The researchers used the Menopause-Specific Quality of Life Questionnaire (MenQOL) to assess vasomotor symptoms and vaginal dryness during intercourse during the past month. VMS included 3 items: hot flashes, night sweats, and sweating. The symptoms were rated according to the “degree of bother caused by the symptom.”
Chronic medical conditions (cardiovascular, pulmonary, musculoskeletal, and metabolic diseases) were also included in the questionnaire.
Depression symptoms were assessed using the Beck Depression Inventory-II (BDI-II), and the total score was categorized as no/minimal (BDI-II score 0-13), mild (14-19), moderate (20-28), or severe (29-33) and were further categorized into a binary outcome of minimal-to-mild (BDI-II score <20) and moderate-to-severe (BDI-II score ≤20).
Participants were also asked to report use of psychotropic medications, including antidepressants, benzodiazepines, antipsychotics, and mood stabilizers.
The researchers found that the mean (SD) body mass index (BMI) of participants was 27.9 (5.9) mg/m2, with 32.4% being obese (BMI ≥30). Most participants were white (97.6%), living in metropolitan areas (66.0%), and currently partnered (52.8%). Only 39.2% were educated beyond high school and 13.5% reported being in paid employment. Of the participants, 7.5% were not confident of their housing security status.
Almost half (47.25%) of participants were classified as having symptomatic pelvic floor dysfunction, and approximately one-quarter (22.5%) reported having vaginal symptoms during intercourse during the past month. Of note, 83.5% of women had at least 1 chronic medical condition.
Overall, 34.2% (95% CI, 31.9%-36.7%) women had any VMS and of these women, 30.3% (95% CI, 28.0%-32.7%) had mild VMS, while 3.9% (95% CI, 3.0%-5.0%) had moderately to severely bothersome VMS.
When the researchers examined women with VMS by age, they found that the prevalence of any VMS was 41.0% (95% CI, 37.3%-44.9%) in women age 65 to 69, 31.9% (95% CI 27.9%-36.2%) in patients 70 to 74, and 25.1% (95% CI 20.9%-29.8%) in women 75 to 79.
As assessed by BDI-II scores, 14.1% (95% CI, 12.4%-15.9%) of the women were classified as having at least mild depressive symptoms and 6.3% (95% CI, 5.2%-7.7%) had moderate to severe depressive symptoms. One-quarter (25.4%) reported having been diagnosed with depression.
Moderate to severe depressive symptoms were more common in women using antidepressants, compared with women not taking these agents (16.6% vs 4.3%; P <.001).
After adjusting for covariates, the study found the following factors to be positively and independently associated with moderate to severe depressive symptoms: obesity (adjusted odds ratio [aOR] 2.18; 95% CI, 1.17-4.04 P <.05), living in financially insecure housing (aOR 3.84; 95% CI, 2.08-8.08, P <.001), being a caregiver (aOR 2.39; 95% CI, 1.36-4.19, P <.01), being a smoker (aOR 2.28; 95% CI 1.12-4.66, P <.001), having “any VMS” (aOR 1.67; 95% CI, 1.03-2.62, P <.05), having pelvic floor dysfunction (aOR 1.78; 95% CI, 1.08-2.94, P <.05), and having vaginal dryness during intercourse (aOR 1.84; 95% CI, 1.06-3.22, P <.05). On the other hand, being currently partnered (aOR 0.57; 95% CI, 0.33-0.97, P <.05) and being employed (aOR 0.38; 95% CI, 0.16-0.92, P <.05) were associated with a lower likelihood of depressive symptoms.
Women who reported any VMS were more likely to have used psychotropic medication in the past 4 weeks vs women who did not have VMS (35.7% vs 22.1%; Χ2=30.8, P <.001).
The researchers summarized their findings as: 1 in 15 (6.3%) community-dwelling older women had moderate to severe depressive symptoms and 1 in 4 (26.8%) had used one or more prescription drugs to treat these symptoms during the preceding month, which “highlights the burden of psychological symptoms amongst older Australian women and the high prevalence of use of psychotropic medications.”
They noted that the major independent factors associated with moderate to severe depressive symptoms were social/financial insecurity or the presence of physical conditions.
“Treatable conditions,” including VMS, symptomatic pelvic floor dysfunction, and vaginal dryness during intercourse, were each independently associated with moderate to severe depressive symptoms, an association that has been documented in previous studies, the investigators stated.
“That ‘any VMS’ in older women is associated with a nearly two-fold likelihood of moderate-to-severe depressive symptoms is noteworthy,” they concluded.
They added that their study highlights that “depressive symptoms are common and associated with VMS and other potentially modifiable risk factors in older women.” For this reason, they emphasize that “a full physical and psychosocial assessment with provision of social support should be integral to the management of depressive symptoms in this group, not merely antidepressant therapy.”