Depressive symptoms and associated factors among Iranian women at midlife: a community-based, cross-sectional study

OBJECTIVE: Little is known of depressive symptoms in Iranian women at midlife. This population-based study was undertaken to document the prevalence of, and factors associated with, depressive symptoms using validated questionnaires. METHODS: A total of 1,520 community-dwelling women, aged 40 to 64 years, residing in Sari, Northern Iran, were recruited, using multistage cluster sampling, to this cross-sectional study, between October 2016 and April 2017. Participants completed the Menopause Quality of Life Questionnaire, the Beck Depression Inventory-II, and the World Health Organization Well-being Index. RESULTS: Participants' mean age was 49.1 (7.0) years and 88.7% were married. Overall, 167 (11%) women had moderate-severe depressive symptoms, 837 (55.1%) had low psychological well-being, and 172 (11.3%) reported taking psychotropic medication in the prior month. Factors independently associated with moderate-severe depressive symptoms included moderate-severe vasomotor symptoms (VMS) (adjusted odds ratio [AOR] 2.6, 95% CI, 1.5-4.6; P = 0.001), age 60 years or older (AOR = 1.9, 95% CI, 1.1-3.5; P = 0.03), body mass index 30 to 39 kg/m (AOR = 1.8, 95% CI, 1.0-3.1; P = 0.04), and housing insecurity (AOR = 5.6, 95% CI, 3.7-8.3; P < 0.001). Education beyond high school was associated with a lower risk (AOR = 0.5, 95% CI, 0.3-0.9; P = 0.04). Women reporting low marital satisfaction (19.2% of married women) were more likely than women who were very satisfied to have moderate-severe depressive symptoms (AOR = 27.9, 95% CI, 10.5-74.2; P < 0.001). CONCLUSIONS: Marital relationship dissatisfaction, reported by one in five women, was strongly associated with moderate-severe depressive symptoms in women at midlife in Iran, in addition to moderate-severe VMS, housing insecurity, obesity, and older age.