Risk and Predictors of Postpartum Depression

描述（由申请人提供）：产后是出现精神疾病的高风险时期，特别是对于已经有情绪障碍史的妇女。鉴于育龄期抑郁症的患病率，确定产后抑郁症新发或复发风险最高的妇女是至关重要的。确定那些产后抑郁症风险最高的妇女可能允许干预措施，以限制与未经治疗的产后抑郁症相关的产妇发病率。本提案概述了针对PA-00-074的一项多机构合作研究项目（R01），该项目将评估有重度抑郁症病史的女性产后抑郁症的风险。至少有过一次DSM-IV重度抑郁症发作的受试者将使用一系列标准化仪器从妊娠晚期（妊娠32-36周）至分娩后6个月进行前瞻性随访。本研究的主要目的是：(1)确定产后抑郁和功能障碍的临床和社会心理预测因素；(2)确定分娩前后的治疗（药物、非药物或联合）在多大程度上调节产后复发的风险。临床和社会心理变量，包括产后抑郁症史、既往抑郁症严重程度、既往发作次数、发病年龄、妊娠期抑郁症和社会支持如何影响产后抑郁症的风险，以及社会心理功能，将被调查。目前的提交是一项正在进行的学术合作的自然延伸，该合作评估了有重度抑郁症病史的孕妇停止或维持抗抑郁药物治疗的抑郁复发风险。这一建议提供了一个机会来研究一个严格跟踪的人群进入一个危险时期——产后时期——并调查在这个时期赋予或调节抑郁风险的因素。本次调查的三个参与地点包括麻省总医院的围产期和生殖精神病学临床研究项目，哈佛医学院(dr。Cohen， Nonacs和Otto)，加州大学洛杉矶分校的女性生活中心和情绪障碍研究项目（AItshuler博士，Hendrick博士），以及埃默里大学医学院的埃默里女性心理健康项目（Stowe博士）。

DESCRIPTION (provided by applicant): The postpartum period is a time of heightened risk for the emergence of psychiatric illness, particularly in women who already have a history of mood disorder. Given the prevalence of depressive disorders during the childbearing years, it is crucial to identify women who are at highest risk for new onset or recurrence of depression during the postpartum period. Identification of those women at greatest risk for postpartum depression may allow for interventions that would limit maternal morbidity associated with untreated postpartum depression. This proposal outlines a multi-institutional collaborative research project (R01) in response to PA-00-074, in which risk for postpartum depression will be evaluated in women with histories of major depressive disorder. Subjects who have had at least one episode of DSM-IV major depression will be followed prospectively from late pregnancy (32-36 weeks gestation) up to six months after delivery using a series of standardized instruments. The primary aims of this investigation are (1) to identify clinical and psychosocial predictors of postpartum depression and functional impairment and (2) to determine the extent to which treatment (pharmacologic, nonpharmacologic or a combination) proximate to delivery modulates risk for postpartum relapse. How clinical and psychosocial variables including history of postpartum depression, severity of past depression, number of previous episodes, age at illness onset, depression during pregnancy, and social support affect risk for postpartum depression, as well as psychosocial functioning, will be investigated. The current submission is a natural extension of an ongoing academically productive collaboration in which risk for depressive relapse is evaluated in pregnant women with histories of major depression who either discontinue or maintain antidepressant treatment. This proposal provides an opportunity to study a rigorously followed population into a period of risk -- the postpartum period -- and to investigate the factors that confer or modulate risk for depression at this time. The three participating sites for this investigation include the Perinatal and Reproductive Psychiatry Clinical Research Program at the Massachusetts General Hospital, Harvard Medical School (Drs. Cohen, Nonacs and Otto), the Women's Life Center and Mood Disorders Research Program at UCLA (Dr. AItshuler, Dr. Hendrick), and the Emory Women's Mental Health Program at Emory University School of Medicine (Dr. Stowe).