Psychiatry - Theses
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ItemNegative mood and depressive symptoms from mid-life to late life: results of the women’s healthy ageing project( 2017)A substantial body of research has been conducted examining depressive symptom prevalence in the early stages of reproductive ageing, yet few studies have examined prevalence into the early and late postmenopause. Much of what is known about the relationship between mood and reproductive ageing is drawn from longitudinal, epidemiological studies of varying durations. This thesis aims to extend this research by utilising data from an Australian longitudinal study, the Women’s Healthy Ageing Project (WHAP), which is of adequate duration to assess mood changes from the late reproductive stage through to late postmenopause. The Women’s Healthy Ageing Project is an ongoing longitudinal, epidemiological study examining factors that contribute to women’s healthy ageing in a sample of community dwelling Australian women. At baseline, in 1992, women were aged between 45 and 55 years, with a mean age of 50 years. In 2012, the last assessment point utilised in this work, women were aged between 65 and 75 years. This project utilises data drawn from the first twenty years of the study, providing an assessment of mood factors spanning two decades. Measures used included the Negative Mood scale from the Affectometer 2 , the Centre for Epidemiological Studies Depression Scale – Short Form (CESD-SF) administered between 2002 and 2012, and the Geriatric Depression Scale – Short Form (GDS-SF) administered in 2012. The thesis is comprised of two main studies, each with two sub-studies. Study 1 explored prevalence rates of negative mood and depressive symptoms in regards to chronological ageing (Study 1.1). In the second sub-study negative mood scores (Affectometer-2) and depressive symptoms (CESD-SF) were examined in relation to the stages of reproductive ageing (Study 1.2). Within this thesis particular emphasis was placed on examining mood scores in the context of early postmenopause and late postmenopause, based on the STRAW+10 criteria, rather than the broader category of ‘postmenopause’ employed by numerous studies. The findings from Study 1 demonstrated that both negative mood and depressive symptoms decreased significantly as women transitioned from mid-life to late life. Scores of negative mood and depressive symptoms were significantly higher in the early postmenopause than the late postmenopause, suggesting the need to distinguish between these two stages in any future research relating to mood and reproductive ageing. While there were significant reductions for both mood measures between the stages of reproductive ageing, age was found to have a stronger association with score. In exploring mood and reproductive ageing, chronological ageing should always be considered. The second part of the thesis, Study 2, determined the extent to which the prevalence of depressive symptoms was consistent between the WHAP cohort and an age matched cross-cultural sample, in this case a sample of community dwelling Japanese women. With the increasing number of women migrating to Western populations, the effects of cross-cultural influence on item selection and score on depressive symptom measures needs to be evaluated to test the generalisability of findings. The first sub-study, Study 2.1, compared the prevalence rates of depressive symptoms in the WHAP cohort and an age matched sample of Japanese women from the Kumamoto prefecture in Southern Japan. Of the Japanese cohort 33% scored within the mild/moderate range on the GDS-SF, compared to 9% of the Australian women. This prompted an examination of cultural influences on item selection and possible inflation of scores to determine if the depressive symptom prevalence reported was a true phenomenon or impacted by the type of measure being used to assess the depressive symptoms (Study 2.2.). Culture specific profiles of item endorsement were found, and it was determined that the GDS-SF was a good fit for assessing the Australian cohort but not for the Japanese cohort. These findings suggest that the GDS picks up on distinctive aspects of depressive symptomatology in different cultural samples, despite the measure being well established to assess symptoms across populations. Any cross-cultural examination of depressive symptoms should use caution when interpreting results and further work in this area is needed to examine culture specific presentations of symptoms.