Perimenopause and risk of psychiatric disorders: a longitudinal, population-based study

问题世界上有超过12亿45岁以上的女性，其中2900万在英国。大约70%的人在围绝经期（最后一次月经的几年）出现神经和精神症状。有人认为，围绝经期也是精神疾病发作或恶化的高风险时期，包括重度抑郁症、精神分裂症和双相情感障碍。到目前为止，研究主要集中在抑郁症状上。很少有研究调查了具有临床意义的重度抑郁症，发现与绝经前相比，围绝经期出现不适的风险高出2-4倍，即使在控制了其他症状和预测因素之后。世界各地的专业团体和机构都强调了心理健康方面的性别差距，包括关于生殖老龄化影响的知识差距。关于严重精神障碍的信息很少，而且不一致，更广泛地说，关于可能使妇女在向更年期过渡期间感到不适的因素的信息也很少。缺乏信息是妇女及其家人和照料者面临的一个主要问题。一些妇女在围绝经期期间发生精神疾病可能没有任何精神病史，或者可能多年来一直很好，没有接触精神病服务。查明这些妇女并为她们提供必要的照顾至关重要。这项研究将解决目前缺乏关于围绝经期严重精神疾病风险的信息。它将系统地调查超过160，000名中年英国女性，这些女性使用初级保健和住院的访谈和电子健康记录随访到绝经后。将使用标准程序提取和清理数据。我们将计算不同时间段的精神障碍风险。我们将检验这一假设，即晚期围绝经期是一个时期的精神障碍的风险增加。由于并非所有妇女都是一样的，我们将设法确定具有类似风险特征的妇女群体。我们还将探讨心理社会，临床和遗传因素对患病风险的影响。有生活经验的妇女参与了这项研究的设计，并将参与研究的各个阶段，通过咨询小组提供投入。他们还将在研讨会和传播活动中发表演讲。这项研究的结果将有助于确定妇女在发展精神疾病的风险与围绝经期。这些妇女可能会受益于更密切的监测，并将被赋予权力，采取措施管理自己的健康，以避免复发。及时识别疾病的早期迹象将有助于更快速的治疗，并有可能挽救生命。通过向公众提供基于证据的，易于理解的信息，该研究还可能有助于提高对围绝经期精神疾病风险的认识。此外，它有可能为妇女提供更有效地管理其疾病的工具，并有助于消除与围绝经期有关的精神障碍的污名，其结果也有可能改善目前的诊断方法，通过影响指南和告知风险评估工具，预防和治疗中年妇女的精神疾病。长期目标是改善个性化的风险预测，并最终帮助围绝经期精神障碍妇女，减少疾病发作对高危妇女的影响。鉴于中年心理健康状况不佳与总体健康状况之间的关联，我们的研究也有可能有助于改善女性的总体健康和福祉。

THE PROBLEMThere are over 1.2 billion women over the age of 45 in the world, 29 million in the UK. About 70% of them develop neurological and psychiatric symptoms during perimenopause (the years around the final menstrual period). It has been suggested that perimenopause is also a high-risk period for the onset or exacerbation of psychiatric disorders, including major depression, schizophrenia and bipolar disorder. Research thus far has mainly focused on depressive symptoms. The very few studies that have investigated clinically significant major depression have found a 2-4 times greater risk of becoming unwell during perimenopause compared to the pre-menopause, even after controlling for other symptoms and predictors. Professional bodies and institutions worldwide have highlighted the gender gap in mental health, including the knowledge gap on the effects of reproductive ageing. Little and inconsistent information is available on severe mental disorders and, more broadly, on the factors that may predispose women to become unwell during the transition to menopause. This lack of information is a major issue for women, their families and carers. Some women who develop psychiatric disorders during perimenopause may not have any psychiatric history or may have been well for many years and not in contact with psychiatric services. Identifying these women and providing them with the necessary care is of vital importance. THE RESEARCHThis research will address the current lack of information on the risk of severe mental illness related to perimenopause. It will systematically investigate a population of over 160,000 middle-aged UK women who have been followed up to the postmenopause using interviews and electronic health records from primary care and hospital admission. Data will be extracted and cleaned using standard procedures. We will calculate the risk of mental disorders at different time periods. We will test the hypothesis that the late perimenopause is a period of increased risk of mental disorders. As not all women are the same, we will seek to identify groups of women with similar risk profiles. We will also explore the effect of psycho-social, clinical and genetic factors on the risk of becoming unwell. Women with lived experience have been involved in the design of this study and will be involved at all stages of research to provide input via an advisory group. They will also give talks at workshops and dissemination events. BENEFITS The findings of this study will help identify women at risk of developing mental illness in relation to the perimenopause. These women may benefit from closer monitoring and will be empowered to take steps to manage their own health to avoid relapse. Prompt recognition of early signs of illness will allow more rapid treatment, with the potential to save lives.By providing evidence-based, easy-to-understand information to the public, the research may also contribute to raising awareness of the risks of mental illness during perimenopause. Moreover, it has the potential to give women themselves the tools to manage their illness more effectively and to contribute to the de-stigmatization of mental disorders associated to the perimenopause.The results will also have the potential to improve the current approach to diagnosis, prevention and treatment of psychiatric disorders in middle-aged women by influencing guidelines and informing risk assessment tools.The long-term goal is to improve personalised risk predictions and ultimately how we help women with perimenopause mental disorder, reducing the impact of episodes of illness in women at risk. Given the association between poor mental health in middle-age years and general health outcomes, our research also has the potential to contribute to improving the general health and wellbeing of women.