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Community-based samples of women were selected at seven sites across the United States using a variety of recruitment strategies and sampling frames. Of the 16, women screened, were enrolled in the longitudinal cohort. Participants did not differ statistically by age, marital status, parity or menopausal status from those eligible women who did not enroll. Women with a high school education or less and those who reported that it was hard or very hard to pay for basics were less likely to participate.
After excluding women with incomplete baseline data, the analytic sample to address the first hypothesis was women. The 41 women who reported surgical menopause bilateral oophorectomy or hysterectomy or pregnancy at a follow-up visit were censored from that visit forward leaving women at visit 5.
Procedures SWAN participants were assessed at baseline and annually with a common protocol. All study forms and materials were translated and back-translated into Spanish, Japanese, and Cantonese. Bilingual staff administered the protocol, as appropriate.
All protocols were approved by the institutional review board at each site and signed written informed consent was obtained from all participants at each visit. Measures Depressive symptoms Depressive symptoms were assessed annually with the Center for Epidemiologic Studies Depression CES-D Scale, a item measure that asks about the frequency of being bothered by depressive symptoms during the previous week on a 4-point scale of 0 rarely to 3 most or all of the time Radloff, A score of 16 or above is commonly used to identify potential clinical depression Boyd et al.
Baseline measures A standard set of baseline sociodemographic variables included ethnicity, age, education attainment, and level of difficulty paying for basics,.
All women were pre- or early perimenopausal at baseline.
Perceived Health was measured with a single question with five response categories excellent to poor extracted from the SF Ware and Sherbourne, Reports of hot flashes or night sweats on at least 6 days in the previous two weeks were used as an indicator of vasomotor symptoms.
Current and past year use of hormone therapy and psychotropic medication were reported and current use was verified by examination of medication containers in the clinic by the interviewers or the labels were read by participants over the telephone. Current smoking was assessed.
Psychosocial variables included social support, 4 items from the Medical Outcomes Study Social Support Survey Sherbourne and Stewart, and stressful life events based on a checklist of 18 life events rated according to how stressful they were. Number of very stressful events since the last study visit was categorized as 0, 1 or 2 or more. Random effects logistic regression models are relatively robust to missing data and make use of all available data across all visits.
Thus, we included the entire sample and not just the women who were premenopausal at study entry. We included an interaction term between baseline CES-D score and menopausal status at each visit to determine if the effect of status on follow up depressive symptoms differed for those who reported high depressive symptoms at baseline versus those who did not.
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