Dysmenorrhea and Sleep Disturbances as Predictors of Depressed Mood in Adolescents

Purpose: Pubertal changes mark a distinction in the trajectory of the sexes such that post-pubescent females are twice as likely to experience disturbed sleep and depression compared to males. Painful menses (dysmenorrhea) may be a contributing factor to this divergence as females who experience dysmenorrhea report both elevated depression and sleep disturbances. We predicted that teens with dysmenorrhea would exhibit increased depressed mood compared to their peers when accounting for disturbed sleep. Methods: Participants were 33 healthy post-pubescent teens from the Fort Worth area. Mean age was 15.2 years (SD=1) with 73% female (mean gynecological age=3.4) and 24% Latino. Data were collected during an experimental study examining sleep and health. Parents and teens gave informed consent/assent before reporting on disturbed sleep (SDIS), depressed mood (PHQ9), phase preference, and daytime sleepiness (PDSS). For 1 week, females reported daily on menstrual status and all teens wore actigraphy to capture sleep from which sleep duration (TST), timing (bed-/wake-time), and efficiency (SE) were calculated. At week’s end, teens completed a second PHQ9 and PDSS. Groups were determined by biological sex, menses status (active or not), and pain medication use resulting in 4 groups: females with menses and pain (dysmenorrhea), females with menses and no pain, females without menses or pain, and males without pain. Univariate ANOVAs determined significant contributors to mood for the final repeated measures ANOVA model that examined group differences in depressed mood. All analyses were evaluated at p Results: A repeated measures ANOVA examined differences in mood with covariates SDIS, PDSS, and wake-time. Results showed trend overall group differences in mood, F(3,25)=2.68, p= 0.069. Planned pairwise comparisons showed females with dysmenorrhea had significantly higher depressed mood than females without menses (12.3 vs 5.5, p=0.037) and males (12.3 vs 3.2, p=0.016). Disturbed sleep also contributed significantly to depressed mood, F(1,25)=9.13, p=0.003). Conclusions: Dysmenorrhea contributed to sustained depressed mood in teens. Importantly, depressed mood remained elevated as menses ended for these females, but not for those without dysmenorrhea. Long-term studies should examine the role dysmenorrhea has in chronic depressed mood in teens, and if sleep interventions can improve dysmenorrhea and prevent chronic depressed mood in adolescent females.