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Association Between Physiological Serum Concentration of Estrogen and the Mental Health of Community-Dwelling Postmenopausal Women Age 70 Years and Over

Received January 4, 2004; revised February 16, March 25, 2004; accepted March 26, 2004. From the School of Psychiatry and Clinical Neurosciences, University of Western Australia, and the Dept. of Psychiatry, Royal Perth Hospital (OPA,NL), the School of Surgery and Pathology, University of Western Australia, and the Dept. of Biochemistry, Royal Perth Hospital (SV), the School of Medicine and Pharmacology, University of Western Australia (PL,LF), the Dept. of Endocrinology and Diabetes, Royal Perth Hospital (PL), the Laboratory for Cancer Medicine, Centre for Medical Research, the Western Australian Institute for Medical Research (PL), and the Dept. of Geriatric Medicine, Royal Perth Hospital (LF). Send correspondence and reprint requests to Prof. Osvaldo P. Almeida, UWA School of Psychiatry and Clinical Neurosciences (M573, Level 6, Ainslie House, Royal Perth Hospital, 35 Stirling Highway, Crawley, Perth, WA 6009, Australia. e-mail: osvalm{at}cyllene.uwa.edu.au
© 2005 American Association for Geriatric Psychiatry

Objective: The authors investigated the association between physiological levels of estrogen and mood/cognitive functioning among older postmenopausal women. Methods: This was a cross-sectional study of 265 postmenopausal women (mean age: 74.6 years), who were given a semistructured psychiatric interview (CAMDEX-R) and self-rated their health with the Beck Depression and Anxiety Inventories (BDI and BAI) and the SF-36 Health Survey. Cognitive abilities were assessed with the cognitive subsection of the CAMDEX (CAMCOG), the Word Lists subtest of the Wechsler Memory Scale, and the Block Design and Verbal Fluency subtests of the Wechsler Adult Intelligence Scale. Estradiol- and estrone-sensitive immunoassays were used to measure serum estradiol and estrone. Results: Women in the lowest 50th percentile of serum estradiol were more likely than women in the highest 50th percentile to have BDI scores suggestive of clinically significant or severe depression. Women in the lowest 50th percentile of serum estrone had higher BAI scores. There was no significant association between serum estradiol/estrone and cognitive functioning. Conclusions: Physiological serum concentrations of estradiol and estrone are inversely associated with depression and anxiety scores in older postmenopausal women. The association between serum estradiol and depression ratings is not linear and seems to be subject to a threshold effect.

Key Words: Estrogen • Memory • Mood