Tag Archive for: bio-psycho-social

Navigating Menopause: Could Better Support Reduce Depression Risk?

Author: Pia Lustig, Psychology student and intern at FemiLab, Lausanne University Hospital, Switzerland | Editor: Romina Garcia de leon (blog coordinator)

Published: May 24th, 2024

There is a wide range of factors that contribue to depression during menopause;  including genetic markers, previous depression history, and menopause symptoms. However, If we look beyond biology, could there be other reasons why women across the world experience menopause so differently? And how much of a factor does society, and the narratives around menopause affect lived experience of this transition?

The natural menopause transition normally starts around mid-forties and continues for 5-10 years. As the body prepares for the “post-fertility” phase, a woman can experience a spectrum of symptoms, including hot flashes and night sweats, insomnia, weight gain, and vaginal dryness. However, there are certain social factors that are also at play. As is the case in many cultures, women are more likely to be caretakers of elderly parents, the primary caretaker of children and household duties. Moreover, women carry out more than 2.5 times more unpaid care work and household duties than men. Balancing the many responsibilities between home, work, and relationships may lead to burn out. When menopause is added to the equation, this becomes further excacerbated. Suddenly, physiological changes come into play. Vasomotor symptoms such as sleeplessness combined with hormonal fluctuations might make everyday life feel like an emotional rollercoaster. Moreover, symptoms like vaginal dryness, hair growth in unwanted places and excessive weight which may lead to feelings of shame and insecurities.

Research shows that women´s self-perception influences overall moods during the menopause transition. If their perception of the transition is more positive, women are less likely to develop depression. The kind of messages women receive from their immediate circle – family and friends –are pivotal in shaping their perceptions and reducing the risk of depression. Can they openly discuss their experiences around menopause, and do they receive the support they need? Equally important is the workplace environment. Are they understanding and accommodating of the possible symptoms women may be facing during working hours?  How is the media representing women in midlife? Are women represented in a way that emphasizes their worth beyond youth, or are they overlooked and deemed less relevant, less attractive? Is menopause even talked about publicly, or does it remain a topic shrouded in silence and shame?

The messages from the environment are closely linked to the broader culture that shapes women’s experiences, including societal attitudes toward women’s health. Globally, the risk of depression is twice as high for women as for men, research shows that women in Western societies experience higher rates of depression during the menopause transition. Furthermore, when looking at self-reported menopausal symptoms, some groups of women in Asia and Latin America hardly report symptoms at all. To understand why women´s experiences are so different, we may need to focus on society´s perceptions about women during this time in their lives, and to what extent the external environment is providing support. In some cultures, status is elevated passing the childbearing years. For example, for Taiwanese women menopause is viewed in a positive and holistic light. If societal perceptions influence menopausal symptoms and depression risk – this is an important avenue to focus on.

Can we support women going through the menopause transition better as a society and as loved ones? Viewing menopause-related risk for depression from a broader perspective could help us better understand how to best support women in these transitional stages. We might discover that support networks and positive messages from the environment may be part of the key that solves the puzzle.

 

 

 

Behind the Science: Examining Inflammation and Depression Through a Bio-Sociological Lens

Interviewee: Tatiana Pakhomova, B.A., M.P.H., Ph.D. student, Simon Fraser University. Authors/Editors: Romina Garcia de leon, Shayda Swann (Blog Co-coordinator).

Published: January 13th, 2023

Could you please briefly explain what your research is about?

My Ph.D. research aims to examine the socio-structural pathways between inflammation and depression. I’m particularly interested in the relationship between depression and chronic inflammation, which refers to persistent immune activation in response to various stressors. We’re interested in looking at socio-structural, biological, and behavioural factors which impact the pathways between chronic inflammation and depression, and their downstream effects. People with chronic inflammation have higher numbers of specific inflammatory markers in their blood associated with increased risk of communicable and non-communicable diseases, like HIV and cardiovascular disease. For my Ph.D. work, I’m interested in how chronic inflammation is associated with an increased risk of poor mental health outcomes. Research shows that people with depression have increased inflammation. However, many pathways are bi-directional, with complex relationships involving hormonal pathways, neurotransmitters, and socio-structural factors. Very little research looks at these relationships in young people or longitudinally. For this reason, we want to look at these long-term trends to better understand this relationship. The study I’m working on is AYAZAZI, a longitudinal cohort across two study sites in Durban and Soweto (South Africa) that was launched in 2014 and investigated intersectional, behavioural, biological, and socio-structural factors that might influence HIV risk among young people aged 16-24. 

What interested you in studying how mental health affects a biological outcome like inflammation?

Part of it is personal. I’ve had episodic depression since my teenage years, but I didn’t seek help or get diagnosed until I was older. Given the barriers to accessing mental health support, my depression was left untreated for a long time. Secondly, from my academic background, my Bachelor’s was in political science and gender studies, and I have always been interested in the political aspect of health. After finishing my B.A., I worked in HIV social services with a regional staff team in Fraser Health for a few years, which led me to do my M.P.H. at Simon Fraser University, where I met Dr. Angela Kaida. I fell in love with the research process and have been fortunate to have worked in research since 2018. I also have a part-time position at the BC Centre for Excellence in HIV, looking at barriers as well as facilitators of healthcare engagement. Given this background, I was very interested in studying mental health from a holistic perspective, considering both the socio-structural and biological factors that interact to influence our health. That’s the great thing about social epidemiology – you get to bring in all of these intersecting concepts, and it’s a much more holistic way to look at health. 

Why do you think it’s important to study women’s health from the social determinants of health lens?

Structural determinants of health are a huge part of my work. Many of the gaps in the literature are centred around factors in the social environment that influence biological relationships. There is evidence out there that indicates that there are both sex and gender differences in inflammation markers among youth and adults, as well as in depression or other mental health outcomes. Gender inequity significantly impacts how people experience life stressors and may influence their health at the biological level, and I am interested in how gender plays a role for both young women as well as young men. As our study participants are aged 16 to 24, we do our work with an understanding that there are numerous fluctuating biological changes in youth and young adulthood that may affect the relationship between inflammation and mental health. 

Could you tell us more about the research projects you’ve worked on before, both in Canada and abroad?

Working with Peer Researchers to co-create knowledge has been a huge highlight of my career. I’ve also been fortunate enough to have a couple of research trips to South Africa. I did my M.P.H. with the AYAZAZI study, which feels like coming back in a circle to finish what I started. My Master’s work was also mental health-focused but focused on factors that are associated with perceived stress. Now, I get to look at mental health outcomes longitudinally. It’s been wonderful to build relationships with researchers in South Africa. I’ve spent a couple of summers at the Perinatal HIV Research Unit in Soweto, which has been an incredibly wonderful experience. 

What impact do you hope to see with your work years from now?

Working from the social determinants of health lens means that a lot of social and structural factors are potentially modifiable. When we’re looking at something like mental health, prevention is key because treatment options are not always accessible for some people. The purpose of this work is to give other researchers, community members, and stakeholders tangible evidence so that they can do something with it. It would be great to see some of this work be applied to policy that is youth-driven and youth-focused, that has real-world impacts, and adds something valuable to the body of research to better understand this important issue.