The Relative Contributions of Endocrine Changes and Social Circumstances to Depression in Mid-Aged Women

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Abstract
Although researched extensively over several decades, the prevalence, costs and reasons for depression among women during the middle years remain a challenge to public health. A vast literature is distilled into two predominant schools of thought, each with profoundly different implications for research and clinical practice. One school (the estrogen-deficiency perspective) holds that depression is associated with or triggered by endocrine changes in women around 50 years of age (menopause). A second school (the social-circumstances perspective) holds that depression is related to social circumstances encountered frequently by women during their fourth and fifth decades. Employing data from a randomly selected cohort of 2,500 premenopausal women sampled in Massachusetts [U.S.A], this paper shows that: depression is associated with a surgical menopause and may even be a cause rather than a consequence of this surgery for this atypical group of women; depression is not associated with the natural changes from pre- to immediately postmenopause; and the most marked increases in depression are associated with multiple causes of worry and multiple roles among currently married women (including paid work, adolescent children, ailing husbands, and aging parents or parents-in-law). Some implications of these findings are discussed in the context of a rapidly aging population.

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