Migraine, Depressive Symptoms, and Maternal Quality of Life in the Postpartum Period: The Role of Comorbidity, Disengagement, and Social and Economic Disadvantage

项目摘要/摘要 在美国，三分之一的育龄妇女会受到偏头痛的影响。女性偏头痛患者 患抑郁症的风险增加五倍之多。产后期是一个特殊的时期 对于患有偏头痛的女性来说，这是一个具有挑战性的时期，因为荷尔蒙的快速变化、疲劳、疲惫和 外界压力是偏头痛和产后抑郁症状的已知诱因。如果女性的 偏头痛自我管理风格(MSMS)主要涉及脱离(即社交退缩、回避、 一厢情愿)，对出现抑郁症状和协同恶化的影响 各种情况下的症状可能更显著。这些风险可能会成倍增加对 社会和/或经济上处于不利地位(SED)的妇女，因为她们从 偏头痛和产后抑郁症状。合并症的特征是(1)较高的患病率 这些共同发生的障碍，以及(2)跨症状和自我管理策略存在的协同作用 一种情况(偏头痛)容易发展成一种共病情况(抑郁)受(3)的影响 社会背景因素(面对产后需求时的社会和/或经济劣势)。尽管 这些疾病单独的高患病率，偏头痛抑郁共病风险的增加 产后期的症状，以及对妇女及其家庭的潜在影响，缺乏 这方面的研究。拟议的研究将使用语义学框架来理解这些关系， 机制，以及偏头痛和抑郁症状、脱离和社交或 产后前3个月经济状况不佳。这将通过以下方式实现： 目的1：研究(A)偏头痛症状严重程度、(B)抑郁症状之间的关系 严重程度，(C)作为偏头痛自我管理方式的脱离程度，和(D)社会和/或 随着时间的推移，经济上的劣势。 目标1a：测试脱离活动在多大程度上调节偏头痛之间的关系 症状严重程度和抑郁症状严重程度。 目标1b：确定社会和/或经济劣势是否会在多大程度上缓和 脱离参与调节偏头痛-抑郁症状之间的关系。 目的2：比较患有合并症(共病)的妇女的母体生活质量 偏头痛和中度至重度产后抑郁症状)和没有这种症状的女性。 申请者概述了根据该奖项将完成的全面培训计划。会议的结果 研究和培训计划将为申请者提供获得职业发展奖的技能和数据 针对合并症的预防干预措施，可能有助于扰乱 偏头痛妇女产后抑郁症状的发展。

PROJECT SUMMARY/ABSTRACT Migraine affects one in three women of childbearing age in the United States (U.S.). Women with migraine have up to a five-fold increased risk for comorbid depression. The postpartum period is an especially challenging time for women with migraine, as rapid hormonal shifts, fatigue, exhaustion, and increased external stressors are known triggers for both migraine and postpartum depressive symptoms. If women's migraine self-management style (MSMS) primarily involves disengagement (i.e. social withdrawal, avoidance, wishful thinking), the implications for developing depressive symptoms and synergistically worsening symptoms across conditions may be more significant. These risks may be exponentially more harmful to socially and/or economically disadvantaged (SED) women, as they experience the greatest burden from migraine and postpartum depressive symptoms. A syndemic is characterized by the (1) higher prevalence of these co-occurring disorders, and (2) synergism that exists across symptoms and self-management strategies of one condition (migraine) that facilitates developing a comorbid condition (depression) are influenced by (3) social contextual factors (social and/or economic disadvantage in the face of postpartum demands). Despite the high prevalence of these disorders individually, the increased risk for comorbid migraine-depressive symptoms in the postpartum period, and the potential impact on women and their families, there is a paucity of research in this area. The proposed study will use a syndemics framework to understand the relationships, mechanisms, and interactions among migraine and depressive symptoms, disengagement, and social or economic disadvantage over the first 3 months postpartum. This will be accomplished by the following: Aim 1: Examine the relationships among (a) migraine symptom severity, (b) depressive symptom severity, (c) level of disengagement as a migraine self-management style, and (d) social and/or economic disadvantage, over time. Aim 1a: Test the extent to which disengagement mediates the relationship between migraine symptom severity and depressive symptom severity. Aim 1b: Determine whether social and/or economic disadvantage moderates the extent to which disengagement mediates the migraine-depressive symptom relationship. Aim 2: Compare maternal quality of life among women who develop the syndemic factor (comorbid migraine and moderate-to-severe postpartum depressive symptoms) and women who do not. The applicant has outlined a comprehensive training plan to be completed under this award. Outcomes of the study and training plan will provide the applicant with skills and data to pursue a career development award on prevention-oriented interventions targeting syndemic conditions that may be useful in disrupting the development of postpartum depressive symptomatology among women with migraine.