Associations of depression and anxiety with menstrual health in Spain: a cross-sectional study

Abstract Background Menstrual health is closely linked to mental health, especially depression and anxiety. However, their relationship remains understudied. This study analysed the association between menstrual health and self-reported depression and anxiety in women and people who menstruate (PWM) (aged 18 year or over) in Spain. Methods A gender-based cross-sectional study was conducted in 5 regions in Spain. Participants were women and PWM aged 18 or over with at least one menstruation in the last 6 months. Data were collected through an online survey in 32 healthcare centres in 2023. Outcome measures were self-reported depression and anxiety and menstrual health variables (e.g., menstrual pain intensity, menstrual poverty). Descriptive statistics and ordinal logistic regression models were performed. Results Among participants (N = 1,404), the odds of depression and anxiety were associated with some menstrual health variables. For instance, a higher menstrual pain intensity increased the odds of depression (aOR= 2.10, 95%CI, 1.58-2.79) and anxiety (aOR= 1.84, 95%CI, 1.39-2.44). This same tendency was identified for the frequency of premenstrual symptoms (aORdepression= 13.59, 95%CI, 9.62-19.19; aORanxiety= 12.34, 95%CI, 8.72-17.48), menstrual taboo, stigma and discrimination (aORdepression= 2.14, 95%CI, 1.65-2.78; aORanxiety= 2.27, 95%CI, 1.75-2.96), menstrual poverty (aORdepression= 2.31, 95%CI, 1.53-3.50; aORanxiety= 2.43, 95%CI, 1.62-3.65), and social participation impairments due to menstruation (aORdepression= 6.84, 95%CI, 4.64-10.07; aORanxiety= 6.45, 95%CI, 4.36-9.53). Some sociodemographic characteristics mediated the relationship between menstrual health variables and anxiety and depression. Conclusions Poorer menstrual health outcomes were associated with higher levels of depression and anxiety. This empathises the need to address both the relationship of menstrual health, depression, and anxiety in future public health interventions, policies and legislation. Key messages • Higher levels of depression and anxiety are associated with poorer menstrual health outcomes. • Sociodemographic factors influence how menstrual health is associated to depression and anxiety.