Heightened menopausal symptoms mediate the associations between stress and depressive symptoms among midlife women.

Objectives: Investigate associations between stress, cortisol, menopause symptoms, and depression in a sample of midlife women. Because stress has been associated with greater menopause symptoms, we examined this as a mediator for the association between stress and depressive symptoms.

Methods: Data from a cross-sectional study of 118 women (40-64 y old) were analyzed. Participants completed in-person visits and self-reported questionnaires, including the Menopause-Specific Quality of Life questionnaire, the Perceived Stress Scale, and the Center for Epidemiological Studies Depression Scale. Saliva samples were collected at 4 intervals upon waking (wake, 30 min, 45 min, and 60 min after waking), and one sample before bed, as a measure of cortisol. Both the diurnal cortisol slope and the cortisol area under the curve with respect to ground (AUCg) were used to characterize cortisol secretion and exposure. A multivariate analysis of variance determined differences in menopause symptoms and depression outcomes. Mediation models examined the indirect effects of menopause symptoms on associations between perceived stress and depressive symptoms.

Results: Women with moderate stress had significantly lower cortisol awakening responses (P = 0.047), poorer psychosocial (P < 0.001), physical (P < 0.001), and sexual (P<0.001) menopause symptoms, and depression symptoms (P < 0.001) compared to women with low stress. Mediation analyses (95% CI) between stress and depression demonstrated significant positive indirect effects of psychological (B = 0.247; 0.117, 0.355), physical (B = 0.120; 0.049, 0.210), and sexual menopause symptoms (B = 0.042; 0.006, 0.106).

Conclusions: Cross-sectional data revealed that greater stress was associated with poorer outcomes of menopause symptoms, depressive symptoms, and a lower cortisol awakening response. The association between stress and depression was mediated by the psychosocial, physical, and sexual menopause symptoms, and future longitudinal studies should seek to confirm these findings.