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女性心理健康研究的公共卫生背景。

Public health context of women's mental health research.

作者信息

Blehar Mary C

机构信息

National Institute of Mental Health, NIH/DHHS, 6001 Executive Boulevard, Suite 8125, MSC9659, Bethesda, MD 20892, USA.

出版信息

Psychiatr Clin North Am. 2003 Sep;26(3):781-99. doi: 10.1016/s0193-953x(03)00039-x.

Abstract

As more attention is directed to the mental health care of women, sex and gender differences in research design and in regulatory policies have interfaced with clinical care and public policy. An emphasis on women's mental health issues in the provision of treatment and care as well as the design of large-scale screening strategies to identify and treat women with mental disorders promises to be effective public health approaches to reducing the burden of mental illness in women. The past decade has seen increased emphasis on women's mental health and sex/gender differences in the federal sector and in the research community. Federal regulations (summarized in the NIH Outreach Notebook) call for the inclusion of women and minorities in NIH-funded clinical research. The regulations also place emphasis on gender analysis of the results of clinical trials, in particular phase III trials, the findings of which are likely to influence practice. There has been substantial progress toward the goal of including women in research, but more remains to be done. A 2000 GAO report titled "Women's Health: NIH Has Increased Its Efforts to Include Women in Research" commended NIH for tracking the number of women in clinical research but the report also noted that relatively few NIH-funded studies, including major clinical trials, had reported findings by gender of study participants. This was seen as an impediment to progress in developing gender-based effective treatments. In the past decade, the women's health field has moved beyond an exclusive emphasis on women's reproductive function to one that defines health as a scientific enterprise to identify clinically important sex and gender differences in prevalence, etiology, course, and treatment of illnesses affecting men and women in the population as well as conditions specific to women. Nonetheless, for mental disorders, women's reproductive function and its impact on mental health conditions is still understudied. Based on the epidemiology of mental disorders, the course of mental disorders in women in relation to reproductive transitions remains an important issue for the mental health field because the burden of mental disorders, such as depression and anxiety, fall disproportionately on women of childbearing and childrearing age. The public health emphasis on women's mental health does not lessen the basic scientific opportunities to be had by a focus on gender and sex differences. A 2001 report of the Institute of Medicine titled "Exploring the Biological Contributions to Health: Does Sex Matter?" underscores the benefit to health care of looking for sex differences at the biological level. Basic and clinical neuroscience research is rapidly accruing a knowledge base that will provide information at the level of genes and cells of the influences of biological sex on mental health outcomes in both women and men. A focus on women's mental health and gender/sex differences research promises to yield improvement in treatments and services and thereby to improve the public health as well as to increase fundamental knowledge about the etiology and neurophysiology of mental disorders.

摘要

随着对女性心理健康护理的关注度不断提高,研究设计和监管政策中的性别差异已与临床护理和公共政策相互关联。在提供治疗和护理以及设计大规模筛查策略以识别和治疗患有精神障碍的女性时,强调女性心理健康问题有望成为减轻女性精神疾病负担的有效公共卫生方法。在过去十年中,联邦部门和研究界越来越重视女性心理健康以及性别差异。联邦法规(总结在《国立卫生研究院推广手册》中)要求将女性和少数族裔纳入由国立卫生研究院资助的临床研究。这些法规还强调对临床试验结果进行性别分析,特别是对III期试验结果的分析,其结果可能会影响临床实践。在将女性纳入研究的目标方面已经取得了重大进展,但仍有更多工作要做。2000年美国政府问责局的一份题为《女性健康:国立卫生研究院加大力度将女性纳入研究》的报告赞扬国立卫生研究院跟踪临床研究中的女性数量,但该报告也指出,包括重大临床试验在内,相对较少的由国立卫生研究院资助的研究报告了按研究参与者性别分类的结果。这被视为阻碍基于性别的有效治疗方法发展的一个因素。在过去十年中,女性健康领域已从单纯强调女性生殖功能,转向将健康定义为一项科学事业,以识别影响人群中男性和女性的疾病在患病率、病因、病程和治疗方面临床上重要的性别差异以及女性特有的情况。尽管如此,对于精神障碍而言,女性生殖功能及其对心理健康状况的影响仍研究不足。基于精神障碍的流行病学,女性精神障碍病程与生殖转变的关系仍然是心理健康领域的一个重要问题,因为诸如抑郁症和焦虑症等精神障碍的负担在育龄和育儿年龄的女性中尤为沉重。公共卫生对女性心理健康的重视并不减少关注性别差异所带来的基本科学机遇。2001年医学研究所题为《探索对健康的生物学贡献:性别重要吗?》的一份报告强调了在生物学层面寻找性别差异对医疗保健的益处。基础和临床神经科学研究正在迅速积累一个知识库,该知识库将在基因和细胞层面提供关于生物性别对男性和女性心理健康结果影响的信息。关注女性心理健康以及性别差异研究有望改善治疗和服务,从而改善公共卫生状况,并增加对精神障碍病因和神经生理学的基础知识。

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