Depression and Associated Factors Among Perimenopausal Women: A Cross-Sectional Study in Ho Chi Minh City, Vietnam

The rise in life expectancy leads to women spending a considerable duration in the postmenopausal phase. 1 Menopause is identified as the definite end of menstrual cycles, 2 usually taking place between the ages of 48 and 52, 3 and is associated with profound hormonal shifts, notably a reduction in estradiol levels. 4 Perimenopause represents a physiological transition phase from reproductive years to post menopause, marked by hormonal fluctuations and irregular menstrual cycles. 4 These hormonal changes not only induce vasomotor symptoms but also impact mental well-being, potentially leading to conditions such as depression. 5 , 6 While perimenopause is not strictly age-dependent, it is generally observed in women aged 45–55, 7 mainly due to menstrual and hormonal alterations. During this phase, women face numerous biological, psychological, and social transformations, heightening the risk of mental health issues, particularly depression. Consequently, this study addresses on women aged 45–55 to evaluate depressive symptoms in this vulnerable demographic during perimenopause. Depressive disorder is a prevalent mental health issue that occurs more frequently in females than males, being especially common among middle-aged women. 8 , 9 The incidence of depression in women who are perimenopausal or postmenopausal ranges from approximately 19% to over 40%, varying by study, thereby underscoring a significant health challenge. 10–13 Ho Chi Minh City is undergoing rapid population aging alongside a continuously low birth rate, resulting in an elevated proportion of middle-aged and older women within the community. 14 This demographic structure illustrates the ongoing trend of population aging in Ho Chi Minh City amid years of low fertility rates, increasing the number of women transitioning into premenopausal and menopausal phases. Given this scenario, addressing mental health concerns, particularly depression among women undergoing menopause, is becoming increasingly critical. As per the 2024 population statistics, Ho Chi Minh City has around 4,754,542 women, representing approximately 51.3% of the total populace. Among them, middle-aged and older women constitute a considerable segment; specifically, those between 45 and 55 years make up about 650,000 individuals, nearly 26.7% of the city’s female population. 15 Despite growing focus on mental health, research on depression in perimenopausal and postmenopausal women remains scarce, especially in community-based studies. Additionally, regional disparities in cultural characteristics, lifestyles, and access to healthcare can influence the prevalence and presentation of depressive disorders. Therefore, it is essential to ascertain the prevalence of depression and associated factors in perimenopausal women within the community. This research intends to identify the frequency and elements connected to depressive disorders among perimenopausal women in Ho Chi Minh City.

A cross-sectional study focusing on community involvement was conducted from March 1, 2025, to December 30, 2025. The study included Vietnamese women aged 45 to 55 residing in Ho Chi Minh City for a minimum of one year prior to the interview. Participants who were deaf, mute, or had mental health issues, as well as those who were unable to complete the questionnaire independently due to illiteracy, were excluded from the research. Sample size was calculated using a formula estimating a prevalence rate in the community. Parameters used in calculating sample size included a type 1 error probability of 0.05, a margin of error of 0.05, and a design effect of 1.5. Based on previous studies, the prevalence of depression in perimenopausal women (p) ranged from 27% to 40%. 11 , 16 A study conducted in Vietnam in a hospital setting recorded this rate as 37.9%. 17 Because the prevalence of depression in perimenopausal women recorded in previous studies varied considerably, this study chose p = 40% to calculate the sample size to ensure sufficient sample capacity for the main research objective. With the above parameters, the minimum sample size required for the study was 554 women aged 45 to 55 years. A community-based cross-sectional study was undertaken employing a multi-stage cluster sampling technique for participant selection. Initially, six out of the sixteen inner-city districts in Ho Chi Minh City were chosen using the probability proportion to size (PPS) approach, specifically District 1, District 7, District 10, Binh Thanh District, Go Vap District, and Binh Tan District. In the second phase, four wards were randomly selected from each of the identified districts for the study. The research team reached out to the District Health Center to get in touch with the relevant ward health stations, which assisted in the data collection process. Following the identification of the wards for study, the research team worked together with the ward health station to develop a list of eligible women and extend invitations for participation at the health station. The researchers outlined the study’s aims and content, provided information forms about the research, and secured written consent prior to data collection. Once consent was obtained, participants filled out the questionnaire independently in a designated area to maintain privacy and confidentiality. Any individuals who opted out of participation or withdrew from the study were treated with respect and replaced by other eligible subjects within the same sampling framework. Those exhibiting screening results indicative of depression or needing professional assistance were offered counseling and referred to suitable healthcare facilities for further assessment. The interview questionnaire included information about personal and social characteristics, medical history, lifestyle habits, premenopausal symptoms, and depressive symptoms. The demographic characteristics of patients included variables such as age, age group (45–47; 48–52; 53–55), ethnicity (Kinh; other ethnicities), occupation (blue labor; white labor; housewife or retired), religion (Buddhism; Catholicism; no religion and other religions), marital status (single; married; separated and widowed), income grouped into 380 USD/month according to income levels commonly used in sociological and public health studies in Vietnam, residential status (owning a house; renting a house), educational level (below secondary school; secondary school; college/university), and body mass index (BMI). Body mass index (BMI) is calculated based on weight and height and then categorized into three groups, including: underweight (< 18.5), normal (18.5–< 23.0) and overweight/obese (≥ 23) for Asian women. 18 The historical characteristics include variables such as the number of births (never given birth, given 1 child, given ≥ 2 children), history of domestic violence (yes/no), history of depression (yes/no), history of chronic medical conditions (yes/no), history of adennomyosis (yes/no), history of endometriosis in the ovaries (yes/no), history of gynecological surgery (yes/no). For the variable of having experienced domestic violence, we rely on the National Guidelines on Reproductive Health Care Services of the Ministry of Health of Vietnam 19 which defines that if one of the four forms of violence is present: psychological violence, physical violence, reproductive and sexual violence, or economic violence, it will be classified as having experienced domestic violence. The variable representing a history of domestic violence was collected using a research questionnaire developed by the research team based on the National Guidelines on Reproductive Health Care Services of the Ministry of Health of Vietnam. Lifestyle characteristics include variables such as smoking (yes/no), alcohol addiction (yes/no), caring for children under 5 years old (yes/no), and worrying about family matters (yes/no). For the alcohol addiction variable, we relied on the standards of the International Classification of Diseases, 10th edition (ICD-10). 20 Characteristics of menstrual issues include variables such as menstrual status (little change; significant change in cycle and amount; menopause ≤ 1 year; menopause > 1 year), hot flashes in the past month (present/absent), night sweats in the past month (present/absent), vaginal dryness in the past month (present/absent), and pain during intercourse in the past month (no intercourse; no pain; pain). Depression status was assessed using the Patient Health Questionnaire-9 (PHQ-9) scale. The total score was summed and categorized into none (0–4), mild (5–9), moderate (10–14), moderately severe (15–19), and severe (20–27). 21 A total PHQ-9 score ≥ 5 was considered indicative of depressive symptoms. The PHQ-9 scale has been shown to be a reliable and valuable tool in screening for depressive disorders. 21 , 22 With a cutoff threshold of ≥ 5, the tool has high sensitivity, estimated at approximately 0.91 (95% CI: 0.85–0.95) and specificity at approximately 0.61 (95% CI: 0.51–0.69), suggesting effective screening in the community. 23 The PHQ-9 scale has been translated into Vietnamese, and the reliability and validity of the Vietnamese version have been confirmed. 24 Several studies in Vietnam using the Vietnamese version of the PHQ-9 tool have also shown high sensitivity and specificity. 25 Data from the research were input and stored using Epi Info 7.2 software developed by the Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia, USA. Stata 17.0 software from Stata Corp LLC, based in College Station, Texas, USA, was utilized for data analysis. Descriptive statistics such as frequency and percentage were employed for qualitative variables. For quantitative variables, the mean and standard deviation were reported if the data followed a normal distribution; otherwise, the median and interquartile range were used to describe the data. To identify factors related to depression, cluster-adjusted logistic regression analysis was conducted. Variables that reached statistical significance in the univariate logistic regression analysis were incorporated into the multivariate logistic regression model, with a p-value of 0.05. The results are presented as Prevalence Odds Ratios and adjusted Prevalence Odds Ratios, along with 95% confidence intervals. This study was conducted in accordance with the Declaration of Helsinki revised in 2013. All research procedures were conducted in accordance with relevant guidelines and approved by the Biomedical Research Ethics Committee of the University of Medicine and Pharmacy of Ho Chi Minh City (No. 3653/DHYD-HDDD dated November 20, 2024). Informed consent was obtained from all participants. If screening revealed a risk of depression, research subjects were referred to the mental health center at Nguyen Tri Phuong Hospital, Ho Chi Minh City, for further examination and management.

From March 1, 2025, to December 30, 2025, a total of 669 women were enrolled in the study. The average age of the study participants was 49.2 ± 3.4 years. The majority were Kinh (92.4%), living with their spouses (78.5%), and had a normal BMI (50.8%). Most had at least secondary education and monthly incomes ranging from $190 to $380. Other socioeconomic characteristics of the study participants are presented in Table 1 . Table 1 Characteristics of Study Participants Characteristics Total (n = 669) Percentage (%) Age in years * : 49.2 ± 3.4 (min = 45; max = 55)  45–47 269 40.2  48–52 253 37.8  53–55 147 22.0 People  Kinh 618 92.4  Other 51 7.6 Occupation  Blue labor 264 39.5  White labor 246 36.8  Homemaker/Retier 159 23.8 Religion  None 313 46.8  Buddha 272 40.7  Catholic 66 9.9  Other 18 2.7 Educational level  Junior secondary 104 15.6  Senior secondary 322 48.1  College or higher 243 36.3 Weight (kg)* : 56.5 ± 6.6 (min = 37, max = 86) Height (m)* : 1.57 ± 0.05 (min = 1.30; max = 1.75) BMI (kg/m 2 )* : 23.0 ± 2.6 (min = 14.0; max = 35.8)  Light weight 16 2.4  Normal 340 50.8  Over weight 313 46.8 Marrital status  Single 76 11.4  Married 525 78.5  Separation 54 8.1  Widow 14 2.1 Economic status  380 USD/month 150 22.4 Housing  Owning 484 72.4  Renting 185 27.7 Notes : *: Mean ± SD (Minimum Value, Maximum Value). Characteristics of Study Participants Notes : *: Mean ± SD (Minimum Value, Maximum Value). Table 2 indicates that the majority of women in the study have given birth to two or more children (59.8%) and do not have significant obstetric or medical histories. The prevalence of a history of depression, smoking, and ovarian endometriosis is relatively low (2.1%, 1.4%, and 1.2%, respectively). However, 31.1% of women reported experiencing anxiety related to family matters, while 11.4% are currently caring for children under the age of five. Table 2 The Historical Characteristics of the Study Subjects Characteristics Total (n = 669) Percentage (%) Number of births  None 76 11.4  1 193 28.9  ≥ 2 400 59.8 Domestic violence  No 638 95.4  Yes 31 4.6 History of Depression  No 655 97.9  Yes 14 2.1 Chronic internal diseases  No 603 90.1  Yes 66 9.9 History of Adenomyosis  No 634 94.8  Yes 35 5.2 History of ovarian endometriosis  No 661 98.8  Yes 8 1.2 History of gynecological surgery  No 635 94.9  Yes 34 5.1 Smoking  No 660 98.7  Yes 9 1.4 Alcoholic Addiction  No 629 94.0  Yes 40 6.0 Taking care of children under 5 years old  No 593 88.6  Yes 76 11.4 Concern about family issues  No 461 68.9  Yes 208 31.1 The Historical Characteristics of the Study Subjects Table 3 indicates that the average age of menopause is 49.7 ± 2.6 years. The perimenopausal symptoms observed include hot flashes (27.4%), vaginal dryness (25.1%), and night sweats (21.8%). Additionally, 16.6% of women reported experiencing pain during intercourse. It is noteworthy that 10.6% of women do not engage in sexual activity. Table 3 Characteristics of the Menstrual Cycle of the Research Subjects Characteristics Total (n = 669) Percentage (%) Menstrual-cycle status  Still remains 518 77.4  Menopause 151 22.6 Among menstrual cycle remain (n = 518)  Normal 392 75.7  Abnormal 126 24.3 Among Menopause (n = 151)  Menopause ≤ 1 year 48 31.8  Menopause > 1 year 103 68.2 Age of Menopause (n = 151) * : 49.7 ± 2.6 (min = 39; max = 54) Hot flush  No 486 72.7  Yes 183 27.4 Night sweats  No 523 78.2  Yes 146 21.8 Vaginal dryness  No 501 74.9  Yes 168 25.1 Painful intercourse  No sexual activity 71 10.6  No 487 72.8  Yes 111 16.6 Notes : *: Mean ± SD (Minimum Value, Maximum Value). Characteristics of the Menstrual Cycle of the Research Subjects Notes : *: Mean ± SD (Minimum Value, Maximum Value). Figure 1 demonstrates the occurrence of depression in women around menopause categorized by age groups in the study, highlighting the disparities in depressive conditions among those aged 45 to 55. Figure 1 Depression prevalences vary by age group. A stacked bar graph showing depression and no depression across age groups from 45 to 55 years old. Depression prevalences vary by age group. Figure 1 shows that 25.1% of women experience depression during the perimenopausal phase. Among different age groups, those aged 53 to 55 have the highest rate of 27.9%, followed by ages 45 to 47 at 26.4%, and the lowest prevalence is in the 48 to 52 age group at 22.1%. To examine the relationship between depression and associated factors in perimenopausal women, the study employed both univariate and multivariate logistic regression analysis. Following the univariate analysis, 12 statistically significant factors (p < 0.05) and 2 potential factors (p < 0.2) were identified. In total, 14 variables were included in the multivariate regression model to account for confounding factors and to ascertain the independent correlates ( Table 4 ). Table 4 Results of Multivariate Regression Characteristics Depression POR POR* CI 95% P* Yes n = 168 (%) No n = 501 (%) Age (years old)  53–55 41 (27.9) 106 (72.1) 1.08 0.88 0.53–1.48 0.64  48–52 56 (22.1) 197 (77.9) 0.79 0.61 0.38–0.98 0.04  45–47 71 (26.4) 198 (73.6) 1 1 Educational level  Senior secondary or higher 131 (23.2) 434 (76.8) 0.55 0.94 0.55–1.62 0.84  Junior secondary 37 (35.6) 67 (64.4) 1 1 Domestic violence  Yes 20 (64.5) 11 (35.5) 6.02 4.72 1.99–11.18 < 0.01  No 148 (23.2) 490 (76.8) 1 1 Chronic internal diseases  Yes 28 (42.4) 38 (57.6) 2.44 1.85 1.00–3.42 0.049  No 140 (23.2) 463 (76.8) 1 1 History of Adenomyosis  Yes 13 (37.1) 22 (62.9) 1.83 0.87 0.37–2.04 0.75  No 155 (24.5) 479 (75.6) 1 1 History of gynecological surgery  Yes 13 (38.2) 21 (61.8) 1.92 1.41 0.59–3.38 0.44  No 155 (24.4) 480 (75.6) 1 1 Smoking  Yes 7 (77.8) 2 (22.2) 10.85 4.40 0.70–27.52 0.11  No 161 (24.4) 499 (75.6) 1 1 Alcoholic Addiction  Yes 20 (50.00 20 (50.0) 3.25 1.87 0.87–4.02 0.11  No 148 (23.5) 481 (76.5) 1 1 Taking care of children under 5 years old  Yes 27 (35.5) 49 (64.5) 1.77 1.38 0.75–2.52 0.30  No 141 (23.8) 452 (76.2) 1 1 Concern about family issues  Yes 83 (39.9) 125 (60.1) 2.94 1.68 1.08–2.59 0.02  No 85 (18.4) 376 (81.6) 1 1 Hot flush  Yes 80 (43.7) 103 (56.3) 3.51 2.04 1.29–3.23 < 0.01  No 88 (18.1) 398 (81.9) 1 1 Night sweats  Yes 70 (48.0) 76 (52.1) 3.99 2.33 1.41–3.83 < 0.01  No 98 (18.7) 425 (81.3) 1 1 Vaginal dryness  Yes 64 (38.1) 104 (61.9) 2.35 0.88 0.51–1.53 0.70  No 104 (20.8) 397 (79.2) 1 1 Painful intercourse  No sexual activity 17 (23.9) 54 (76.1) 1.23 0.97 0.49–1.88 0.92  Yes 52 (46.8) 59 (53.2) 3.45 2.02 1.13–3.60 0.02  No 99 (20.3) 388 (79.7) 1 1 Notes : *: Multivariate regression adjustment. P-value with bold: significant differences. Results of Multivariate Regression Notes : *: Multivariate regression adjustment. P-value with bold: significant differences. Following multivariate analysis, the independent factors associated with depression include experiencing domestic violence (POR = 4.72; 95% CI: 1.99–11.18), having a chronic medical condition (POR = 1.85; 95% CI: 1.00–3.42), concerning family issues (POR = 1.68; 95% CI: 1.08–2.59), experiencing hot flashes (POR = 2.04; 95% CI: 1.29–3.23), and experiencing pain during intercourse (POR = 2.02; 95% CI: 1.13–3.60). In contrast, individuals aged 48 to 52 have a lower likelihood of experiencing depression compared to those aged 45 to 47 (POR = 0.61; 95% CI: 0.38–0.98).

The prevalence of depression among perimenopausal women was found to be 25.1% (95% CI: 21.9–28.6). In Vietnam, depression remains a significant issue for this demographic group. This rate is higher than that observed in women of reproductive age and is similar to the prevalence seen in older women. Such findings suggest that the perimenopausal stage is particularly critical for mental health, highlighting the need for community-based screening and proactive intervention strategies. Factors linked to increased depression risk included domestic violence (POR = 4.72), chronic health issues (POR = 1.85), anxiety related to family matters (POR = 1.68), hot flashes (POR = 2.04), and painful sexual intercourse (POR = 2.02). Recognizing these risk factors can enhance healthcare providers’ ability to effectively screen and counsel perimenopausal women regarding their mental health.

This study was conducted within the community in Vietnam, focusing on the prevalence of depressive symptoms among women undergoing menopause (ages 45–55). The PHQ-9 scale was employed in this research, using a cutoff score of ≥5 points to screen for instances of depressive symptoms in the community. The findings indicated that 25.1% of women exhibited depressive symptoms, which falls within the range reported by prior studies utilizing the same PHQ-9 scale with a cutoff of ≥5 points. Specifically, this percentage is comparable to that found in a study by Ps in India (26.1%), 11 but is significantly lower than those reported in studies conducted in the United States (38.2%), 16 Canada (37.7%), 26 and the UAE (56.6%). 27 Conversely, the prevalence of depression in our study was higher compared to Li’s research in China (13.6%). 28 The variations in depression rates across these studies may be attributed to differences in the demographic characteristics of the study populations, cultural and social contexts, economic conditions, healthcare systems, and awareness of mental health. Furthermore, despite the use of the same assessment tool and cutoff score, differences in sampling methods, survey timing, sample size, and participant characteristics may also contribute to the observed variability in the reported rates of depression ( Table 5 ). Table 5 Compare the Prevalence of Depression with Findings from Other Authors Authors Nation Size Sample Research Tools (Cut off Point) Prevalence Ps (2017) 11 India Degree 594 PHQ-9 (≥ 5) 26.1% Li (2019) 27 China 5537 PHQ-9 (≥ 5) 13.6% Kapoor (2021) 16 United States 1670 PHQ-9 (≥ 5) 38.2% Vohra (2026) 28 UAE 279 PHQ-9 (≥ 5) 56.6% Brotto (2026) 26 Canada 1850 PHQ-9 (≥ 5) 37.7% Ours (2026) Vietnam 669 PHQ-9 (≥ 5) 25.1% Compare the Prevalence of Depression with Findings from Other Authors The study was conducted from March 2025 to December 2025, during which seasonal factors might have an impact on the depression levels of the participants. Nevertheless, existing evidence from systematic reviews and meta-analyses indicates that the relationship between seasons and depression rates is inconsistent, with a generally minor influence. 29 Additionally, Vietnam’s proximity to the equator suggests a lower likelihood of being affected by seasonal affective disorders. 30 Consequently, any potential bias introduced by seasonal factors in this research is considered negligible ( Table 6 ). Table 6 Comparison of Depression Prevalence Across Various Research Subjects Authors Study Participants Sample Size Research Tools (Cut off Point) Prevalence Guo (2018) 31 Women in reproductive age 3705 PHQ-9 (≥ 5) 10.8% Murray (2015) 32 Postpartum Women 431 EPDS (≥ 13) 18.1% NX Long (2023) 33 Postpartum Women 1086 EPDS (≥ 10) 16.9% NT Nguyen (2024) 34 Menopausal Women 1772 CES-D (≥ 6) 29.5% Ours (2026) Perimemopause menopause 669 PHQ-9 (≥ 5) 25.1% Comparison of Depression Prevalence Across Various Research Subjects In comparison to the general population of reproductive-aged women, the rate of depression among women approaching menopause is significantly higher. Guo’s research indicates that the prevalence of depression in reproductive-aged women in the United States is approximately 10.8%. 31 In Vietnam, the postpartum depression rate is below 20%. 32 , 33 Furthermore, when examining the depression rates among older women (over 60 years old) in Vietnam, the incidence of depression during the menopausal transition is almost similar. 34 Although comparisons between studies should be interpreted with caution due to variations in screening tools, cutoff thresholds, and demographic characteristics of the research populations, the findings suggest that the menopausal transition may represent a particularly vulnerable period for women’s mental health. This underscores the necessity for psychological support measures and early depression screening programs within the community of women undergoing menopause. The novelty of this study lies in providing community data on the prevalence of depression among peri-menopausal women in Ho Chi Minh City, utilizing a relatively large sample size, and identifying independent factors associated with this condition. The findings contribute to the empirical evidence regarding mental health in peri-menopausal women in Vietnam and may assist in developing screening programs, early detection, and appropriate interventions for high-risk groups. Firstly, the relatively high depression prevalence observed in a large community sample suggests that depressive disorders may remain undetected and inadequately managed among peri-menopausal women in Vietnam. Secondly, early and regular screening, followed by optimal treatment, could benefit this group of women and alleviate the burden of depression on the healthcare system. Third, the study identified various factors independently related to depression in peri-menopausal women. Specifically, a history of domestic violence, chronic medical conditions, anxiety over family issues, hot flashes, and pain during intercourse are independent factors that increase the risk of depression. Lastly, the findings from this research will offer scientific backing for the formulation of suitable intervention strategies aimed at the early detection, management, and enhancement of mental health for this demographic. The study has several limitations. The cross-sectional design does not allow for the identification of causal relationships between the associated factors and depression. Additionally, the use of self-reported questionnaires may introduce information bias due to recall inaccuracies among participants. While we attempted to minimize this bias by employing standardized data collection tools and ensuring privacy during responses, the possibility of bias cannot be eliminated. Furthermore, the PHQ-9 scale, with a cut-off score of ≥ 5, serves as a high-sensitivity screening tool for early detection of depressive symptoms in the community, rather than a clinical diagnostic instrument. Therefore, similar to other community studies, this research only reflects the prevalence of women exhibiting depressive symptoms based on initial screening. Participants require further specialized assessments for an accurate diagnosis of their condition.