{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T07:08:34Z","timestamp":1789628914244,"version":"build-2803163510"},"reference-count":42,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T00:00:00Z","timestamp":1789603200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T00:00:00Z","timestamp":1789603200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100008723","name":"Suomen L\u00e4\u00e4ketieteen S\u00e4\u00e4ti\u00f6","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100008723","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100007083","name":"Orionin Tutkimuss\u00e4\u00e4ti\u00f6","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100007083","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Obstet Gynecol Scand"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>The incidence of several morbidities increases during the menopausal transition. However, studies of the association between early\u2010onset menopause and psychiatric symptoms and morbidity are scarce. We aimed to investigate how climacteric status at age 46 was associated with depressive and anxiety symptoms.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Material and Methods<\/jats:title>\n                    <jats:p>This prospective cohort study included 2632 female participants from the Northern Finland Birth Cohort 1966 who participated in the 46\u2010year follow\u2010up. Among these, 356 participants (13%) were classified as climacteric. Data regarding the participants' backgrounds as well as anxiety and depressive symptoms (measured by the Hopkins Symptom Checklist\u201025 and the Beck Depression Inventory) were analyzed. Information on psychiatric medication purchases was retrieved from a national registry. The association between climacteric status at age 46 and the presence of psychiatric symptoms or medication purchases was evaluated using binary logistic regression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Climacteric women exhibited a higher prevalence of significant anxiety symptoms compared with preclimacteric women (22.6% vs. 16.0%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.002) with an odds ratio of 1.53 (95% confidence interval: 1.16\u20132.02), as measured by the Hopkins Symptom Checklist\u201025 questionnaire. This association remained statistically significant after adjusting for smoking, alcohol consumption, body mass index, and education (odds ratio 1.44; 95% confidence interval: 1.04\u20132.00). The climacteric women also reported depression symptoms more frequently than the preclimacteric women (30.1% vs. 24.6%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.032), and the association persisted after adjustment for covariates (odds ratio 1.39; 95% confidence interval: 1.03\u20131.85). The Beck Depression Inventory\u201021 indicated higher rates of depression among climacteric women (17.7% vs. 13.6%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.046); however, no independent association was observed following adjustment. Purchases of antidepressants (48% vs. 41%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.012) and benzodiazepine derivatives (18.3% vs. 13.3%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.012) between the ages 40 and 57 were more frequent among climacteric women aged 40\u201357, yet no independent association was identified between advanced climacteric status and medication purchases in the multivariate model.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Advanced menopausal status at age 46 was linked to a higher risk of anxiety and depressive symptoms. It is crucial to support the mental health and well\u2010being of women during and after menopause, especially for those experiencing early\u2010onset menopause.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/aogs.70358","type":"journal-article","created":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T07:00:51Z","timestamp":1789628451000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Menopausal status at the age of 46: Its association with depressive and anxiety symptoms and morbidity in women\u2014A northern Finland birth cohort 1966 study"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-6168-3103","authenticated-orcid":false,"given":"Tiia","family":"Saarinen","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology Oulu University Hospital, Wellbeing Services County of North Ostrobothnia  Oulu Finland"},{"name":"Medical Research Center University of Oulu and Oulu University Hospital, Wellbeing Services County of North Ostrobothnia  Oulu Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2491-0458","authenticated-orcid":false,"given":"Susanna M.","family":"Savukoski","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Oulu University Hospital, Wellbeing Services County of North Ostrobothnia  Oulu Finland"},{"name":"Medical Research Center University of Oulu and Oulu University Hospital, Wellbeing Services County of North Ostrobothnia  Oulu Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paula","family":"Pesonen","sequence":"additional","affiliation":[{"name":"Northern Finland Birth Cohorts, Infrastructure for Population Studies, Faculty of Medicine University of Oulu  Oulu Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0575-2669","authenticated-orcid":false,"given":"Jouko","family":"Miettunen","sequence":"additional","affiliation":[{"name":"Research Unit of Population Health University of Oulu  Oulu Finland"},{"name":"Medical Research Center Oulu, Oulu University Hospital and University of Oulu  Oulu Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0927-0472","authenticated-orcid":false,"given":"Maarit","family":"Niinim\u00e4ki","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Oulu University Hospital, Wellbeing Services County of North Ostrobothnia  Oulu Finland"},{"name":"Medical Research Center University of Oulu and Oulu University Hospital, Wellbeing Services County of North Ostrobothnia  Oulu Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,17]]},"reference":[{"key":"e_1_2_14_2_1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1210\/clinem\/dgaa764","article-title":"The menopause transition: signs, symptoms, and management options","volume":"106","author":"Santoro N","year":"2021","journal-title":"J Clin Endocrinol Metab"},{"key":"e_1_2_14_3_1","first-page":"217","article-title":"Intensity of menopausal symptoms and quality of life in climacteric women","volume":"8","author":"Szadowska\u2010Szlachetka ZC","year":"2019","journal-title":"Przegl Menopauzalny"},{"key":"e_1_2_14_4_1","doi-asserted-by":"crossref","first-page":"531","DOI":"10.1001\/jamainternmed.2014.8063","article-title":"Duration of menopausal vasomotor symptoms over the menopause transition","volume":"175","author":"Avis NE","year":"2015","journal-title":"JAMA Intern Med"},{"key":"e_1_2_14_5_1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s13048-018-0438-4","article-title":"Reproductive aging and elective fertility preservation","volume":"11","author":"Fritz R","year":"2018","journal-title":"J Ovarian Res"},{"key":"e_1_2_14_6_1","doi-asserted-by":"crossref","first-page":"911","DOI":"10.1016\/S0140-6736(10)60355-8","article-title":"Primary ovarian insufficiency","volume":"376","author":"De Vos M","year":"2010","journal-title":"Lancet"},{"key":"e_1_2_14_7_1","doi-asserted-by":"crossref","DOI":"10.3390\/ijms24076566","article-title":"Cognitive decline in early and premature menopause","volume":"24","author":"Sochocka M","year":"2023","journal-title":"Int J Mol Sci"},{"key":"e_1_2_14_8_1","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1016\/j.maturitas.2009.08.003","article-title":"Premature menopause or early menopause: long\u2010term health consequences","volume":"65","author":"Shuster LT","year":"2010","journal-title":"Maturitas"},{"issue":"8","key":"e_1_2_14_9_1","doi-asserted-by":"crossref","first-page":"636","DOI":"10.1177\/00048674241253944","article-title":"Menopause depression: under recognised and poorly treated","volume":"58","author":"Kulkarni J","year":"2024","journal-title":"Aust N Z J Psychiatry"},{"key":"e_1_2_14_10_1","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1177\/10398562231165439","article-title":"Does menopause elevate the risk for developing depression and anxiety? Results from a systematic review","volume":"31","author":"Alblooshi S","year":"2023","journal-title":"Australas Psychiatry"},{"key":"e_1_2_14_11_1","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1016\/j.ogc.2018.07.005","article-title":"Vasomotor symptoms across the menopause transition: differences among women","volume":"45","author":"Avis NE","year":"2018","journal-title":"Obstet Gynecol Clin N Am"},{"key":"e_1_2_14_12_1","first-page":"1","article-title":"Stress, depression, and anxiety: psychological complaints across menopausal stages","volume":"15","author":"Kuck MJ","year":"2024","journal-title":"Front Psychiatry"},{"key":"e_1_2_14_13_1","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1007\/s00737-016-0701-x","article-title":"Depression during the menopause transition: impact on quality of life, social adjustment, and disability","volume":"20","author":"Wariso BA","year":"2018","journal-title":"Arch Womens Ment Health"},{"key":"e_1_2_14_14_1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s40359-023-01267-3","article-title":"Linkage of premature and early menopause with psychosocial well\u2010being: a moderated multiple mediation approach","volume":"11","author":"Kundu S","year":"2023","journal-title":"BMC Psychol"},{"key":"e_1_2_14_15_1","doi-asserted-by":"crossref","first-page":"132","DOI":"10.5152\/alphapsychiatry.2024.231501","article-title":"Premature ovarian insufficiency is associated with increased risk of depression, anxiety, and poor life quality: a systematic review and meta\u2010analysis","volume":"25","author":"Tian Y","year":"2024","journal-title":"Alpha Psychiatry"},{"key":"e_1_2_14_16_1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1002\/alz.70063","article-title":"Associations among age at menopause, depressive symptoms, and cognitive function","volume":"21","author":"Nakanishi M","year":"2025","journal-title":"Alzheimers Dement"},{"key":"e_1_2_14_17_1","doi-asserted-by":"crossref","first-page":"2701","DOI":"10.1210\/jc.2018-02025","article-title":"Climacteric status at the age of 46: impact on metabolic outcomes in population\u2010based study","volume":"104","author":"Savukoski S","year":"2019","journal-title":"J Clin Endocrinol Metab"},{"key":"e_1_2_14_18_1","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1097\/GME.0000000000001658","article-title":"Onset of the climacteric phase by the mid\u2010forties associated with impaired insulin sensitivity: a birth cohort study","volume":"28","author":"Savukoski SM","year":"2020","journal-title":"Menopause (New York, NY)"},{"key":"e_1_2_14_19_1","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1097\/GME.0000000000002327","article-title":"Climacteric status at age 46 is associated with poorer work ability, lower 2\u2010year participation in working life, and a higher 7\u2010year disability retirement rate: a northern Finland birth cohort 1966 study","volume":"31","author":"Saarinen T","year":"2024","journal-title":"Menopause"},{"key":"e_1_2_14_20_1","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1016\/j.maturitas.2015.12.006","article-title":"Menopause in the workplace: what employers should be doing","volume":"85","author":"Jack G","year":"2016","journal-title":"Maturitas"},{"key":"e_1_2_14_21_1","unstructured":"University of Oulu Northern Finland Birth Cohort 1966. University of Oulu.http:\/\/urn.fi\/urn:nbn:fi:att:bc1e5408\u2010980e\u20104a62\u2010b8"},{"key":"e_1_2_14_22_1","doi-asserted-by":"crossref","first-page":"1786","DOI":"10.1093\/ije\/dyab109","article-title":"Cohort profile: 46\u2009years of follow\u2010up of the northern Finland birth cohort 1966 (NFBC1966)","volume":"50","author":"Nordstr\u00f6m T","year":"2021","journal-title":"Int J Epidemiol"},{"key":"e_1_2_14_23_1","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1097\/gme.0b013e31824d8f40","article-title":"Executive summary of the stages of reproductive aging workshop +10: addressing the unfinished agenda of staging reproductive aging Methods\u2010scientists from five countries and multiple disciplines evaluated data from cohort studies of midlife women","volume":"19","author":"Harlow SD","year":"2012","journal-title":"Menopause"},{"key":"e_1_2_14_24_1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3390\/ijerph18157843","article-title":"Validation and psychometric properties of the Spanish version of the Hopkins symptom Checklist\u201025 scale for depression detection in primary care","volume":"18","author":"Rodr\u00edguez\u2010Barrag\u00e1n M","year":"2021","journal-title":"Int J Environ Res Public Health"},{"key":"e_1_2_14_25_1","first-page":"1","article-title":"The French version of the HSCL\u201025 has now been validated for use in primary care","volume":"14","author":"Id PN","year":"2019","journal-title":"PLoS One"},{"key":"e_1_2_14_26_1","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1007\/s001270050112","article-title":"The meaning and significance of caseness: the Hopkins symptom Checklist\u201025 and the composite international diagnostic interview II","volume":"34","author":"Sandanger I","year":"1999","journal-title":"Soc Psychiatry Psychiatr Epidemiol"},{"key":"e_1_2_14_27_1","doi-asserted-by":"crossref","first-page":"204","DOI":"10.3109\/08039488.2012.711856","article-title":"Correspondence between clinical diagnoses of depressive and anxiety disorders and diagnostic screening via the Hopkins symptom check List\u201025 in the Lundby study","volume":"67","author":"Mattisson C","year":"2013","journal-title":"Nord J Psychiatry"},{"key":"e_1_2_14_28_1","doi-asserted-by":"crossref","first-page":"174","DOI":"10.1093\/occmed\/kqv087","article-title":"Beck depression inventory","volume":"66","author":"Jackson\u2010Koku G","year":"2016","journal-title":"Occup Med"},{"key":"e_1_2_14_29_1","doi-asserted-by":"crossref","first-page":"1050","DOI":"10.1097\/gme.0b013e318174f155","article-title":"Long\u2010term risk of depressive and anxiety symptoms after early bilateral oophorectomy","volume":"15","author":"Rocca WA","year":"2008","journal-title":"Menopause"},{"key":"e_1_2_14_30_1","doi-asserted-by":"crossref","first-page":"728","DOI":"10.1097\/gme.0b013e3181967e16","article-title":"Temporal association of hot flashes and depression in the transition to menopause","volume":"16","author":"Freeman EW","year":"2009","journal-title":"Menopause"},{"key":"e_1_2_14_31_1","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1089\/jwh.2018.27099.mensocrec","article-title":"Guidelines for the evaluation and treatment of perimenopausal depression: summary and recommendations","volume":"28","author":"Maki PM","year":"2019","journal-title":"J Women's Health"},{"issue":"14","key":"e_1_2_14_32_1","doi-asserted-by":"crossref","DOI":"10.3390\/ijerph18147256","article-title":"The comparison of physical activity, sedentary behavior, and mental health between early menopausal women and age\u2010matched general middle\u2010aged women","volume":"18","author":"Kim JS","year":"2021","journal-title":"Int J Environ Res Public Health"},{"key":"e_1_2_14_33_1","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1097\/GME.0000000000002661","article-title":"Inflammation and insulin resistance partially mediate the relationship between age at menopause and depression in postmenopausal women: a cross\u2010sectional study of","volume":"33","author":"Riveros PA","year":"2026","journal-title":"Menopause"},{"key":"e_1_2_14_34_1","doi-asserted-by":"crossref","first-page":"2341","DOI":"10.1093\/humrep\/deae196","article-title":"Reproductive epidemiology association between parity and female mortality: the mediative role of depressive symptoms","volume":"39","author":"Deng Z","year":"2024","journal-title":"Hum Reprod"},{"key":"e_1_2_14_35_1","doi-asserted-by":"crossref","first-page":"549","DOI":"10.1093\/humrep\/15.3.549","article-title":"Serum concentrations of dimeric inhibins, activin a, gonadotrophins and ovarian steroids during the menstrual cycle in older women","volume":"15","author":"Muttukrishna S","year":"2000","journal-title":"Hum Reprod"},{"key":"e_1_2_14_36_1","doi-asserted-by":"crossref","first-page":"845","DOI":"10.1093\/ije\/29.5.845","article-title":"Smoking, body mass index, socioeconomic status and the menopausal transition in a British national cohort","volume":"29","author":"Hardy R","year":"2000","journal-title":"Int J Epidemiol"},{"key":"e_1_2_14_37_1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/1471-2458-7-149","article-title":"Early menopause, association with tobacco smoking, coffee consumption and other lifestyle factors: a cross\u2010sectional study","volume":"7","author":"Mikkelsen TF","year":"2007","journal-title":"BMC Public Health"},{"key":"e_1_2_14_38_1","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1093\/ntr\/ntw140","article-title":"The association of cigarette smoking with depression and anxiety: a systematic review","volume":"19","author":"Fluharty M","year":"2017","journal-title":"Nicotine Tob Res"},{"key":"e_1_2_14_39_1","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1016\/j.drugalcdep.2012.05.001","article-title":"Association of smoking and nicotine dependence with severity and course of symptoms in patients with depressive or anxiety disorder","volume":"126","author":"Jamal M","year":"2012","journal-title":"Drug Alcohol Depend"},{"key":"e_1_2_14_40_1","first-page":"63","article-title":"Mental health screening instruments for adult refugees in resettlement: a systematic review of psychometric properties","volume":"23","author":"Potocky M","year":"2025","journal-title":"Intervention"},{"key":"e_1_2_14_41_1","doi-asserted-by":"crossref","first-page":"1245","DOI":"10.1111\/aogs.14445","article-title":"National register data are of value in studies on miscarriage\u2014validation of the healthcare register data in Finland","volume":"101","author":"Helle N","year":"2022","journal-title":"Acta Obstet Gynecol Scand"},{"key":"e_1_2_14_42_1","doi-asserted-by":"crossref","first-page":"376","DOI":"10.1093\/ije\/25.2.376","article-title":"Declining induced abortion rate in Finland: data quality of the Finnish abortion register","volume":"25","author":"Gissler M","year":"1996","journal-title":"Int J Epidemiol"},{"key":"e_1_2_14_43_1","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1097\/01.gme.0000198489.49618.96","article-title":"Limitations of follicle\u2010stimulating hormone in assessing menopause status: findings from the National Health and nutrition examination survey (NHANES 1999\u20132000)","volume":"13","author":"Henrich JB","year":"2006","journal-title":"Menopause"}],"container-title":["Acta Obstetricia et Gynecologica Scandinavica"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/aogs.70358","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/aogs.70358","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/aogs.70358","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T07:01:02Z","timestamp":1789628462000},"score":1,"resource":{"primary":{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/10.1111\/aogs.70358"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,17]]},"references-count":42,"alternative-id":["10.1111\/aogs.70358"],"URL":"https:\/\/doi.org\/10.1111\/aogs.70358","archive":["Portico"],"relation":{},"ISSN":["0001-6349","1600-0412"],"issn-type":[{"value":"0001-6349","type":"print"},{"value":"1600-0412","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,17]]},"assertion":[{"value":"2026-01-23","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-26","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-17","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"aogs.70358"}}