Perimenopause and risk of psychiatric disorders: a longitudinal, population-based study

问题：全世界45岁以上的女性超过12亿，其中英国有2900万。其中约70%的人在围绝经期（最后一次月经前后的几年）出现神经和精神症状。有研究表明，围绝经期也是精神疾病发病或加重的高危期，包括重度抑郁症、精神分裂症和双相情感障碍。迄今为止的研究主要集中在抑郁症状上。很少有研究发现，即使在控制了其他症状和预测因素之后，围绝经期出现身体不适的风险是绝经前的2-4倍。世界各地的专业团体和机构都强调了心理健康方面的性别差距，包括关于生殖老龄化影响的知识差距。关于严重精神障碍的资料很少，也不一致，更广泛地说，关于妇女在过渡到更年期期间易患病的因素的资料也很少。对妇女、她们的家庭和照顾者来说，缺乏信息是一个重大问题。一些在围绝经期出现精神疾病的妇女可能没有任何精神病史，或者可能多年来一直很好，但没有接触过精神科服务。确定这些妇女并为她们提供必要的护理至关重要。研究：这项研究将解决目前缺乏与围绝经期有关的严重精神疾病风险的信息。它将系统地调查超过16万名中年英国妇女的人口，这些妇女通过访谈和初级保健和住院的电子健康记录被跟踪到绝经后。使用标准程序提取和清理数据。我们将计算不同时期精神障碍的风险。我们将检验这一假设，即绝经后期是精神障碍风险增加的时期。由于并非所有妇女都是一样的，我们将设法确定具有类似风险概况的妇女群体。我们还将探讨心理社会、临床和遗传因素对患病风险的影响。有实际经验的妇女参与了这项研究的设计，并将参与研究的所有阶段，通过一个咨询小组提供投入。他们还将在讲习班和宣传活动上发表演讲。益处：这项研究的发现将有助于确定女性是否有患与绝经期有关的精神疾病的风险。这些妇女可能受益于更密切的监测，并将有权采取措施管理自己的健康，以避免复发。及时识别疾病的早期迹象将有助于更迅速地进行治疗，从而有可能挽救生命。通过向公众提供基于证据的、易于理解的信息，这项研究也可能有助于提高人们对围绝经期精神疾病风险的认识。此外，它有可能为妇女本身提供更有效地管理疾病的工具，并有助于消除对与绝经期有关的精神障碍的污名化。研究结果还将有可能通过影响指导方针和为风险评估工具提供信息，改进目前对中年妇女精神疾病的诊断、预防和治疗方法。长期目标是改善个性化的风险预测，并最终帮助患有围绝经期精神障碍的女性，减少疾病发作对处于危险中的女性的影响。鉴于中年心理健康状况不佳与总体健康状况之间的关联，我们的研究也有可能有助于改善女性的总体健康和福祉。

THE PROBLEMThere are over 1.2 billion women over the age of 45 in the world, 29 million in the UK. About 70% of them develop neurological and psychiatric symptoms during perimenopause (the years around the final menstrual period). It has been suggested that perimenopause is also a high-risk period for the onset or exacerbation of psychiatric disorders, including major depression, schizophrenia and bipolar disorder. Research thus far has mainly focused on depressive symptoms. The very few studies that have investigated clinically significant major depression have found a 2-4 times greater risk of becoming unwell during perimenopause compared to the pre-menopause, even after controlling for other symptoms and predictors. Professional bodies and institutions worldwide have highlighted the gender gap in mental health, including the knowledge gap on the effects of reproductive ageing. Little and inconsistent information is available on severe mental disorders and, more broadly, on the factors that may predispose women to become unwell during the transition to menopause. This lack of information is a major issue for women, their families and carers. Some women who develop psychiatric disorders during perimenopause may not have any psychiatric history or may have been well for many years and not in contact with psychiatric services. Identifying these women and providing them with the necessary care is of vital importance. THE RESEARCHThis research will address the current lack of information on the risk of severe mental illness related to perimenopause. It will systematically investigate a population of over 160,000 middle-aged UK women who have been followed up to the postmenopause using interviews and electronic health records from primary care and hospital admission. Data will be extracted and cleaned using standard procedures. We will calculate the risk of mental disorders at different time periods. We will test the hypothesis that the late perimenopause is a period of increased risk of mental disorders. As not all women are the same, we will seek to identify groups of women with similar risk profiles. We will also explore the effect of psycho-social, clinical and genetic factors on the risk of becoming unwell. Women with lived experience have been involved in the design of this study and will be involved at all stages of research to provide input via an advisory group. They will also give talks at workshops and dissemination events. BENEFITS The findings of this study will help identify women at risk of developing mental illness in relation to the perimenopause. These women may benefit from closer monitoring and will be empowered to take steps to manage their own health to avoid relapse. Prompt recognition of early signs of illness will allow more rapid treatment, with the potential to save lives.By providing evidence-based, easy-to-understand information to the public, the research may also contribute to raising awareness of the risks of mental illness during perimenopause. Moreover, it has the potential to give women themselves the tools to manage their illness more effectively and to contribute to the de-stigmatization of mental disorders associated to the perimenopause.The results will also have the potential to improve the current approach to diagnosis, prevention and treatment of psychiatric disorders in middle-aged women by influencing guidelines and informing risk assessment tools.The long-term goal is to improve personalised risk predictions and ultimately how we help women with perimenopause mental disorder, reducing the impact of episodes of illness in women at risk. Given the association between poor mental health in middle-age years and general health outcomes, our research also has the potential to contribute to improving the general health and wellbeing of women.