The correct answer is B (prior hysterectomy). Large scale studies show an elevated risk of depression in women following hysterectomy with and without oophorectomy. A is incorrect because vasomotor symptoms are associated with depressive symptoms but not MDEs, except in women with first lifetime onset of a depressive episode during the perimenopause. D is incorrect because common midlife stressors for women (eg, caring for children and parents, career and relationshipshifts, aging, body changes) and personal/family illness can adversely affect mood but ‘‘empty nest’’ has little enduring effect. C and E are incorrect because nulliparity and low educational level may be more consistent risk factors for MDD in this age group.

Publication reference : Maki PM et al, Menopause 2018; 25: 1069-1085
Reference URL: https://www.ncbi.nlm.nih.gov/pubmed/30179986