Risk Factors for Recurrent MDD in Midlife Women


Are you aware of 2 newly identified predictors of a pernicious depression course in middle-aged women?

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Persistent and recurrent forms of depression are common among women during midlife, according to findings derived from the Study of Women’s Health Across the Nation (SWAN).1 The analysis sought to get a better picture of patterns of depression in middle-aged women.

Different sites that participate in the SWAN Study collect and analyze data on specific, predetermined demographics. In the current study, the site at the University of Pittsburgh collected and analyzed mental health data on 297 African American and white women. They were premenopausal, aged 42 to 52 years at baseline, and were followed for 13 years.

Information on lifetime psychiatric diagnoses was obtained at baseline, and participants underwent psychiatric interviews annually to assess occurrences of depression. The measure used was the Structured Clinical Interview for the Diagnosis of DSM-IV Axis I Disorders. Other interview-based assessment tools were used to gather information on health and well-being, physical activity, stress, family history of depression, and childhood maltreatment.

After 13 years of follow-up, 4 depression patterns emerged: 31% of the cohort had persistent/recurrent MDD, 9% had single-episode MDD, 12% had minor depression, and 48% were free of depression. Baseline risk factors for the persistent/recurrent MDD group were compared with each of the other 3 groups. Women in the persistent/recurrent group were more likely to report a lifetime history of major or minor depression and 2 or more very upsetting life events in the previous year.

The differences were statistically significant, with a P value of .001 for the association between life events and major depression and P values of .003 and .04 for associations between recent upsetting events and major and minor depression, respectively. Women in the persistent/recurrent group also were more likely than women with minor depression to report a family history of depression (P = .03) and more likely to report sleep problems than the single-episode MDD group (P = .002).

In all, the researchers reported that at least 1 depressive episode of MDD occurred in 40% of the study cohort and of those who had at least 1 episode of MDD, 71% went on to experience a persistent or recurrent course.

Clinical implications

Even though the incidence and gravity of depression in women are well known-with perimenopause being reported as a mediator in some studies-heretofore, no study of midlife or perimenopause has examined risk-factor patterns of depression or depression over the course of time. “Such information is particularly relevant for aiding healthcare providers of midlife women in identifying and preventing an incident MDD or minor depressive episode or its recurrence,” the study authors-a team from the University of Pittsburgh, Rush University, and Harvard Medical School-wrote. They noted that providers of midlife health care should be vigilant of, not only personal and family histories of depression, but also current sleep problems and recent very upsetting events, because these “are strong risk factors for a pernicious depression course.”


1. Bromberger JT, Kravitz HM, Youk A, et al. Patterns of depressive disorders across 13 years and their determinants among midlife women: SWAN mental health study. J Affect Disord. 2016;206:31-40.


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