Perimenopausal depression: characterisation and risk

Epidemiological data has highlighted that during perimenopause, women show a significantly increased risk for developing either first-onset depressive symptoms, or a relapse of a previous mood disorder. Some researchers have even proposed that Perimenopausal Depression may be a unique form of depression that is associated with mechanisms unique to the perimenopausal transition. While debate is continuing regarding the possibility of Perimenopausal Depression as a unique depression subtype, the best evidence to date strongly supports the existence of a relationship between perimenopause and depression. The exact nature of this relationship, however, remains unclear. With this in mind, the broad aims of this research were: (i) to explore whether the experience of adverse mood symptoms during perimenopause is different from that during childbearing years; (ii) to measure factors that are associated with increased or decreased risk of depressive symptoms during perimenopause; and (iii) to assess the role of personality characteristics in the development of depressive symptoms during perimenopause. Three studies are reported. The first was an investigation of the symptomatic differences in mood profile between depressive symptoms during perimenopause, as compared to symptoms during the childbearing years. Based on self-report measures of symptoms, it was found that the depressive symptoms experienced during perimenopause could be differentiated from depression during the childbearing years. Specifically, it was found that during perimenopause, there were lower levels of depressive symptoms, there were lower levels of anxiety, and higher levels of anger, fatigue and sleep disturbance. The second study looked at factors that were associated with increased depression symptoms during perimenopause. A number of factors that have previously been found to be associated with risk of depression symptoms at this time were considered to see if they contributed significantly to depression severity as measured using the Beck Depression Inventory 2 (BDI-II). Recent negative life events, a history of depression and severity of somatic symptoms were all found to be significant multivariate predictors of current severity of depressive symptoms. There was also a trend for a protective role for aerobic exercise. The third study examined the role of coping styles in the development of depressive symptoms during perimenopause, above and beyond the variance explained by history of depression, somatic symptoms and recent life events. The coping styles of behavioural disengagement and self-blame were found to significantly predict BDI-II scores. Additionally, behavioural disengagement was found to mediate the relationship between a history of depression and current BDI-II scores in perimenopausal women. This indicates that either use of behavioural disengagement as a coping style chronically predisposes women to developing depressive symptoms or alternatively, a prior experience of a depressive disorder may increase the use of behavioural disengagement as a coping style. Further research into the timeframe of this association may be important to assess the chronicity with which behavioural disengagement increases depressive risk. Collectively, the findings from these three studies have implications for our understanding of the concept of Perimenopausal Depression, as well as for the assessment and management of depression at this time. These results also have important implications for the conceptualisation of Perimenopausal Depression, its assessment, and its treatment. This research provides clarification regarding which factors do and do not contribute to Perimenopausal Depression, and identifies targets for future research. These results suggest that the way Perimenopausal Depression is thought of and managed by health care professionals may require revision to ensure that women are provided with the information they need to make informed choices about risk, prevention, and management of depressive symptoms during this time.