Study: Girlhood trauma linked to depression in menopause

Women who suffered multiple traumatic events as they were growing up are at significant risk of serious depression beginning in the years leading into menopause, according to a University of Pennsylvania study released Wednesday.

However, the findings by the Penn researchers also suggest that a single trauma may be associated with greater resiliency later in life.

"Our results show that women who experience at least two adverse events during their formative years – whether it be abuse, neglect, or some type of family dysfunction – are more than twice as likely to experience depression during perimenopause and menopause as women who experienced those stressors earlier in life, or not at all," said lead study author C. Neill Epperson, director of the Penn Center for Women's Behavioral Wellness.

Epperson said the study results suggest that early life stress can not only have long-lasting effects on the parts of the brain responsible for emotions, mood, and memory, but that the timing of those events can be just as important. The report was published Wednesday in the Journal of Clinical Psychiatry.

Follow-up studies may also show ways to lessen or relieve those effects, suggested the author, either through lifestyle changes or medical assistance.

The Penn study joins a large body of research showing how adverse childhood experiences are linked to a variety of physical, emotional, and psychological problems that can last a lifetime.

A growing body of scientific evidence has linked childhood traumas like parental divorce and living in unsafe neighborhoods to potentially lifelong afflictions, from diabetes and heart disease to depression and substance abuse.

The study followed 243 Philadelphia women, between the ages of 35 and 47 at the time of enrollment, from 1996 through 2012. They underwent periodic behavioral, cognitive, and endocrine evaluations. Between study years 14 and 16, phone interviews were conducted regarding their menopause status.

"Following these women for so many years allowed us to track the significant changes many of them experienced with the onset of the transition to menopause," said Mary Sammel, a study coauthor and Penn biostatistics professor.

The researchers also used a questionnaire to help examine the impact of stressful or traumatic childhood events. Those negative experiences included physical, emotional, or sexual abuse; physical or emotional neglect; and household dysfunction such as parental separation or divorce, domestic violence toward a mother or stepmother, alcohol or substance abuse, mental illness, or a household member being incarcerated.

In the study, women who reported two or more adverse childhood experiences were twice as likely to experience major depressive disorder (MDD) in their lifetime and 2½ times as likely to experience MDD in their perimenopausal to menopausal years than women who had no such bad childhood experiences.

The women who had two or more traumatic experiences in their post-puberty girlhood years were 2.3 times more like to suffer MDD in their menopausal years.

Interestingly, however, the study also suggests that girls may develop resiliency in the face of adversity, said Epperson, who is also a Penn professor of psychiatry and obstetrics and gynecology.

The study participants who experienced only one of the trauma events in their prepuberty years, regardless of other adverse events later in childhood, were less likely to experience MDD, even than the women who experience none of the adverse events in their prepuberty years.

Epperson said the hormonal changes during menopause may unmask depression that had been held in check prior to those changes.

"There's clearly a strong link between childhood adversity and risk of depression throughout a woman's life, but particularly during the transition to menopause," Ellen W. Freeman, a study author and Penn research professor of obstetrics and gynecology. "Our study points to the need for more research examining the long-term brain effects of childhood adversity, particularly around the time of puberty."