Promoting good mental health over the menopause transition

———《柳叶刀》第403卷第10430期, 2024年——

【摘要】更年期过渡期期间发生心理健康问题的潜在风险影响着女性的期望，并为调节女性心理健康的假定生理机制提供了信息。我们回顾了前瞻性研究的证据，这些研究报告了心理健康问题与更年期过渡期之间的关联。重度抑郁症和更普遍的亚阈值抑郁症状是研究中最常见的疾病。我们回顾了12项前瞻性研究，这些研究报告了更年期过渡期期间的抑郁症状、重度抑郁症或两者兼有，没有发现任何令人信服的证据表明这两种疾病的风险普遍增加。然而，特定亚群的参与者，主要由更年期相关风险因素（即严重或扰乱睡眠的血管舒缩症状、较长的过渡期或生殖激素动态）和心理社会风险因素（例如紧张的生活事件）定义，容易出现抑郁症状。更年期过渡期期间重度抑郁症风险的增加主要出现在以前患有重度抑郁症的个体中。有必要在初级保健中更加注重识别风险因素。根据稀缺的数据，我们没有发现令人信服的证据表明焦虑、躁郁症或精神病的风险在更年期过渡期普遍升高。将心理困扰和精神障碍错误地归因于更年期可能会对女性造成伤害，因为这可能会延迟准确诊断和开始有效的心理治疗，并给即将进入更年期的人带来负面期望。需要进行范式转变。我们最后提出了检测和治疗抑郁症状或重度抑郁症的建议，以及在更年期过渡期间促进良好心理健康的策略，同时负责任地为处于危险中的人做好准备并提供支持。

[Summary] The potential risk for mental health conditions over the menopause transition shapes women's expectations and informs putative physiological mechanisms regulating women's mental health. We review evidence from prospective studies reporting on associations between mental health conditions and the menopause transition. Major depressive disorder and the more prevalent subthreshold depressive symptoms are the most common conditions studied. We reviewed 12 prospective studies reporting depressive symptoms, major depressive disorder, or both over the menopause transition and found no compelling evidence for a universal increased risk for either condition. However, specific subgroups of participants, primarily defined by menopause-related risk factors (ie, vasomotor symptoms that are severe or disturb sleep, a long duration of the transition, or reproductive hormone dynamics) and psychosocial risk factors (eg, stressful life events), were vulnerable to depressive symptoms. The increased risk of major depressive disorder over the menopause transition appears predominantly in individuals with previous major depressive disorder. Greater focus on recognising risk factors in primary care is warranted. On the basis of scarce data, we found no compelling evidence that risk of anxiety, bipolar disorder, or psychosis is universally elevated over the menopause transition. Potential misattribution of psychological distress and psychiatric disorders to menopause could harm women by delaying accurate diagnosis and the initiation of effective psychotropic treatments, and by creating negative expectations for people approaching menopause. A paradigm shift is needed. We conclude with recommendations for the detection and treatment of depressive symptoms or major depressive disorder and strategies to promote good mental health over the menopause transition, while responsibly preparing and supporting those at risk.

论文原文：Lydia Brown, Myra S Hunter, Rong Chen, et al. (2024). Promoting good mental health over the menopause transition. The Lancet, Volume 403, Issue 10430, Pages 969-983, 2024.

https://doi.org/10.1016/S0140-6736(23)02801-5

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