Association of life events and depressive symptoms among early postmenopausal Chinese women in Hong Kong

OBJECTIVE: This study examined the occurrence of stressful life events (SLEs) and its association with the risk of developing depressive symptoms in midlife women. METHODS: A total of 518 Hong Kong Chinese postmenopausal women aged 50 to 64 years were recruited through random telephone dialing. Information on sociodemographic, health, and lifestyle variables was obtained through face-to-face interviews at baseline, and at 3-year (T1) and 5-year (T2) follow-up. A Centre of Epidemiological Study Depression scale (CES-D) score ≥16 was used to indicate high depressive symptoms. At T2, SLEs were assessed by a 21-item life-event scale, adapted from the Holmes and Rahe Social Readjustment Rating Scale for Adults. Potential confounders were controlled for in the multivariable logistic regression analysis on the relation between SLEs and high depressive symptoms among 379 women without CES-D score ≥16 at T1. RESULTS: 87.6% had experienced SLEs since T1 and 11.9% had CES-D score ≥16 at T2. Compared with those without SLEs, women with one to three SLEs had 2.7-fold (95% CI, 0.6-12.1) increased risk of having CES-D score ≥16, whereas those with four to nine SLEs had 5.2-fold (95% CI, 1.1-25.4) increased risk. A dose-response relationship was observed (P for trend = 0.005). Each additional SLEs experienced was associated with a 28% (95% CI, 1.07-1.54) increased risk of high depressive symptoms. CONCLUSIONS: Hong Kong Chinese women encounter many SLEs at midlife. Multiple episodes of SLE had a cumulative effect on the onset of depressive symptoms. Our findings have important implications for the identification and management of midlife women with high depressive symptoms.