Psychosocial Factors in Reproductive Aging

该CDA将为候选人提供制定全面培训计划的机会，使她能够成为一名独立的跨学科研究调查员，在女性生殖衰老领域具有特定专业知识，这是一个巨大的公共卫生问题，因为每年进入更年期的美国妇女人数迅速增加。更年期不仅标志着妇女的生殖状况发生重大变化，而且标志着妇女的一般健康状况发生重大变化。进入更年期的妇女患几种慢性病的风险增加，这些疾病造成了严重的发病率和死亡率负担。在这方面，阐明解释更年期发病时间差异的因素至关重要。新出现的证据表明，社会心理因素，包括较低的社会经济地位（SES）和抑郁症史，与绝经期提前有关。然而，这些因素与绝经期发病的生殖老化过程的关系尚不清楚。在这里，将检查与卵巢衰老相关的心理社会因素，以窦卵泡计数（AFC）为指标，在健康的育龄妇女样本（N = 850）中。具体而言，候选人将利用她在妇女健康流行病学，生殖内分泌学和心理神经内分泌学领域的CDA培训经验，进行2项研究，这些研究来自加州旧金山弗朗西斯科正在进行的资助研究。研究1的目的是（1）检查SES在生命过程中（儿童期，青春期，成年期）与卵巢衰老的关系，（2）检查SES对卵巢衰老影响的潜在行为/心理社会中介，（3）确定SES对卵巢衰老的影响是否在不同种族背景的女性中存在差异。研究2旨在确定（1）与从未抑郁的女性（N = 50）相比，患有重度抑郁症的女性（N = 50）是否表现出加速的卵巢衰老，以及（2）下丘脑-垂体-性腺（HPG）轴对女性生殖系统的调节及其与下丘脑-垂体-肾上腺（HPA）轴的相互作用是否可以解释这种差异。生活过程SES和精神病诊断将通过结构化访谈进行评估，心理社会因素通过标准化自我报告问卷进行评估，AFC通过经阴道超声进行评估，HPG和HPA功能分别通过雌二醇和皮质醇的唾液测量进行评估。结果将阐明可能的可改变的风险因素，加速卵巢老化的基础提前绝经。

DESCRIPTION (provided by applicant): This CDA will provide the candidate the opportunity to enact a comprehensive training plan that will enable her to become an independent, interdisciplinary research investigator with specific expertise in the area of female reproductive aging, a topic of enormous public health concern in light of the rapidly increasing number of American women entering menopause each year. Menopause marks a time of significant change not only in a woman's reproductive status but also in her health more generally. Women entering menopause are at increased risk for several chronic diseases which account for a significant morbidity and mortality burden. In this regard, elucidating factors that explain variance in the timing of menopause onset is of critical importance. Emerging evidence shows that psychosocial factors, including lower socioeconomic status (SES) and depression history, are related prospectively to earlier onset menopause. The relation of these factors to the reproductive aging process underlying menopause onset, however, is not known. Here, psychosocial factors will be examined in relation to ovarian aging, indexed by antral follicle count (AFC), in a sample of healthy, reproductive age women (N = 850). Specifically, the candidate will utilize her CDA training experiences in the areas of the epidemiology of women's health, reproductive endocrinology, and psycho-neuroendocrinology to conduct 2 studies that stem from an ongoing funded research study at the University of California San Francisco. Study 1 aims (1) to examine SES over the life course (periods of childhood, adolescence, adulthood) in relation to ovarian aging, (2) to examine the potential behavioral/psychosocial mediators of SES effects on ovarian aging, and (3) to determine whether SES effects on ovarian aging differ across women of various ethnic backgrounds. Study 2 aims to determine (1) whether women with Major Depressive Disorder (N = 50) exhibit accelerated ovarian aging compared to never-depressed women (N = 50) and (2) whether disruptions in the regulation of the female reproductive system by the hypothalamic-pituitary-gonadal (HPG) axis and its interaction with the hypothalamic-pituitary-adrenal (HPA) axis may explain this difference. Life course SES and psychiatric diagnoses will be assessed by structured interviews, psychosocial factors by standardized self-report questionnaires, AFC by transvaginal ultrasound, and HPG and HPA function by salivary measures of estradiol and cortisol, respectively. Results will elucidate possible modifiable risk factors for accelerated ovarian aging underlying earlier onset menopause.