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.
