Psychoneuroimmune Contributions to Postpartum Depression

描述（由申请人提供）：产后抑郁症（PPD）发生在多达20%的产后妇女，并带来可能持续一生的后果。虽然已经确定了几个有助于PPD的心理社会变量，但单独考虑这些变量时，PPD的发展仍然存在很大差异。下面的应用程序集中在产后期间发生的生理变化，可能会影响妇女从分娩中恢复过来，并使她陷入抑郁症。具体而言，拟议的研究将调查促炎细胞因子网络对PPD发展的影响，直接和通过改变其与下丘脑-垂体-肾上腺（HPA）轴激素的双向关系。促炎反应在分娩和分娩期间在女性中被激发，并且在产后恢复中起关键作用。虽然在非妊娠和非产后人群中，夸大的促炎反应与抑郁症的发展有关;它在影响产后妇女情绪方面的作用很少得到解决。同样，HPA轴在产后期间也是不稳定的;该系统的失调也与非妊娠、非产后人群的抑郁症有关，但是，它在产后妇女抑郁症中的作用仍然不清楚。最后，迄今为止还没有研究调查炎症细胞因子和HPA轴激素之间的双向相互作用是否会在产后妇女中失调，从而增加PPD的风险。在以下应用中，研究人员将对健康女性进行6次家庭访视，以收集数据;妊娠第32-36周期间一次，产后第7天和第14天以及第1、3和6个月再次访视。每一次，他们将完成对抑郁和压力的调查，并将提供一个血液样本，用于测量促炎和抗炎细胞因子和HPA轴的激素。为了收集细胞因子和HPA激素的昼夜变化信息，参与者还将在抽血前2天每天收集5次尿液（用于细胞因子）和唾液（用于皮质醇）。抑郁症的发展将根据这些变量独立和相互关系进行评估。据推测，经历过度促炎反应的女性将表现出HPA轴的失调和PPD的发病率增加。确定有助于PPD的可改变的生物风险因素将使卫生保健提供者能够识别处于风险中的妇女，并最终制定有效的策略来预防或减少这种疾病的发展。公共卫生相关性：产后抑郁症是一种潜在的破坏性疾病，影响妇女在她生命中最脆弱和最重要的时期之一。在这项研究中，我们的目标是更好地了解非抑郁症产后妇女的免疫和激素变化，并通过将这些变化与产后抑郁症妇女的变化进行比较，确定这种疾病的生物学基础。

DESCRIPTION (provided by applicant): Postpartum depression (PPD) occurs in up to 20 percent of postpartum women, and carries consequences that may last a lifetime. Although several psychosocial variables contributing to PPD have been identified, substantial variance in the development of PPD remains when considering these variables alone. The following application focuses on physiological changes occurring during the postpartum period that may influence a woman s recovery from childbirth and her descent into depression. Specifically, the proposed study will investigate the impact of the pro-inflammatory cytokine network on the development of PPD, both directly and via alterations in its bidirectional relationship with the hormones of the hypothalamic-pituitary-adrenal (HPA) axis. The pro- inflammatory response is stimulated in women during labor and delivery and plays a key role in postpartum recovery. Although in non-pregnant and non-postpartum populations, an exaggerated pro-inflammatory response has been linked to the development of depression; its role in influencing the mood of postpartum women has been minimally addressed. Likewise, the HPA axis is in flux during the postpartum period; dysregulation of this system also has been linked to depression in non-pregnant, non-postpartum populations, but, again, its role in the depression of postpartum women is unclear. And finally, no studies to date have investigated whether the bidirectional interaction between inflammatory cytokines and HPA axis hormones may become dysregulated in postpartum women, thereby increasing the risk of PPD. In the following application, healthy women will be visited at home by researchers 6 times for data collection; once during weeks 32-36 of pregnancy, and again on postpartum days 7 and 14, and months 1, 3, and 6. Each time, they will complete surveys on depression and stress, and will provide a blood sample for measurement of pro- and anti- inflammatory cytokines and the hormones of the HPA axis. To gather information on diurnal variability in cytokines and HPA hormones, participants also will collect urine (for cytokines) and saliva (for cortisol) 5 times a day for 2-days preceding the blood draw. Development of depression will be evaluated in light of these variables independently and in relation to each other. It is hypothesized that women who experience an exaggerated pro-inflammatory response will demonstrate dysregulation of the HPA axis and an increased incidence of PPD. Identifying modifiable biological risk factors contributing to PPD will enable health care providers to identify women at risk and ultimately, to develop effective strategies to prevent or reduce the development of this disorder. PUBLIC HEALTH RELEVANCE: Postpartum depression is a potentially devastating disorder that affects a woman during one of the most vulnerable and important times of her life. In this study, we aim to better understand the immunological and hormonal changes that occur in non-depressed postpartum women, and, by comparing these changes to those that occur in women with postpartum depression, identify a biological basis for the disorder.