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Psychological Medicine
Volume 48, Issue 15
November 2018 , pp. 2550-2561

The role of sleep difficulties in the vasomotor menopausal symptoms
and depressed mood relationships: an international pooled analysis ofeight studies in the InterLACE consortium
Hsin-Fang Chung (a1), Nirmala Pandeya (a1), Annette J. Dobson (a1), Diana Kuh (a2) ...
DOI: https://doi-org.offcampus.lib.washington.edu/10.1017/S0033291718000168
Published online by Cambridge University Press: 12 February 2018

Abstract
Background
Many women experience both vasomotor menopausal symptoms (VMS) and depressed mood at midlife, but littleis known regarding the prospective bi-directional relationships between VMS and depressed mood and the role ofsleep difficulties in both directions.
Methods
A pooled analysis was conducted using data from 21 312 women (median: 50 years, interquartile range 49−51) ineight studies from the InterLACE consortium. The degree of VMS, sleep difficulties, and depressed mood was selfreported and categorised as never, rarely, sometimes, and often (if reporting frequency) or never, mild, moderate,and severe (if reporting severity). Multivariable logistic regression models were used to examine the bi-directional
associations adjusted for within-study correlation.
Results
At baseline, the prevalence of VMS (40%, range 13–62%) and depressed mood (26%, 8–41%) varied substantiallyacross studies, and a strong dose-dependent association between VMS and likelihood of depressed mood wasfound. Over 3 years of follow-up, women with often/severe VMS at baseline were more likely to have subsequent
depressed mood compared with those without VMS (odds ratios (OR) 1.56, 1.27–1.92). Women with often/severe

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The role of sleep difficulties in the vasomotor menopausal symptoms … the InterLACE consortium | Psychological Medicine | Cambridge Core11/8/20, 1(31 PM

depressed mood at baseline were also more likely to have subsequent VMS than those without depressed mood
(OR 1.89, 1.47–2.44). With further adjustment for the degree of sleep difficulties at baseline, the OR of having a
subsequent depressed mood associated with often/severe VMS was attenuated and no longer significant (OR 1.13,0.90–1.40). Conversely, often/severe depressed mood remained significantly associated with subsequent VMS (OR1.80, 1.38–2.34).
Conclusions
Difficulty in sleeping largely explained the relationship between VMS and subsequent depressed mood, but it had
little impact on the relationship between depressed mood and subsequent VMS.

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Copyright
COPYRIGHT: © Cambridge University Press 2018

Corresponding author
Author for correspondence: Dr Hsin-Fang Chung, E-mail: h.chung1@uq.edu.au (mailto:h.chung1@uq.edu.au)

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