Abstract
OBJECTIVES: The cessation of the menstrual cycle is associated with numerous physiological changes and symptoms, with depression being common during perimenopause and postmenopause, causing significant impacts on one's life. The objective of this study was to explore the relationship between the severity of moderate to severe postmenopausal depression and reproductive health factors, as well as sociodemographic characteristics. METHODS: This secondary analysis is based on data from a randomized controlled trial conducted at both a psychiatric hospital (Beijing Anding Hospital) and a general hospital (Beijing Chaoyang Hospital) between April 2013 and September 2017. The original randomized controlled trial employed a multicenter, randomized design over an 8-week period to evaluate depression and associated clinical characteristics. Of the 189 women screened, 5 did not meet the inclusion criteria, leaving 184 eligible for this secondary analysis. The study group consisted of 184 postmenopausal women. Depression was the primary outcome, measured by a 24-item Hamilton Depression Rating Scale observer-rated scale. Quick Inventory of Depressive Symptomatology-Self-Report was used for sensitivity analysis and was considered a secondary outcome. The visual analog scale (VAS) primarily assesses physical pain symptoms. The patient's basic sociodemographic characteristics and reproductive-related information are considered secondary indicators. RESULTS: Linear regression analysis revealed that a lower age at menopause (β = -0.380; P < 0.001), married/partnered (β = -3.028; P = 0.001), higher body mass index (BMI) (β = 0.744; P < 0.001), higher VAS (β = 0.126; P < 0.001), and have chronic physical diseases (β = 2.335; P = 0.015) are significantly associated with more severe depressive symptoms in moderate to severe postmenopausal depression. Logistic regression analysis revealed that BMI [odds ratio (OR) = 1.156; 95% CI: 1.012-1.32], VAS (OR = 1.04; 95% CI: 1.017-1.063), and being single (OR = 3.658; 95% CI: 1.618-8.27) were significantly associated with an increased risk of severe depressive symptoms in postmenopausal participants, while age at menopause (OR = 0.857; 95% CI: 0.765-0.96) emerged as a protective factor. CONCLUSIONS: Our findings indicate that an earlier age at menopause, being single, the presence of concomitant physical illnesses, a higher BMI, and more severe pain symptoms are associated with increased severity of moderate to severe postmenopausal depression. These results contribute to raising awareness of moderate to severe depression among postmenopausal women and underscore the importance of early diagnosis through targeted screening efforts.