Prevalence of depression in Iranian premenopausal and postmenopausal women and its association with sex hormone levels

Abstract Background Despite the global interest in depression as a disorder, few studies have been conducted on the association of female sex hormones and depression across different reproductive ages, and the findings have not been consistent to date. This study aimed to investigate the prevalence of depression in premenopausal and postmenopausal women in southeast Iran and its association with sex hormone levels. Methods This cross-sectional study included 952 women aged 18–65 years, recruited randomly across four socioeconomic regions of Kerman, southeast Iran, in 2024. Depressive symptoms were assessed using a validated Persian language version of the Beck Depression Inventory-II (BDI-II), a self-report screening instrument, with a cut-off score of > 14 to identify women with elevated depressive symptoms. Serum levels of progesterone, prolactin, estradiol, and testosterone were measured. Demographic variables such as body mass index (BMI) and age were also recorded. Multivariable logistic regression models were stratified by menopausal status to examine hormone-depression associations. Results The overall prevalence of elevated depressive symptoms was 40%; separately, 39% in premenopausal and 41% in postmenopausal women. In the adjusted multivariable models, lower estradiol levels were independently associated with greater odds of depressive symptoms in premenopausal women (adjusted OR = 0.63, 95% CI: 0.18–0.92, p = 0.038) and postmenopausal women (adjusted OR = 0.61, 95% CI: 0.23–0.88, p = 0.034). Older age and higher BMI were also independently associated with elevated depressive symptoms in both groups. Divorced or widowed marital status was an additional significant predictor in premenopausal women (adjusted OR = 1.36, 95% CI: 1.17–1.59, p = 0.043). There were no significant associations between progesterone, prolactin, or testosterone with elevated depressive symptoms after adjustment. Conclusions Our findings on women in southeast Iran suggest that postmenopausal women are slightly more likely to experience elevated depressive symptoms than premenopausal ones. Additionally, women with elevated depressive symptoms had significantly lower estradiol levels than those without. In both premenopausal and postmenopausal groups, older age, higher BMI, and lower estradiol levels were independently associated with greater odds of elevated depressive symptoms. Divorced or widowed marital status was an additional significant predictor in premenopausal women.