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Psychol Med. 2019 Jan;49(2):250-259. doi: 10.1017/S0033291718000703. Epub 2018 Apr 6.

Psychosocial and health-related risk factors for depressive symptom trajectories among midlife women over 15 years: Study of Women's Health Across the Nation (SWAN).

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Department of Epidemiology, Graduate School of Public Health,University of Pittsburgh, Pittsburgh, PA,USA.
Department of Social Sciences and Health Policy,Wake Forest School of Medicine,Winston-Salem, NC,USA.
Department of Medicine,University of Massachusetts Medical School,Worcester, MA,USA.
Department of Epidemiology,School of Public Health, University of Michigan,Ann Arbor, MI,USA.
Department of Psychiatry, Brigham and Women's Hospital,Harvard Medical School,Boston, MA,USA.
Department of Psychiatry and Department of Preventive Medicine,Rush University Medical Center,Chicago, IL,USA.



Psychosocial and health-related risk factors for depressive symptoms are known. It is unclear if these are associated with depressive symptom patterns over time. We identified trajectories of depressive symptoms and their risk factors among midlife women followed over 15 years.


Participants were 3300 multiracial/ethnic women enrolled in a multisite longitudinal menopause and aging study, Study of Women's Health Across the Nation. Biological, psychosocial, and depressive symptom data were collected approximately annually. Group-based trajectory modeling identified women with similar longitudinal patterns of depressive symptoms. Trajectory groups were compared on time-invariant and varying characteristics using multivariable multinomial analyses and pairwise comparisons.


Five symptom trajectories were compared (50% very low; 29% low; 5% increasing; 11% decreasing; 5% high). Relative to whites, blacks were less likely to be in the increasing trajectory and more likely to be in the decreasing symptom trajectory and Hispanics were more likely to have a high symptom trajectory than an increasing trajectory. Psychosocial/health factors varied between groups. A rise in sleep problems was associated with higher odds of having an increasing trajectory and a rise in social support was associated with lower odds. Women with low role functioning for 50% or more visits had three times the odds of being in the increasing symptom group.


Changes in psychosocial and health characteristics were related to changing depressive symptom trajectories. Health care providers need to evaluate women's sleep quality, social support, life events, and role functioning repeatedly during midlife to monitor changes in these and depressive symptoms.


Asians; Hispanics; blacks; depressive symptom trajectories; midlife women; risk factors


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