Neuroendocrine Mechanisms Underlying Perimenopausal Risk for Trauma-Related Hyperarousal in Black Women

总结 重复创伤暴露的累积率在城市，低社会经济地位的黑人社区中更高。 状态，并与不良、创伤后心理健康结果的患病率增加有关， 包括创伤后应激障碍创伤后应激障碍与创伤相关性过度觉醒（TRH）有关 以及依赖于调节对威胁的反应的大脑区域的失调的恐惧反应， 包括杏仁核和腹内侧前额叶皮层。一个生物因素，赋予增加 TRH的风险是女性。虽然严格的研究表明，低水平的类固醇激素雌二醇 (E2)与TRH风险增加和创伤暴露妇女对威胁的高度敏感有关， 这些先前的研究比较了那些在E2水平上自然不同的女性， 生殖状态/阶段。因此，需要进一步的研究来确定绝经后E2的变化 过渡期增加了创伤暴露妇女对TRH的脆弱性和对威胁的高反应性。当前 考虑到我们招募了黑人实习生， 来自高创伤风险人群的女性。拟议的研究将结合联合收割机临床采访，恐惧 心理生理学、神经影像学和神经内分泌学，以检查围绝经期和 随着时间的推移，E2水平会影响TRH和对威胁的反应。研究神经内分泌如何改变 在绝经过渡期影响恐惧心理生理学和杏仁核反应的威胁的影响 TRH对于围绝经期这些症状的识别、评估和治疗至关重要 在妇女，特别是黑人妇女中，她们经历累积创伤的比例不成比例地高， 暴露和PTSD

Summary The cumulative rate of repeated trauma exposure is greater in Black communities of urban, low socioeconomic status and is associated with increased prevalence of adverse, posttraumatic mental health outcomes, including posttraumatic stress disorder (PTSD). PTSD is associated with trauma-related hyperarousal (TRH) and dysregulated fear responses that are dependent upon brain regions that modulate responses to threat, including the amygdala and the ventromedial prefrontal cortex. One biological factor that confers increased risk for TRH is female sex. While rigorous studies have shown that low levels of the steroid hormone estradiol (E2) are associated with increased risk for TRH and hyper-sensitivity to threat in trauma-exposed women, these prior studies compared women who naturally differed from one another in E2 levels regardless of reproductive status/stage. Thus, further work is needed to determine how changes in E2 over the menopausal transition increase vulnerability to TRH and hyper-reactivity to threat in trauma-exposed women. The current study is well positioned to address this gap in knowledge given our recruitment of perimenopausal Black women from a high trauma risk population. The proposed research will combine clinical interviews, fear psychophysiology, neuroimaging, and neuroendocrinology to examine how the perimenopause and changes in E2 levels over time influence TRH and responsivity to threat. Investigating how neuroendocrine changes during the menopausal transition influence fear psychophysiology and amygdala reactivity to threat to impact TRH is critical for the identification, assessment, and treatment of these symptoms during the perimenopause in women, especially Black women, who experience disproportionately higher rates of cumulative trauma exposure and PTSD.