobbie-Hurder, A, Li, X, Habin, K, Goss, P et al. (2010) Augmentation of venlafaxine and selective serotonin reuptake inhibitors with zolpidem improves sleep and quality of life in breast cancer patients with hot flashes: a randomized, double-blind, placebo-controlled trial. Menopause 17, 908–916.Google Scholar
Joffe, H, Petrillo, LF, Koukopoulos, A, Viguera, AC, Hirschberg, A, Nonacs, R et al. (2011) Increased estradiol and improved sleep, but not hot flashes, predict enhanced mood during the menopausal transition. The Journal of Clinical Endocrinology and Metabolism 96, E1044–E1054.Google Scholar
Kessler, R and Gadermann, A (2013) Chapter 83: gender and mood disorders. In Goldman, M, Troisi, R, Rexrode, K (eds). Women and Health, 2nd edn., Academic Press, London, pp. 1247–1256.Google Scholar
Li, Y, Yu, Q, Ma, L, Sun, Z and Yang, X (2008) Prevalence of depression and anxiety symptoms and their influence factors during menopausal transition and postmenopause in Beijing city. Maturitas 61, 238–242.Google Scholar
Marmot, M and Brunner, E (2005) Cohort profile: the whitehall II study. International Journal of Epidemiology 34, 251–256.Google Scholar
Mishra, GD, Anderson, D, Schoenaker, DA, Adami, HO, Avis, NE, Brown, D et al. (2013) InterLACE: a New international collaboration for a life course approach to women's reproductive health and chronic disease events. Maturitas 74, 235–240.Google Scholar
Mishra, GD, Chung, HF, Pandeya, N, Dobson, AJ, Jones, L, Avis, NE et al. (2016) The InterLACE study: design, data harmonization and characteristics across 20 studies on women's health. Maturitas 92, 176–185.Google Scholar
Mitchell, ES and Woods, NF (2011) Cognitive symptoms during the menopausal transition and early postmenopause. Climacteric 14, 252–261.Google Scholar
Power, C and Elliott, J (2006) Cohort profile: 1958 British birth cohort (national child development study). International Journal of Epidemiology 35, 34–41.Google Scholar
Rapkin, AJ, Mikacich, JA, Moatakef-Imani, B and Rasgon, N (2002) The clinical nature and formal diagnosis of premenstrual, postpartum, and perimenopausal affective disorders. Current Psychiatry Report 4, 419–428.Google Scholar
Shaver, JL and Woods, NF (2015) Sleep and menopause: a narrative review. Menopause 22, 899–915.Google Scholar
Sowers, M, Crawford, SL, Sternfeld, B, Morganstein, D, Gold, EB, Greendale, GA et al. (2000) SWAN: A Multi-Center, Multiethnic, Community-Based Cohort Study of Women and the Menopausal Transition. San Diego, CA: Academic Press.Google Scholar
The CROWN initiative (2016) Core outcome set in Menopause (COMMA). Available at http://www.crown-initiative.org/core-outcome-sets/ongoing-core-outcome-sets-2 (Accessed 27 November 2017).Google Scholar
Timur, S and Sahin, NH (2010) The prevalence of depression symptoms and influencing factors among perimenopausal and postmenopausal women. Menopause 17, 545–551.Google Scholar
Vincent, AJ, Ranasinha, S, Sayakhot, P, Mansfield, D and Teede, HJ (2014) Sleep difficulty mediates effects of vasomotor symptoms on mood in younger breast cancer survivors. Climacteric 17, 598–604.Google Scholar
Wadsworth, M, Kuh, D, Richards, M and Hardy, R (2006) Cohort profile: the 1946 national birth cohort (MRC national survey of health and development). International Journal of Epidemiology 35, 49–54.Google Scholar
Worsley, R, Bell, R, Kulkarni, J and Davis, SR (2014) The association between vasomotor symptoms and depression during perimenopause: a systematic review. Maturitas 77, 111–117.Google Scholar
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