Association of depressive symptoms using patient health questionnaire-9 with quality of life in postmenopausal women with DXA-confirmed osteoporosis

Abstract

Depression is an under-recognized risk factor for osteoporosis (OP) and adversely affects quality of life (QOL). Data on depressive symptoms among postmenopausal women aged ≥50 years with osteoporosis in India are limited. This study aimed to assess depressive symptoms and their impact on QOL among postmenopausal women with osteoporosis from low- and middle-income urban communities. A total of 688 menopausal women aged ≥50 years were recruited through community-based camps (2016–2019), of whom 14.2%, 31.5%, and 54.2% were diagnosed as normal, osteopenia, and osteoporosis, respectively, by dual-energy X-ray absorptiometry (DXA) scans. A subset of 100 postmenopausal women aged 50–75 years with osteoporosis and ≥5 years since menopause was included using a consecutive convenience sampling technique. Depressive symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9), and QOL was assessed using the WHOQOL-BREF through face- to- face (in-person) interviews. Participants were also assessed for non-communicable diseases (NCD) and musculoskeletal complaints. Mild, moderate, and moderately severe depressive symptoms were observed in 17%, 4%, and 1% of the participants, respectively. The comparison of WHOQOL-BREF with depressive symptoms revealed that the physical domain of WHOQOL was significantly associated with depressive symptoms, indicating that women with depressive symptoms had substantially lower median scores [63.0 (IQR:50.0-69.0) vs. 88.0 (IQR: 81.0-94.0), Mann-Whitney U=128.0, z= -6.136, p <0.001, r=0.61]. Screening with the PHQ-9 and WHOQOL-BREF in community-based NCD camps may help in the early identification of depressive symptoms among menopausal women with osteoporosis. Integrating mental health screening with current geriatric and primary healthcare services through national initiatives, such as the National Mental Health Programme and Ayushman Bharat, may improve the overall quality of life.