Depressive symptoms are increased in the early perimenopausal stage in ethnically diverse human immunodeficiency virus-infected and human immunodeficiency virus-uninfected women.

Although mood complaints at midlife have long been attributed to menopause, there has been substantial debate regarding the impact of menopause on mood and cognition.1 The 2005 NIH State-of-the-Science Conference Statement on Management of Menopause-Related Symptoms concluded that there is strong evidence from both longitudinal and cross-sectional observational studies that the menopausal transition causes vasomotor symptoms and vaginal dryness.1 By contrast, the evidence that the menopausal transition leads to mood changes was considered “mixed.” Although large gaps in knowledge remain, a number of recent studies have informed our understanding of mood symptoms at midlife. The scientific literature indicates that most women experience the menopausal transition without mood difficulties. However, there are six studies that characterize the perimenopausal stage as a period of increased risk for elevated depressive symptoms and/or depressive disorders, including a study of women from Eindhoven Netherlands,2 the Study of Women’s Health Across the Nation (SWAN),3–6 the National Institutes of Mental Health,7 the Penn Ovarian Aging (POA) study,8, 9 the Harvard Study of Moods and Cycles,10 and the Seattle Midlife Women’s Health Study11. The magnitude of this risk is sizeable, with studies using diagnostic clinical interviews finding a two- to four-fold increased risk of depression during the transition in women with no previous history of mood disorder.5, 7, 10 One limitation of our understanding of perimenopausal-related depression is that research on this topic has largely been confined to cohorts of healthy women of middle-class or higher socioeconomic status. Two exceptions are the ethnically diverse cohort of women studied in the SWAN, a sample that included 28% African American women and 8% Latina,3 and the Penn Ovarian Aging Study, a sample that included 50% African American women.8, 9 One significant, and as-yet unstudied question concerning perimenopausal depression is whether women of lower socioeconomic status may be at increased risk for perimenopausal depression because of other exacerbating factors including low income, low educational attainment, unemployment, interpersonal violence, and drug and alcohol use.12 Similarly, since previous studies were based on cohorts of healthy women, little is known about the differential risk of depression among healthy women versus those with serious medical illnesses. Understanding factors that are associated with depression in HIV-infected women is especially important is especially important because depression is associated with nonadherence to HAART as well as increased mortality.13, 14 We therefore investigated the potential interactive effects of menopausal stage and HIV status on elevated depressive symptoms in the Women’s Interagency HIV Study (WIHS). The WIHS is the largest study of the natural and treated history of HIV in women. Here we report data from 835 HIV-infected women and 335 HIV-uninfected controls. One substantial benefit of examining this question in the WIHS is that the controls are similar to the HIV-infected women in risk factors for depressive symptoms and HIV. We hypothesized that there would be an increased risk for elevated depressive symptoms in the perimenopausal period and that this risk would be higher in HIV-infected women. We further hypothesized that women treated with HAART would show lower depressive symptoms in the perimenopausal period compared to women who have not received HAART because of evidence that initiation or maintenance of HAART decreases depressive symptoms in patients with HIV.15, 16