{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T05:10:30Z","timestamp":1788844230198,"version":"build-2803163510"},"reference-count":45,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T00:00:00Z","timestamp":1788825600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study aimed to examine the associations among menopausal symptoms, depressive symptoms, and sleep quality in peri- and postmenopausal women, with particular attention to the indirect statistical association through sleep quality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A multicenter cross-sectional study including 2,330 peri- and postmenopausal women was conducted. Menopausal symptoms were assessed using the Kupperman Menopausal Index (KMI), depressive symptoms using the Patient Health Questionnaire-9 (PHQ-9), and sleep quality using the Pittsburgh Sleep Quality Index (PSQI). Multivariable logistic regression and bootstrap-based statistical mediation models were applied to quantify associations and indirect effects.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Depressive symptoms (PHQ-9 \u22655) were observed in 34.0% of participants. Increasing severity of menopausal symptoms was significantly associated with both depressive symptoms and poor sleep quality (P&amp;lt;0.001). Poor sleep quality (PSQI &amp;gt;5) was strongly associated with depressive symptoms (odds ratio [OR]=4.48, 95% confidence interval [CI]: 3.72-5.40). Statistical mediation analysis indicated significant indirect associations through sleep quality, with proportions statistically mediated ranging from 17.08% to 63.39% and the largest proportion observed for hot flashes and sweating.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Sleep quality statistically accounted for part of the observed association between menopausal symptoms and depressive symptoms. These findings support incorporating sleep assessment into menopause care and provide a rationale for prospective studies evaluating temporal relationships and the potential value of sleep-focused interventions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fendo.2026.1915371","type":"journal-article","created":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T04:25:56Z","timestamp":1788841556000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Statistical mediation by sleep quality in the association between menopausal symptoms and depressive symptoms in peri- and postmenopausal women: a multicenter cross-sectional study"],"prefix":"10.3389","volume":"17","author":[{"given":"Zhiling","family":"Guo","sequence":"first","affiliation":[{"name":"The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University","place":["Shanghai, China"]},{"name":"Shanghai Key Laboratory of Embryo Original Diseases","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dongjian","family":"Yang","sequence":"additional","affiliation":[{"name":"The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University","place":["Shanghai, China"]},{"name":"Shanghai Key Laboratory of Embryo Original Diseases","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoyi","family":"Wang","sequence":"additional","affiliation":[{"name":"The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University","place":["Shanghai, China"]},{"name":"Shanghai Key Laboratory of Embryo Original Diseases","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shenglan","family":"Zuo","sequence":"additional","affiliation":[{"name":"The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University","place":["Shanghai, China"]},{"name":"Shanghai Key Laboratory of Embryo Original Diseases","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danqi","family":"Liu","sequence":"additional","affiliation":[{"name":"The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University","place":["Shanghai, China"]},{"name":"Shanghai Key Laboratory of Embryo Original Diseases","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mengfan","family":"Song","sequence":"additional","affiliation":[{"name":"The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University","place":["Shanghai, China"]},{"name":"Shanghai Key Laboratory of Embryo Original Diseases","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Furui","family":"Jin","sequence":"additional","affiliation":[{"name":"The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University","place":["Shanghai, China"]},{"name":"Shanghai Key Laboratory of Embryo Original Diseases","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,8]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"497","DOI":"10.1016\/j.ecl.2015.05.001","article-title":"Menopausal symptoms and their management","volume":"44","author":"Santoro","year":"2015","journal-title":"Endocrinol Metab Clinics North America"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1097\/GME.0000000000002386","article-title":"Sleep disturbance associated with the menopause","volume":"31","author":"Maki","year":"2024","journal-title":"Menopause"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(23)02801-5","article-title":"Promoting good mental health over the menopause transition","volume":"403","author":"Brown","year":"2024","journal-title":"Lancet"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1016\/j.maturitas.2013.11.007","article-title":"The association between vasomotor symptoms and depression during perimenopause: a systematic review","volume":"77","author":"Worsley","year":"2014","journal-title":"Maturitas"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1080\/13697137.2021.1998435","article-title":"Association of menopausal status and symptoms with depressive symptoms in middle-aged Chinese women","volume":"25","author":"Wang","year":"2022","journal-title":"Climacteric"},{"key":"B6","doi-asserted-by":"publisher","first-page":"358","DOI":"10.1080\/13697137.2026.2663898","article-title":"Do menopausal symptoms signal early biological aging? 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