Factors associated with depression in midlife women in the Middle East region: A Systematic Review

Factors associated with depression in midlife women in the Middle East region: A Systematic Review Ensieh Fooladi 1, Marzieh Azizi*2, Forouzan Elyasi 3, Fatemeh Abdollahi 4, Mohsen Aarabi 5 1 Department of Reproductive Health and Midwifery, Mazandaran University of Medical Sciences, Nasibeh Nursing and Midwifery Faculty, Sari, Iran. 2* Master Student of Midwifery counseling, Research student Committee, Mazandaran University of Medical Science, Nasibeh Nursing and Midwifery Faculty, Sari, Iran. (marziehazizi70@gmail .com) 3 Department of Psychiatry, Psychiatry and Behavioral Sciences Research Center and addiction Institute, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran 4Department of Public Health, Psychiatry and Behavioral Sciences Research Center, Mazandaran University of Medical Sciences, Sari, Iran. 5 Department of Epidemiology, Health Sciences Research Center, Mazandaran University of Medical Sciences, Sari, Iran. ABSTRACT Introduction: Depression is one of the important causes of disability in the world and the most common psychiatric disorder in midlife women. The exact etiology of depression in midlife is unclear. Given the differences between women who lived in Middle-East region and western communities, this study is conducted with the aim of determining contributing factors of depression in midlife women living in the Middle East region. Materials and Methods: The present study is a systematic review in which researchers conducted their computer search in database including PubMed, Medline, PsycINFO, CINAHL, Web of Science, SCOPUS, and Google scholar were searched. The quality of articles was assessed by using risk of bias tool. Results: After full appraisal of the retrieved studies, fifteen articles were chosen and included in this review. Depression was prevalent in midlife women (minimum of 1 in every 4 women). Several factors play a role in making women vulnerable to develop depressive symptoms. Researcher’s finding regarding related factors of depression in the Middle-East in 4 categories. They are include of demographic factors (age, parity or numbers of children, marital status, ethnic/racial differences, educational level, employment status), biological factors (transition to menopause and experiencing a longer perimenopausal period, severe menopausal symptoms, early menopause and inability to give birth, took hormones during menopause, type of menopause such as surgical menopause, menopause stages), Physical factors (poor woman’s health status, chronic physical diseases, history of surgery, number of medical symptoms and diseases, physical illness and disability caused by psychiatric disorders, presence of premenstrual syndrome (PMS), having irregular menstruation before menopause, obesity), Psychological factors (previous history of depression and other psychiatric disorders, family history of mood disturbance, negative attitudes toward menopause and aging, unpleasant and stressful life events, high levels of stress and anxiety, acute and chronic stress, inadequate emotional support, loss of sense of control over the life). Risk of bias for a majority of the studies conducted in the Middle Eastern region on depression in midlife was moderate. Conclusion: Multiple factors need to be taken into account when assessing a midlife woman for the presence of depression symptoms. This will help primary health care providers including psychiatrists in providing a better care by considering appropriate interventions. Key words: Depression, midlife, Middle-east, related factors

Factors associated with depression in midlife women in the Middle East region: A Systematic Review Ensieh Fooladi 1, Marzieh Azizi*2, Forouzan Elyasi 3, Fatemeh Abdollahi 4, Mohsen Aarabi 5 1 Department of Reproductive Health and Midwifery, Mazandaran University of Medical Sciences, Nasibeh Nursing and Midwifery Faculty, Sari, Iran. 2* Master Student of Midwifery counseling, Research student Committee, Mazandaran University of Medical Science, Nasibeh Nursing and Midwifery Faculty, Sari, Iran. (marziehazizi70@gmail .com) 3 Department of Psychiatry, Psychiatry and Behavioral Sciences Research Center and addiction Institute, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran 4Department of Public Health, Psychiatry and Behavioral Sciences Research Center, Mazandaran University of Medical Sciences, Sari, Iran. 5 Department of Epidemiology, Health Sciences Research Center, Mazandaran University of Medical Sciences, Sari, Iran. ABSTRACT Introduction: Depression is one of the important causes of disability in the world and the most common psychiatric disorder in midlife women. The exact etiology of depression in midlife is unclear. Given the differences between women who lived in Middle-East region and western communities, this study is conducted with the aim of determining contributing factors of depression in midlife women living in the Middle East region. Materials and Methods: The present study is a systematic review in which researchers conducted their computer search in database including PubMed, Medline, PsycINFO, CINAHL, Web of Science, SCOPUS, and Google scholar were searched. The quality of articles was assessed by using risk of bias tool. Results: After full appraisal of the retrieved studies, fifteen articles were chosen and included in this review. Depression was prevalent in midlife women (minimum of 1 in every 4 women). Several factors play a role in making women vulnerable to develop depressive symptoms. Researcher’s finding regarding related factors of depression in the Middle-East in 4 categories. They are include of demographic factors (age, parity or numbers of children, marital status, ethnic/racial differences, educational level, employment status), biological factors (transition to menopause and experiencing a longer perimenopausal period, severe menopausal symptoms, early menopause and inability to give birth, took hormones during menopause, type of menopause such as surgical menopause, menopause stages), Physical factors (poor woman’s health status, chronic physical diseases, history of surgery, number of medical symptoms and diseases, physical illness and disability caused by psychiatric disorders, presence of premenstrual syndrome (PMS), having irregular menstruation before menopause, obesity), Psychological factors (previous history of depression and other psychiatric disorders, family history of mood disturbance, negative attitudes toward menopause and aging, unpleasant and stressful life events, high levels of stress and anxiety, acute and chronic stress, inadequate emotional support, loss of sense of control over the life). Risk of bias for a majority of the studies conducted in the Middle Eastern region on depression in midlife was moderate. Conclusion: Multiple factors need to be taken into account when assessing a midlife woman for the presence of depression symptoms. This will help primary health care providers including psychiatrists in providing a better care by considering appropriate interventions. Key words: Depression, midlife, Middle-east, related factors