MENOPAUSE TRANSITION, MENTAL HEALTH, AND ETHNICITY

在这项精神疾病临床研究(CSMD)协作R01的应用中，来自三个站点的研究人员建议继续我们在全国妇女健康研究(SWAN)第一阶段开始的工作。我们的主要目的是评估有精神障碍病史的女性是否比没有精神障碍病史的女性更容易经历艰难的更年期过渡。利用NIMH对核心天鹅项目的一小部分补充奖励，我们使用DSM-IV的结构化临床访谈(SCID)对42-52岁的绝经前非裔美国人、西班牙裔和高加索女性进行了精神病学评估。在CSMD为这项前瞻性队列研究提供资金的情况下，我们将继续对1000多名开始或即将开始更年期过渡到围绝经期的妇女进行年度跟踪SCID评估。通过继续系统地收集关于大型多种族队列的精神病学数据，我们可以利用天鹅现有的广泛的生物学和心理社会数据。我们有一个独特的机会来扩大对中年及以后女性心理健康的了解。我们的具体目标是(1)估计围绝经期和绝经期后症状和亚症候群抑郁和焦虑障碍的发生率和流行率；(2)确定焦虑或抑郁障碍的终生病史是否是：(A)围绝经期期间的抑郁或焦虑，(B)绝经困难，(C)健康指标差的模式，(D)绝经年龄较小，以及(3)描述更年期过渡期间躯体形式障碍的患病率及其对各种社会、医疗保健利用和症状报告措施的影响。我们将确定生理和心理状况和行为模式的差异是否因种族和社会经济地位而异，并评估精神症状和症状、围绝经期和绝经期以及生活压力对目标1-3中确定的躯体、心理和健康结果的相对贡献。

In this Collaborative R01 for Clinical Studies of Mental Disorders (CSMD) application the investigators from the three sites propose to continue the work we began in the first phase of the Study of Women's Health Across the Nation (SWAN). Our primary aim was to assess whether women with a history of psychiatric disorder are more vulnerable than women without such a history to a difficult menopause transition. With a small supplement award to the core SWAN project from NIMH we have conducted psychiatric assessments using the Structured Clinical Interview (SCID) for DSM-IV on pre-menopausal African American, Hispanic and Caucasian women, 42-52 years old. With funding from the CSMD for this prospective cohort study we will continue the task of conducting yearly follow-up SCID assessments of over 1000 women who are beginning or will soon begin the menopause transition into perimenopause. By continuing to collect systematically psychiatric data on a large multi- ethnic cohort we can take advantage of the extensive biological and psychosocial data available in SWAN. We have a unique opportunity to expand the knowledge of women's mental health in midlife and beyond. Our specific aims are to (1) estimate the incidence and prevalence of syndromal and sub-syndromal depressive and anxiety disorders during the per- and post-menopause; (2) determine if having a lifetime history of an anxiety or depressive disorder is a risk factor for: (a) depression or anxiety during perimenopause, (b) a difficult menopause, (c) a pattern of poor health indicators, (d) younger age at menopause, and (3) describe the prevalence of somatoform disorders during the menopausal transition and their impact on the various social, health care utilization and symptom reporting measures. We will determine whether the differences in patterns of physical and psychological conditions and behaviors vary by ethnicity and socioeconomic status, and evaluate the relative contributions of psychiatric symptoms and syndromes, peri- and post-menopause, and life str to the somatic, psychological, and health outcomes identified in aims 1-3.