The National Comorbidity Survey estimates that by the time women reach midlife, approximately 23% have experienced at least one episode of major depression and 30% have been diagnosed with an anxiety disorder. Depression and anxiety disorders are each associated with impaired functioning and lower quality of life (QOL). There is also some data to suggest that, even after a depressive episode resolves, those with a history of a affective illness have a lower quality of life than those without histories of depression, with impairment in social and interpersonal functioning.
Dr. Hadine Joffe from the Center for Women’s Mental Health recently published a study looking at the long-term effects of previous depression (with or without anxiety) on the quality of life in midlife women. This study included a total of 425 midlife women who were enrolled in the Study of Women’s Health Across the Nation (SWAN). All completed the Structured Clinical Interview for DSM-IV (SCID). The 36-Item Short Form Health Survey (SF-36) was administered annually during 6 years of follow-up in order to assess health-related quality of life (HRQOL).
Ninety-seven women (22.8%) had comorbid illness histories (depression and anxiety), 162 (38.1%) had previous depression only, and 21 (4.9%) had previous anxiety only. Those with histories of depression with comorbid anxiety and those with depression alone were twice as likely to report lower HRQOL than women with neither disorder. After adjusting for vasomotor symptoms and sleep disturbance, the comorbid group continued to have lower HRQOL, whereas the association was significant only for the social functioning (SF) and body pain (BP) domains in the depression alone group.
So what this study tells us is that even in the absence of an acute illness episode, women with a history of both depression and anxiety disorders are at risk for lower QOL during midlife. Although previous studies have shown that vasomotor symptoms (VMS) and sleep disruption are more common in women with histories of depression and/or anxiety and may contribute to lower QOL, the authors found that the association between previous illness and lower QOL is not explained by an increased vulnerability to these menopause-related symptoms.
Exactly how previous affective illness affects subsequent QOL in midlife women is not well understood at this point and will be a topic for further research. What is clear, however, is that midlife women with a history of affective illness should be monitored during the menopause transition. They are at increased risk of recurrence of depression and are more vulnerable to the emergence of vasomotor symptoms and sleep disturbance. And what this study tells us is that, even in the absence of acute depressive symptoms or anxiety, women with a history of affective illness are more vulnerable to lower quality of life.
Ruta Nonacs, MD PhD
Joffe H, Chang Y, Dhaliwal S, Hess R, Thurston R, Gold E, Matthews KA, Bromberger JT. Lifetime history of depression and anxiety disorders as a predictor of quality of life in midlife women in the absence of current illness episodes. Arch Gen Psychiatry. 2012 May; 69(5):484-92.