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，女性从青春期开始并持续到一生的抑郁症风险要大得多。此外，女性特定年龄的抑郁症发病率在生育后期达到高峰。然而，在没有情绪障碍病史的女性中，围绝经期在多大程度上代表着新发抑郁症的风险更大还有待确定。哈佛情绪和周期研究(HSMC)是一项基于人群的前瞻性研究，对绝经前晚期女性进行了研究，因为它对精神疾病发病率和月经周期随时间的变化进行了严格的系统评估，因此特别适合研究这种联系。在这项研究中，对大约1000名有和没有终生抑郁史的绝经前妇女进行了超过36个月的跟踪调查，每半年进行一次精神评估、病史访谈和早期卵泡期血液样本，以测量血清中生殖激素的水平。我们已发表的研究结果表明：1)初潮年龄和早期生殖生活中的其他事件与抑郁症的风险有关；2)有终生抑郁症史的女性(尤其是那些在围绝经期附近有更严重抑郁症状的女性)发生月经周期变化的风险更大，这些变化与那些预示着与没有抑郁症病史的女性相比更早过渡到围绝经期的变化一致；3)与没有抑郁症史的晚期生殖年龄女性相比，患有抑郁症的晚期生殖年龄女性的卵泡早期FSH和黄体生成素水平较高，而雌二醇水平较低。 在仔细收集了有关精神障碍和月经变化的前瞻性数据后，我们现在有了一个独特的机会来评估围绝经期转变对首次出现情绪障碍的风险的影响。在目前的意见书中，我们计划从最初的HSMC中纳入大约500名没有严重抑郁症病史的女性，并将增加200名来自普通人群的主要是少数族裔的女性来丰富样本。我们的初步数据表明，在没有抑郁症病史的女性中，较早发病到围绝经期过渡期与新发抑郁症的风险是前者的3倍。此外，似乎开始激素治疗来治疗月经周期改变、异常或躯体症状可以减轻首次出现抑郁发作的风险。我们计划更好地评估围绝经期发病对新的情绪紊乱发作风险的影响，独立于过去的抑郁症病史，明显影响复发发作的风险。本项目旨在通过使用结构化的临床访谈来确认和扩大这些初步发现，以获得准确的精神诊断，并对更年期过渡时的临床症状进行全面评估。