围产期抑郁症是严重影响孕产妇及其子代健康的精神问题，可能对家庭和社会产生深远的危害。若能预测其发生的风险可为早期识别和进行针对性干预提供时机和空间，延缓、减弱、或阻止其负面结局的发生。目前的研究大多仅关注产后抑郁情绪，未能充分重视妊娠期的症状。在已有的危险因素研究里，侧重于社会环境和心理因素，忽视生物学因素的影响，缺乏将这三者综合起来的作用模型。我们拟建立孕产妇队列，结合产检及产后随访流程，在7个时间点逐步测量危险因素，同时筛查、确诊围产期抑郁症，以此作为结局变量开展巢式病例对照研究，由此筛选预测因子。在每个时间点利用基于概化估计方程的Logistic回归建立动态预测模型，随访结束后使用生存分析建立总模型，并比较合验证其效度。本研究拟将社会环境、心理和生理因素综合起来，动态监测抑郁症的发生，探索一种能与我国现有的妇幼保健系统整合，不仅限于产后而是纵贯整个围产期的抑郁症预测模型。

Perinatal depression(PND) is a serious mental disorder which affects function, well-being and quality of life for the mother, her baby and their families. Predicting the risk of PND will provide opportunities for early identification and intervention of PND so as to delay, reduce or prevent negative outcomes. To date, studies have focused primarily on postpartum depression(PPD) after the baby’s birth rather than PND. Moreover, studies on risks centered on social-environment and psychological factors, lacking models integrating those two with biological factors. We aim to develop a cohort of pregnant women to test the strengths of associations between various risk factors with PND at 7 time points along with routine maternal examination and follow-ups in a nested case control design. A package of risk factors will be selected based on the result of the nested case control study to form the predictive model for PND, which will be fitted with a Generalized Estimating Equation (GEE) estimated logistical regression. The data of the cohort will be used to test the sensitivity and specificity of this predictive model. The study in summary will develop a dynamic predictive model for PND throughout the entire duration of pregnancy, which fully takes account of social-environment, psychological and biological factors and is integrated with routine maternal care.

围产期抑郁症是严重危及孕产妇及其子代健康的精神疾病，进行干预的关键在于早期预测与识别。既往的研究没有足够重视产前的抑郁情绪，仅关注产后抑郁症及其某一两种危险因素的确认，也没有将社会环境、心理和生物学因素综合起来考虑。若能用在覆盖围产期的多个时间点收集相关暴露并进行抑郁症的筛查，有利于了解多种危险因素如何联合作用的致病机理，也能够在此基础上建立有效的预测模型，为早期识别与干预围产期抑郁症提供时机和空间。本项目在两家医院招募了1126名孕早期妇女进行队列研究，在围产期进行了7个时间点的抑郁筛查和可能的预测因子测量，覆盖了孕早、孕中、孕晚和分娩及产后，充分了解了抑郁症的患病率与发病率，动态监测孕产妇各项与围产期抑郁症相关的社会环境、心理及相关生物学因素，目前所有数据已经收集完整，共有488名孕产妇的7点完整数据，通过统计分析正探索一种能够与已有的妇幼保健系统相结合的，不仅限于产后，而是纵贯整个妊娠期与产褥期的围产期抑郁症预测模型，并已在此数据的基础上申请了面上项目，继续在队列中研究母亲抑郁与子代健康之间的关系与中介、调节因素。