Depression in Pregnancy and the Postpartum Period

描述（由申请人提供）：围产期抑郁症被认为会影响相当一部分孕妇和产后妇女，造成大量人群处于危险之中的公共卫生事件。如果不治疗，它可能会对妇女、她的孩子和家庭产生长期的负面影响。过去许多关于围产期抑郁症患病率和发病率及其危险因素的研究有两个重要的局限性：（a）它主要是基于狭义的，同质的样本;（B）它依赖于筛查工具来评估围产期抑郁症，而没有确诊。这使得过去的结果容易引起争议。拟议的研究提供了一种具有成本效益的方法来克服这些限制。我们将提供更准确的发病率和患病率估计比以前提供了一个不同的妇女群体，更好地确定围产期抑郁症的危险因素，并首次研究妇女的居住地的特点是如何与她的围产期抑郁症的风险。具体而言，我们将：（1）估计妊娠晚期开始时，产后两周和六个月时重度和轻度抑郁发作的患病率和发生率，包括年龄，种族，教育，收入，婚姻状况和产次的估计。(2)估计，净的其他特征，心理社会特征之间的关系，包括个人和家族历史的情绪障碍和家庭压力，并经历重大和/或轻微的抑郁症状的可能性在每三个时间点。(3)估计，怀孕意图，分娩方式和并发症对三个时间点经历抑郁症的可能性的净影响。(4)估计妇女居住地的社区特征（例如，健康护理资源和提供者的类型和可用性，社区的社会、经济和人口组成，以及管理寻求健康护理行为的规范环境）和在三个时间点中的每一个时间点经历抑郁症的可能性。我们建议从一个更大的和更多样化的妇女样本中收集数据比以前的美国围产期抑郁症的研究，并验证抑郁症的诊断在每个时间点与结构化临床访谈DSM-IV-TR轴I障碍（SCID-I）的妇女得分高于爱丁堡产后抑郁量表的既定水平。我们将使用这些数据来估计发病率和患病率，以解决特定目标1，并估计多变量模型，以解决特定目标2-4。

DESCRIPTION (provided by applicant): Perinatal depression is thought to affect a considerable portion of pregnant and postpartum women, creating a public health event with a large population at risk. Untreated, it can have long-term, negative consequences for the woman, her child, and family. Much past research on the prevalence and incidence of perinatal depression and its risk factors has two important limitations: (a) it is largely based on narrowly defined, homogeneous samples; and (b) it has relied on screening tools to assess perinatal depression without confirming the diagnosis. This makes past results vulnerable to dispute. The proposed research provides a cost-effective approach to overcoming the limitations. We will provide more accurate incidence and prevalence estimates than have previously been available for a diverse group of women, better identify risk factors for perinatal depression, and for the first time examine how characteristics of a woman's place of residence are related to her perinatal depression risks. Specifically, we will: (1) Estimate the prevalence and incidence of major and minor depressive episodes at the beginning of the third trimester of pregnancy, and at two weeks and six months postpartum, including estimates by age, race, education, income, marital status, and parity. (2) Estimate, net of other characteristics, the relationships between psychosocial characteristics, including personal and family history of mood disorders and family stressors, and the likelihood of experiencing major and/or minor depression symptoms at each of the three points in time. (3) Estimate, the net effect of pregnancy intention, delivery method and complications on the likelihood of experiencing depression at the three points in time. (4) Estimate the relationships between community characteristics of women's place of residence (e.g., types and availability of health care resources and providers, social, economic, and demographic composition of the community, and the normative environment governing health care seeking behaviors) and the likelihood of experiencing depression at each of the three points in time. We propose to collect data from a larger and more diverse sample of women than in prior U.S. studies of perinatal depression, and to validate a diagnosis of depression at each point in time with the Structured Clinical Interview for DSM-IV-TR Axis I Disorders (SCID-I) for the women who score above an established level on the Edinburgh Postnatal Depression Scale. We will use these data to estimate incidence and prevalence to address Specific Aim 1 and to estimate multivariate models to address Specific Aims 2-4.