Table 1.

Summary of included studies

Study	Date published	Location of study	Study design	Number of participants	Psychiatric history assessment?	Quality rating (GRADE)	Key results
Almeida et al.	2016	Perth, Australia	Cross-sectional survey	1612	Yes	Low	Non-significant excess of depressive symptoms during transition and early post-menopause.
Amore et al.	2004	Italy	Cross-sectional	1434	Yes	Low	Depressive symptoms lower in pre-menopausal than post-menopause. Depression and significant anxiety present throughout and after menopause. Prior depression predicts subsequent post-menopausal depression.
Amore et al.	2007	Italy	Cross-sectional survey	1345	Yes	Low	Depressive and sexual symptoms more severe in the post-menopausal group, and strongly associated with life events.
Annivero et al.	2017	Milan, Italy	Prospective cohort	156	Yes	High	No significant difference across the menopause
Chou et al.	2015	Tainan City, Taiwan	Cross-sectional survey	111	Yes	Low	Depressive symptoms during the menopausal transition predicted depressive symptoms over 30 months. However, after controlling for it, the previous diagnosis of major depressive disorder menopausal status and vasomotor symptoms did not predict depressive symptoms over 30 months whereas neuroticism did.
Filipa et al.	2012	Portugal	Cross-sectional	992	Yes	Low	All symptoms in peri- and post-menopausal women elevated risk compared to pre-menopause. Peri-menopausal women did not differ from post-menopausal regarding perceived loss of control, anxiety or depression.
HUNT-II study	2009	Norway	Prospective cohort	16,080	No	Moderate	Hospital anxiety and depression scale-Anxiety peaked in perimenopause. High anxiety connected to hormone fluctuation.
Juang et al.	2005	Taiwan	Cross-sectional survey	1273	No	Low	Depression and anxiety were not associated with menopausal status but with hot flashes. After controlling for educational status and insomnia, anxiety and depression were significantly higher in peri- and post- menopausal women who experienced hot flashes.
Melbourne women’s midlife health project	2016	Melbourne, Australia	Cohort study	438	No	Moderate	Experience of negative mood and depressive symptoms was highest during the menopausal transition and lowest in the late post-menopause. Furthermore, increasing age was associated with reduction of depressive symptoms and negative mood. Yet when controlling for age, there was no difference found between early and late post-menopause stage.
Peking Union Medical College Hospital Aging Longitudinal Cohort of Women in Midlife (PALM) study	2019	Beijing, China	Prospective cohort	430	No	Low	Depression is more common than anxiety Both anxiety and depression are frequent in early years of menopause Poor health status and sleep independently associated with anxiety, whereas higher body mass index, poor physical health, low level of education, and night sweats independently associated with depression
Peking Union Medical College Hospital Aging Longitudinal Cohort of Women in Midlife (PALM) study	2020	Beijing, China	Prospective cohort	430	No	Low	Strong relationship between vasomotor and mood symptoms during menopause.
Personality and total health (PATH) through life project	2017	Canberra, Australia	Prospective cohort	711	Yes	Moderate	Higher risk of depression during perimenopause and symptoms of anxiety during post-menopause. In women with no history of depression or anxiety, the perimenopause and post-menopausal stages are associated with increased risk, relative to pre-menopause.
Penn ovarian aging study	2006	Pennsylvania, USA	Prospective cohort	231	Yes	Moderate	Menopause strongly associated with de novo depression in women with no prior history of depression.
Study of Women’s Health Across the Nation (SWAN)	2008	Pittsburgh, USA	Prospective cohort	226	Yes	Moderate	Earlier psychological problems and contemporary stressors more important than vasomotor symptoms for first episode of depression during menopause.
Study of Women’s Health Across the Nation (SWAN)	2012	Pittsburgh, USA	Prospective cohort	1970	No	Moderate	Women who undergo a hysterectomy with or without bilateral oophorectomy do not experience more depressive symptoms post-surgery.
Study of Women’s Health Across the Nation (SWAN)	2015	Pittsburgh, USA	Prospective cohort	443	Yes	Moderate	Women without history of depression at baseline at lower risk of developing depression than those with a prior history. For peri- and post-menopausal, prior anxiety was risk factors for depression.
Terauchi et al.	2012	Tokyo, Japan	Cross-sectional survey	237	No	Low	Insomnia is highly prevalent among peri- and post- menopausal women. Difficulty in initiating sleep and non-restorative sleep are significantly associated with anxiety and depression respectively.
The Harvard study of mood and cycles	2006	Massachusetts, USA	Prospective cohort	460	Yes	Moderate	Those with no history of depression who enter menopause early have a significant risk for new depression.
The Maccabi Healthcare Services (MHS) database study	2020	Israel	Retrospective cohort	17,051	Yes	Moderate	Menopausal symptoms are associated with increased burden of disease and healthcare utilization. Symptomatic peri- and post-menopausal women are more likely to have a higher prevalence of depression and anxiety in the year following their first menopause diagnosis.
The MIDUS study	2011	New Jersey, USA	Prospective longitudinal study	986	No	Moderate	Depressive symptoms predicted 9-year follow-up levels of menopausal symptoms controlling for depressive symptoms, age, financial status and education. Menopausal symptoms predicted 9-year follow-up levels of depressive symptoms controlling for menopausal symptoms, age, financial status and education.
The Zurich study	2016	Zurich, Switzerland	Prospective cohort	168	No	Low	Mental health problems between ages 41 and 50 not directly related to menopause
Ying et al.	2008	Beijing, China	Cross-sectional	1280	Yes	Low	Depression and anxiety common in menopause, related to psychosocial factors.