Hysterectomy and incidence of depressive symptoms in midlife women: the Australian Longitudinal Study on Women's Health.

Louise F. Wilson, Nirmala Pandeya, Byles J, Gita D. Mishra
Epidemiology and psychiatric sciences · 2018 · doi:10.1017/s2045796016001220 · PMID:28190411 · PMC6998864
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A 12-year longitudinal analysis of midlife Australian women found that hysterectomy with ovarian conservation or bilateral oophorectomy increases the long-term incidence of depressive symptoms, independent of lifestyle factors.

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This study utilized data from the Australian Longitudinal Study on Women's Health to examine the association between hysterectomy and the incidence of depressive symptoms among midlife women. The researchers analyzed longitudinal data to determine whether undergoing a hysterectomy increased the risk of developing depression compared to women who did not have the procedure. Key findings indicated that women who underwent hysterectomies had a higher incidence of depressive symptoms in the years following surgery, even after adjusting for various confounding factors such as age and baseline health status. Relevance to endometriosis: Hysterectomy is a definitive surgical treatment option for severe, refractory endometriosis, making this paper relevant to understanding the mental health outcomes associated with one of the potential management strategies for the condition.

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Abstract

AimsThere is limited longitudinal research that has looked at the longer term incidence of depressive symptoms, comparing women with a hysterectomy to women without a hysterectomy. We aimed to investigate the association between hysterectomy status and the 12-year incidence of depressive symptoms in a mid-aged cohort of Australian women, and whether these relationships were modified by use of exogenous hormones.MethodsWe used generalised estimating equation models for binary outcome data to assess the associations of the incidence of depressive symptoms (measured by the 10-item Centre for Epidemiologic Studies Depression Scale) across five surveys over a 12-year period, in women with a hysterectomy with ovarian conservation, or a hysterectomy with bilateral oophorectomy compared with women without a hysterectomy. We further stratified women with hysterectomy by their current use of menopausal hormone therapy (MHT). Women who reported prior treatment for depression were excluded from the analysis.ResultsCompared with women without a hysterectomy (n = 4002), both women with a hysterectomy with ovarian conservation (n = 884) and women with a hysterectomy and bilateral oophorectomy (n = 450) had a higher risk of depressive symptoms (relative risk (RR) 1.20; 95% confidence interval (CI) 1.06-1.36 and RR 1.44; 95% CI 1.22-1.68, respectively). There were differences in the strength of the risk for women with a hysterectomy with ovarian conservation, compared with those without, when we stratified by current MHT use. Compared with women without a hysterectomy who did not use MHT, women with a hysterectomy with ovarian conservation who were also MHT users had a higher risk of depressive symptoms (RR 1.57; 95% CI 1.31-1.88) than women with a hysterectomy with ovarian conservation but did not use MHT (RR 1.17; 95% CI 1.02-1.35). For women with a hysterectomy and bilateral oophorectomy, MHT use did not attenuate the risk. We could not rule out, however, that the higher risk seen among MHT users may be due to confounding by indication, i.e. MHT was prescribed to treat depressive symptoms, but their depressive symptoms persisted.ConclusionsWomen with a hysterectomy (with and without bilateral oophorectomy) have a higher risk of new incidence of depressive symptoms in the longer term that was not explained by lifestyle or socio-economic factors.
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Crossref Citations This article has been cited by the following publications. This list is generated based on data provided by Crossref. Dohbit, Julius Sama Foumane, Pascal Nkwabong, Elie Kamouko, Christelle Ogolong Tochie, Joel Noutakdie Otabela, Bernard and Mboudou, Emile 2017. Uterus preserving surgery versus hysterectomy in the treatment of refractory postpartum haemorrhage in two tertiary maternity units in Cameroon: a cohort analysis of perioperative outcomes. BMC Pregnancy and Childbirth, Vol. 17, Issue. 1, Harnod, Tomor Chen, Weishan Wang, Jen-Hung Lin, Shinn-Zong and Ding, Dah-Ching 2018. Hysterectomies Are Associated with an Increased Risk of Depression: A Population-Based Cohort Study. Journal of Clinical Medicine, Vol. 7, Issue. 10, p. 366. Gazzuola Rocca, Liliana Smith, Carin Y. Bobo, William V. Grossardt, Brandon R. Stewart, Elizabeth A. Laughlin-Tommaso, Shannon K. and Rocca, Walter A. 2019. 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