MENOPAUSE TRANSITION, MENTAL HEALTH, AND ETHNICITY

在这个精神障碍临床研究（CSMD）的协作R01申请中，来自三个地点的研究人员建议继续我们在全国妇女健康研究（SWAN）第一阶段开始的工作。我们的主要目的是评估有精神病史的女性是否比没有精神病史的女性更容易经历艰难的更年期过渡。利用NIMH核心SWAN项目的一小笔补充奖金，我们使用DSM-IV的结构化临床访谈（SCID）对42-52岁的绝经前非裔美国人、西班牙裔和高加索女性进行了精神病学评估。在CSMD对这项前瞻性队列研究的资助下，我们将继续对1000多名正在或即将开始更年期过渡到围绝经期的妇女进行年度随访SCID评估。通过继续系统地收集大型多民族队列的精神病学数据，我们可以利用SWAN中广泛的生物学和社会心理数据。我们有一个独特的机会来扩大中年及以后妇女心理健康的知识。我们的具体目的是：(1)估计绝经前后综合征和亚综合征抑郁症和焦虑症的发病率和患病率；(2)确定是否有焦虑或抑郁障碍的终生病史是以下风险因素：(a)围绝经期抑郁或焦虑，(b)困难的绝经期，(c)健康指标不佳的模式，(d)绝经年龄较低，以及(3)描述更年期过渡期间躯体形式疾病的患病率及其对各种社会、医疗保健利用和症状报告措施的影响。我们将确定生理和心理状况和行为模式的差异是否因种族和社会经济地位而异，并评估精神症状和综合征、绝经前后和寿命对目标1-3中确定的躯体、心理和健康结果的相对贡献。

In this Collaborative R01 for Clinical Studies of Mental Disorders (CSMD) application the investigators from the three sites propose to continue the work we began in the first phase of the Study of Women's Health Across the Nation (SWAN). Our primary aim was to assess whether women with a history of psychiatric disorder are more vulnerable than women without such a history to a difficult menopause transition. With a small supplement award to the core SWAN project from NIMH we have conducted psychiatric assessments using the Structured Clinical Interview (SCID) for DSM-IV on pre-menopausal African American, Hispanic and Caucasian women, 42-52 years old. With funding from the CSMD for this prospective cohort study we will continue the task of conducting yearly follow-up SCID assessments of over 1000 women who are beginning or will soon begin the menopause transition into perimenopause. By continuing to collect systematically psychiatric data on a large multi- ethnic cohort we can take advantage of the extensive biological and psychosocial data available in SWAN. We have a unique opportunity to expand the knowledge of women's mental health in midlife and beyond. Our specific aims are to (1) estimate the incidence and prevalence of syndromal and sub-syndromal depressive and anxiety disorders during the per- and post-menopause; (2) determine if having a lifetime history of an anxiety or depressive disorder is a risk factor for: (a) depression or anxiety during perimenopause, (b) a difficult menopause, (c) a pattern of poor health indicators, (d) younger age at menopause, and (3) describe the prevalence of somatoform disorders during the menopausal transition and their impact on the various social, health care utilization and symptom reporting measures. We will determine whether the differences in patterns of physical and psychological conditions and behaviors vary by ethnicity and socioeconomic status, and evaluate the relative contributions of psychiatric symptoms and syndromes, peri- and post-menopause, and life str to the somatic, psychological, and health outcomes identified in aims 1-3.