Risk for New onset of Depression in Perimenopausal Women

围绝经期女性新发抑郁症的风险

• 批准号: 6826793
• 负责人: BERNARD L HARLOW
• 金额: $ 50.31万
• 依托单位: BRIGHAM AND WOMEN'S HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2004
• 资助国家: 美国
• 起止时间: 2004-05-13 至 2009-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6826793
• 关键词: age difference; clinical research; depression; disease /disorder onset; disease /disorder proneness /risk; estradiol; ethnic group; female; follicle stimulating hormone; hormone regulation /control mechanism; hormone therapy; human data; human subject; interview; longitudinal human study; luteinizing hormone; menopause; menstrual cycle; mental disorder diagnosis; mental health epidemiology; psychological stressor; social support network; socioeconomics; vasomotion; women' s health

DESCRIPTION (provided by applicant): Several epidemiological studies have shown that women, compared to men, are at a substantially greater risk of depression beginning in adolescence and continuing through their entire life. In addition, the age-specific incidence of depression in women peaks during the late reproductive years. However, the extent to which the perimenopause represents a time of greater risk for new onset of depression in women with no history of mood disorder is yet to be determined. The Harvard Study of Moods and Cycles (HSMC), a population-based prospective study of late premenopausal aged women, is uniquely suited to investigate this association because of the rigorous systematic assessment of psychiatric morbidity and menstrual cycle changes over time. In this study, approximately 1000 premenopausal women with and without a lifetime history of depression were followed over 36 months with semi-annual psychiatric assessments, medical history interviews, and early follicular phase blood specimens to measure reproductive hormones in serum. Our published results have shown that 1) age at menarche and other events in early reproductive life are associated with risk for depression, 2) women with a lifetime history of major depression (particularly those with more severe depressive symptoms proximate to the perimenopause) are at a greater risk of developing menstrual cycle changes consistent with those that signal an earlier transition to the perimenopause compared to women with no depression history, and 3) early follicular phase FSH and LH are higher, and estradiol levels are lower in depressed compared to non-depressed late reproductive aged women as they move toward the climacteric. Having carefully gathered prospective data on psychiatric disorders and changes in menstruation, we now have a unique opportunity to evaluate the impact of the perimenopausal transition on risk of first onset of mood disturbance. In this current submission, we plan to include approximately 500 women from the original HSMC with no lifetime history of major depression, and will enrich this sample with an additional 200 largely minority women from the general population. Our preliminary data suggest that an earlier onset to the perimenopausal transition is associated with a 3-fold risk of new onset of major depression in women with no prior history of depressive disorder. Furthermore, it appears that initiation of hormonal therapy to treat menstrual cycle changes, irregularities, or somatic symptoms attenuates this increased risk of a first onset of depressive episode. We plan to better assess the effect of onset to the perimenopause on the risk for new onset of mood disturbance independent of past depression history that clearly influences the risk of recurrent episodes. The present project is designed to confirm and expand upon these preliminary findings by using structured clinical interviews for accurate psychiatric diagnoses, and comprehensive assessments of clinical symptoms at the time of the menopausal transition.

描述（由申请人提供）：几项流行病学研究表明，与男性相比，女性在青春期开始抑郁症的风险要大得多，并持续一生。此外，在生殖晚期，女性抑郁症的特定年龄发病率是峰值。但是，围绝经期在没有情绪障碍史的女性中代表了更大风险的抑郁症风险的时间。哈佛大学对情绪和周期的研究（HSMC）是对后期前老年妇女的基于人群的前瞻性研究，非常适合调查这种关联，因为对精神病性发病率和月经周期的严格评估随着时间的流逝而进行了严格的系统评估。在这项研究中，在36个月内，经过了36个月的精神病学评估，病史访谈和早期的卵泡期血液标本，以测量血清中生殖激素，大约有1000名具有和没有终生抑郁史的绝经前女性。我们已发表的结果表明，1）初潮和早期生殖生活中的其他事件的年龄与抑郁症的风险有关，2）具有严重抑郁症患有终身历史的妇女（尤其是那些与围绝经期更严重的抑郁症状的女性）与没有抑郁病史的女性相比，与早期过渡到围产期过渡的月经周期变化的风险更大，而3）早期卵泡期FSH和LH较高，并且与非 - 相比，雌二醇水平较低。沮丧的晚期生殖老年妇女朝着高潮生殖时。 在仔细收集了有关精神疾病和月经变化的前瞻性数据之后，我们现在有一个独特的机会来评估围绝经期过渡对首次发作情绪障碍风险的影响。在此目前的提交中，我们计划包括来自原始HSMC的大约500名女性，没有一生的大抑郁症史，并将以另外200名来自一般人群的少数少数妇女的身份丰富了这一样本。我们的初步数据表明，临时过渡的早期发作与没有先前没有抑郁症史的女性发生重大抑郁症的新风险有关。此外，似乎激素疗法开始治疗月经周期的变化，不规则或体细胞症状，这会削弱这种首次发作抑郁发作的风险。我们计划更好地评估发作对围栏的影响对独立于过去抑郁史的新发作的风险，这显然会影响复发性发作的风险。本项目旨在通过使用结构化的临床访谈来确认和扩展这些初步发现，以准确的精神诊断，并在绝经期过渡时对临床症状进行全面评估。