Risk and Predictors of Postpartum Depression

描述（由申请人提供）：产后时期是出现精神疾病的风险增加的时期，特别是在已经有情绪障碍病史的女性中。鉴于抑郁症在育龄期的患病率，确定产后抑郁症新发或复发风险最高的妇女至关重要。确定那些妇女在产后抑郁症的最大风险可能允许干预，将限制孕产妇发病率与未经治疗的产后抑郁症。该提案概述了一项响应PA-00-074的多机构合作研究项目（R 01），其中将在有重度抑郁症病史的女性中评估产后抑郁症的风险。使用一系列标准化工具，对至少有一次DSM-IV重度抑郁发作的受试者进行前瞻性随访，从妊娠晚期（妊娠32-36周）至分娩后6个月。本研究的主要目的是（1）确定产后抑郁症和功能障碍的临床和心理社会预测因素，（2）确定分娩前治疗（药物、非药物或联合治疗）对产后复发风险的调节程度。临床和心理社会变量，包括产后抑郁症的历史，过去抑郁症的严重程度，以前发作的次数，发病年龄，怀孕期间的抑郁症，社会支持如何影响产后抑郁症的风险，以及心理社会功能，将进行调查。目前的提交是一个正在进行的学术生产性合作的自然延伸，其中抑郁症复发的风险是在有重度抑郁症病史的孕妇中评估的，这些孕妇要么停止或维持抗抑郁药治疗。这项建议提供了一个机会，研究一个严格遵循的人口进入一个时期的风险-产后期-并调查因素，赋予或调节抑郁症的风险在这个时候。本研究的三个参与研究中心包括马萨诸塞州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（科恩博士、诺纳茨博士和奥托博士）、加州大学洛杉矶分校的妇女生活中心和情绪障碍研究项目（艾茨赫姆博士、亨德里克博士）以及埃默里大学医学院的埃默里妇女心理健康项目（斯托博士）。

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).