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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])
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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 

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