The mental health of women in this DMXAA study was also negatively impacted by previous diagnosis with depression and/or anxiety. This is consistent with literature suggesting that past mental health problems greatly increase the odds of future depressive episodes [46] and [47]. Possibly, the stress-responsive system dysfunction persist after remission [46], and that the stress associated with midlife [48] and [49], may increase women's vulnerability to mental health problems in those who are at increased risk. One of the strategies therefore, for the preservation of good mental health in mid-life and older women, may be through the promotion of positive health behaviors and the maintenance of good general physical and mental health earlier in life [19] and [20].
Several limitations of termination codon study should be acknowledged. First, although data were collected using random sampling, attrition over time may have influenced the representativeness of the sample. There was evidence to suggest, that among study participants, those who were more frail and unwell were more likely to withdraw from the study. Research suggests participants with poorer health have a greater risk of attrition compared with participants in generally good health. Also the data collection methods used (i.e., mail surveys) in this study may have posed a higher risk of attrition. Indeed, mail surveys are considered to be less personal than face-to-face interviews, and therefore participants may be less persuaded to continue in the study [53].
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