Associations between low sex hormone concentrations and depression in older women: An observational study

Rakibul M Islam; Robin J Bell; Michael Berk; David J Handelsman; John J McNeil; Rory Wolfe; Robyn L Woods; Susan R Davis

doi:10.1016/j.maturitas.2023.107822

Associations between low sex hormone concentrations and depression in older women: An observational study

Maturitas. 2023 Oct:176:107822. doi: 10.1016/j.maturitas.2023.107822. Epub 2023 Aug 4.

Authors

Rakibul M Islam¹, Robin J Bell², Michael Berk³, David J Handelsman⁴, John J McNeil⁵, Rory Wolfe⁶, Robyn L Woods⁷, Susan R Davis⁸

Affiliations

¹ Women's Health Research Program, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria 3004, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria 3004, Australia. Electronic address: rakib.islam@monash.edu.
² Women's Health Research Program, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria 3004, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria 3004, Australia. Electronic address: robin.bell@monash.edu.
³ The Institute for Mental and Physical Health and Clinical Translation Strategy Research Centre, Deakin University School of Medicine, Geelong, Australia; Department of Psychiatry, University of Melbourne, Parkville, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria 3004, Australia. Electronic address: michael.berk@deakin.edu.au.
⁴ ANZAC Research Institute, University of Sydney, New South Wales 2139, Australia. Electronic address: djh@sydney.edu.au.
⁵ School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria 3004, Australia. Electronic address: john.mcneil@monash.edu.
⁶ School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria 3004, Australia. Electronic address: rory.wolfe@monash.edu.
⁷ School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria 3004, Australia. Electronic address: robyn.woods@monash.edu.
⁸ Women's Health Research Program, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria 3004, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria 3004, Australia; Department of Endocrinology and Diabetes, Alfred Health, Melbourne 3004, Australia. Electronic address: susan.davis@monash.edu.

PMID: 37591034
DOI: 10.1016/j.maturitas.2023.107822

Abstract

Objective: We investigated whether low sex hormone concentrations are associated with depression in older women.

Study design: This was a cross-sectional study of Australian women, aged at least 70 years, not taking medications modulating sex hormone levels. Associations between hormones, measured by liquid chromatography-tandem mass spectrometry, and depression were examined by logistic regression adjusted for potential confounders.

Main outcome measures: The primary outcome was a Center for Epidemiologic Studies Depression score >10, designated as 'depression', with an expanded definition that included anti-depressant use as a secondary outcome.

Results: For the 5535 participants in the analysis, median age 74.0 years (interquartile range 71.7-77.7), depression prevalence was 5.8 % (95 % CI 5.2-6.4 %). In the adjusted models, a statistically significantly greater likelihood of depression was seen for women with testosterone and oestrone blood concentrations in quartile 1 compared with quartiles 2-4 (odds ratio 1.33, 95 % CI 1.04 to 1.70, p = 0.022; and 1.37, 95 % CI 1.06 to 1.78, p = 0.017, respectively). For the expanded definition, the odds ratios for the lowest testosterone and oestrone quartile compared with other quartiles were 1.47 (95 % CI 1.24 to 1.75, p < 0.001) and 1.31 (95 % CI 1.09 to 1.58, p < 0.001), respectively. A significant association for low DHEA was seen only for the expanded definition of depression (1.36, 95 % CI 1.13 to 1.64, p = 0.001). Receiver operating characteristic curves showed that the contribution of each sex hormone to the likelihood of depression was small.

Conclusions: Amongst older women not taking medications that influence sex hormone concentrations, low testosterone and oestrone levels are associated with a greater likelihood of depression, but the effects are small.

Trial registration: International Standard Randomized Controlled Trial Number Register (ISRCTN83772183) and clinicaltrials.gov (NCT01038583).

Keywords: DHEA; Depression; Mental disorders; Oestrone; Testosterone; Women.

Publication types

Observational Study

MeSH terms

Aged
Australia / epidemiology
Cross-Sectional Studies
Estrone*
Female
Gonadal Steroid Hormones*
Humans
Testosterone

Substances

Estrone
Gonadal Steroid Hormones
Testosterone

Associated data

ClinicalTrials.gov/NCT01038583