Hostname: page-component-586b7cd67f-vdxz6 Total loading time: 0 Render date: 2024-11-30T19:47:51.208Z Has data issue: false hasContentIssue false
  • English
  • Français

Hysterectomy and incidence of depressive symptoms in midlife women: the Australian Longitudinal Study on Women's Health

Published online by Cambridge University Press:  13 February 2017

L. Wilson Open the ORCID record for L. Wilson [Opens in a new window] ,
N. Pandeya ,
J. Byles  and
G. Mishra
L. Wilson*
Affiliation:
The University of Queensland, Centre for Longitudinal and Life Course Research, School of Public Health, Public Health Building, Herston Road, Herston, QLD 4006, Australia
N. Pandeya
Affiliation:
The University of Queensland, Centre for Longitudinal and Life Course Research, School of Public Health, Public Health Building, Herston Road, Herston, QLD 4006, Australia QIMR Berghofer Medical Research Institute, 300 Herston Road, Herston, QLD 4006, Australia
J. Byles
Affiliation:
Faculty of Health and Medicine, Research Centre for Generational Health and Ageing, The University of Newcastle, Newcastle, Australia
G. Mishra
Affiliation:
The University of Queensland, Centre for Longitudinal and Life Course Research, School of Public Health, Public Health Building, Herston Road, Herston, QLD 4006, Australia
*
*Address for correspondence: L. F. Wilson, The University of Queensland, Centre for Longitudinal and Life Course Research, School of Public Health, Public Health Building, Herston Road, Herston, QLD 4006, Australia. (Email: [email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Aims.

There is limited longitudinal research that has looked at the longer term incidence of depressive symptoms, comparing women with a hysterectomy to women without a hysterectomy. We aimed to investigate the association between hysterectomy status and the 12-year incidence of depressive symptoms in a mid-aged cohort of Australian women, and whether these relationships were modified by use of exogenous hormones.

Methods.

We used generalised estimating equation models for binary outcome data to assess the associations of the incidence of depressive symptoms (measured by the 10-item Centre for Epidemiologic Studies Depression Scale) across five surveys over a 12-year period, in women with a hysterectomy with ovarian conservation, or a hysterectomy with bilateral oophorectomy compared with women without a hysterectomy. We further stratified women with hysterectomy by their current use of menopausal hormone therapy (MHT). Women who reported prior treatment for depression were excluded from the analysis.

Results.

Compared with women without a hysterectomy (n = 4002), both women with a hysterectomy with ovarian conservation (n = 884) and women with a hysterectomy and bilateral oophorectomy (n = 450) had a higher risk of depressive symptoms (relative risk (RR) 1.20; 95% confidence interval (CI) 1.06–1.36 and RR 1.44; 95% CI 1.22–1.68, respectively). There were differences in the strength of the risk for women with a hysterectomy with ovarian conservation, compared with those without, when we stratified by current MHT use. Compared with women without a hysterectomy who did not use MHT, women with a hysterectomy with ovarian conservation who were also MHT users had a higher risk of depressive symptoms (RR 1.57; 95% CI 1.31–1.88) than women with a hysterectomy with ovarian conservation but did not use MHT (RR 1.17; 95% CI 1.02–1.35). For women with a hysterectomy and bilateral oophorectomy, MHT use did not attenuate the risk. We could not rule out, however, that the higher risk seen among MHT users may be due to confounding by indication, i.e. MHT was prescribed to treat depressive symptoms, but their depressive symptoms persisted.

Conclusions.

Women with a hysterectomy (with and without bilateral oophorectomy) have a higher risk of new incidence of depressive symptoms in the longer term that was not explained by lifestyle or socio-economic factors.

Keywords

Depressionepidemiologyprospective studywomen
Type
Original Articles
Information
Epidemiology and Psychiatric Sciences , Volume 27 , Issue 4 , August 2018 , pp. 381 - 392
Copyright
Copyright © Cambridge University Press 2017 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Andresen, EM, Malmgren, JA, Carter, WB, Patrick, DL (1994). Screening for depression in well older adults: evaluation of a short form of the CES-D (Center for Epidemiologic Studies Depression Scale). American Journal of Preventive Medicine 10, 77–84.Google Scholar
Barker, MG (1968). Psychiatric illness after hysterectomy. British Medical Journal 2, 91–95.Google Scholar
Blumel, JE, Chedraui, P, Baron, G, Benitez, Z, Flores, D, Espinoza, MT, Gomez, G, Gonzalez, E, Hernandez, L, Lima, S, Martino, M, Montano, A, Monterrosa, A, Mostajo, D, Ojeda, E, Onatra, W, Robles, C, Saavedra, J, Sanchez, H, Tserotas, K, Vallejo, MS, Vallejo, C, Collaborative Group for Research of the Climacteric in Latin, A. (2014). A multicentric study regarding the use of hormone therapy during female mid-age (REDLINC VI). Climacteric 17, 433–441.CrossRefGoogle ScholarPubMed
Cabness, J (2010). The psychosocial dimensions of hysterectomy: private places and the inner spaces of women at midlife. Social Work in Health Care 49, 211–226.Google Scholar
Chou, PH, Lin, CH, Cheng, C, Chang, CL, Tsai, CJ, Tsai, CP, Lan, TH, Chan, CH (2015). Risk of depressive disorders in women undergoing hysterectomy: a population-based follow-up study. Journal of Psychiatric Research 68, 186–191.Google Scholar
Colditz, GA, Stampfer, MJ, Willett, WC, Stason, WB, Rosner, B, Hennekens, CH, Speizer, FE (1987). Reproducibility and validity of self-reported menopausal status in a prospective cohort study. American Journal of Epidemiology 126, 319–325.CrossRefGoogle ScholarPubMed
Commonwealth Department of Health and Aged Care (1999). An Active Way to Better Health: National Physical Activity Guidelines for Adults. AGPS: Cancerra, AUST.Google Scholar
Darwish, M, Atlantis, E, Mohamed-Taysir, T (2014). Psychological outcomes after hysterectomy for benign conditions: a systematic review and meta-analysis. European Journal of Obstetrics, Gynecology, and Reproductive Biology 174, 5–19.CrossRefGoogle ScholarPubMed
Dennerstein, L, Guthrie, JR, Clark, M, Lehert, P, Henderson, VW (2004). A population-based study of depressed mood in middle-aged, Australian-born women. Menopause 11, 563–568.Google Scholar
Dobson, AJ, Hockey, R, Brown, WJ, Byles, JE, Loxton, DJ, McLaughlin, D, Tooth, LR, Mishra, GD (2015). Cohort profile update: Australian longitudinal study on women's health. International Journal of Epidemiology 44, 1547, 1547a–1547f.Google Scholar
Elson, J (2003). Hormonal hierarchy – hysterectomy and stratified stigma. Gender and Society 17, 750–770.Google Scholar
Farquhar, CM, Sadler, L, Stewart, AW (2008). A prospective study of outcomes five years after hysterectomy in premenopausal women. Australian and New Zealand Journal of Obstetrics and Gynaecology 48, 510–516.Google Scholar
Guthrie, JR, Dennerstein, L, Dudley, EC (1999). Weight gain and the menopause: a 5-year prospective study. Climacteric 2, 205–211.CrossRefGoogle ScholarPubMed
Hammer, A, Rositch, AF, Kahlert, J, Gravitt, PE, Blaakaer, J, Sogaard, M (2015). Global epidemiology of hysterectomy: possible impact on gynecological cancer rates. American Journal of Obstetrics and Gynecology 213, 23–29.CrossRefGoogle ScholarPubMed
Hehenkamp, WJ, Volkers, NA, Broekmans, FJ, de Jong, FH, Themmen, AP, Birnie, E, Reekers, JA, Ankum, WM (2007). Loss of ovarian reserve after uterine artery embolization: a randomized comparison with hysterectomy. Human Reproduction 22, 1996–2005.Google Scholar
Lee, C, Dobson, AJ, Brown, WJ, Bryson, L, Byles, J, Warner-Smith, P, Young, AF (2005). Cohort profile: the Australian longitudinal study on women's health. International Journal of Epidemiology 34, 987–991.Google Scholar
Moorman, PG, Myers, ER, Schildkraut, JM, Iversen, ES, Wang, F, Warren, N (2011). Effect of hysterectomy with ovarian preservation on ovarian function. Obstetrics and Gynecology 118, 1271–1279.Google Scholar
Nahas, E, Pontes, A, Traiman, P, NahasNeto, J, Dalben, I, De Luca, L (2003). Inhibin B and ovarian function after total abdominal hysterectomy in women of reproductive age. Gynecological Endocrinology 17, 125–131.Google Scholar
National Health and Medical Research Council (2001). Australian Alcohol Guidelines: Health Risks and Benefits. Endorsed October 2001. Commonwealth of Australia: Canberra, AC.Google Scholar
Parker, WH (2010). Bilateral oophorectomy versus ovarian conservation: effects on long-term women's health. Journal of Minimally Invasive Gynecology 17, 161–166.Google Scholar
Parker, WH, Jacoby, V, Shoupe, D, Rocca, W (2009). Effect of bilateral oophorectomy on women's long-term health. Womens Health (Lond Engl) 5, 565–576.Google Scholar
Payne, JL, Palmer, JT, Joffe, H (2009). A reproductive subtype of depression: conceptualizing models and moving toward etiology. Harvard Review of Psychiatry 17, 72–86.Google Scholar
Phipps, AI, Buist, DS (2009). Validation of self-reported history of hysterectomy and oophorectomy among women in an integrated group practice setting. Menopause 16, 576–581.Google Scholar
Redburn, JC, Murphy, MF (2001). Hysterectomy prevalence and adjusted cervical and uterine cancer rates in England and Wales. BJOG: An International Journal of Obstetrics and Gynaecology 108, 388–395.Google Scholar
Richards, DH (1974). A post-hysterectomy syndrome. Lancet 2, 983–985.Google Scholar
Rocca, WA, Grossardt, BR, Geda, YE, Gostout, BS, Bower, JH, Maraganore, DM, de Andrade, M, Melton, LJ III (2008). Long-term risk of depressive and anxiety symptoms after early bilateral oophorectomy. Menopause 15, 1050–1059.Google Scholar
Rositch, AF, Nowak, RG, Gravitt, PE (2014). Increased age and race-specific incidence of cervical cancer after correction for hysterectomy prevalence in the United States from 2000 to 2009. Cancer 120, 2032–2038.Google Scholar
Sarrel, PM, Sullivan, SD, Nelson, LM (2016). Hormone replacement therapy in young women with surgical primary ovarian insufficiency. Fertility and Sterility 106, 1580–1587.Google Scholar
Soares, CN (2014). Mood disorders in midlife women: understanding the critical window and its clinical implications. Menopause 21, 198–206.Google Scholar
Twisk, JWR (2013). Applied Longitudinal Data Analysis for Epidemiology. A Practical Guide, 2nd edn. Cambridge University Press: Cambridge, UK.Google Scholar
Whiteman, MK, Staropoli, CA, Benedict, JC, Borgeest, C, Flaws, JA (2003). Risk factors for hot flashes in midlife women. Journal of Womens Health (Larchmt) 12, 459–472.CrossRefGoogle ScholarPubMed
World Health Organisation Consultation on Obesity (1999). Obesity: Preventing and Managing the Global Epidemic: Report of a WHO Consultation. WHO: Geneva (CHE).Google Scholar
Worsley, R, Bell, RJ, Gartoulla, P, Davis, SR (2016). Low use of effective and safe therapies for moderate to severe menopausal symptoms: a cross-sectional community study of Australian women. Menopause 23, 11–17.Google Scholar
Xiangying, H, Lili, H, Yifu, S (2006). The effect of hysterectomy on ovarian blood supply and endocrine function. Climacteric 9, 283–289.Google Scholar
Yelland, LN, Salter, AB, Ryan, P (2011). Performance of the modified Poisson regression approach for estimating relative risks from clustered prospective data. American Journal of Epidemiology 174, 984–992.CrossRefGoogle ScholarPubMed
Zou, G (2004). A modified poisson regression approach to prospective studies with binary data. American Journal of Epidemiology 159, 702–706.Google Scholar
Supplementary material: File

Wilson supplementary material

Table S1

Download Wilson supplementary material(File)
File 19.1 KB