Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, Illinois; Department of Psychiatry, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Department of Psychiatry, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Womens Health Issues. 2017 Nov-Dec;27(6):673-682. doi: 10.1016/j.whi.2017.06.004. Epub 2017 Aug 2.
Latinas are disproportionately affected by perinatal depression (PND) as well as by adverse life events (ALEs), an independent predictor of PND. Dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis has been seen both in women with PND and with a history of ALEs in non-Latinas. Although some evidence suggests that HPA axis dysregulation may mediate the link between ALEs and PND, this hypothesis has received little attention and there are no studies that have examined these pathways in Latinas. The primary aim of the present study was to explore, in a Latina sample, associations between ALEs, PND, and HPA axis stress reactivity to a physical stressor, the cold pressor test (CPT). The secondary aim was to explore whether HPA axis reactivity and PND were associated with pain sensitivity to the CPT.
Thirty-four Latinas were enrolled in their third trimester of pregnancy and interviewed at 4 and 8 weeks postpartum. Depression status was determined using the Edinburgh Postnatal Depression Scale (≥10). At 8 weeks postpartum, 27 women underwent laboratory-induced pain testing using the CPT. Plasma adrenocorticotropic hormone and cortisol were sampled before and after the CPT to generate a stress reactivity score (post-pre). Pain sensitivity and ALEs were also assessed.
At enrollment, 26% of women were depressed, and 18% were depressed at 8 weeks postpartum. Fifty-two percent reported at least one childhood ALE. There was a significant and positive association between any childhood ALE and prenatal depression scores (p = .025). Infant-related ALEs were significantly associated with greater adrenocorticotropic hormone reactivity to the CPT (p = .030). Women with a history of any childhood ALE exhibited a blunted cortisol response to the CPT (p = .045). Women with a history of PND at 4 weeks had greater adrenocorticotropic hormone stress reactivity to the CPT (p = .027). No effects of PND were seen for pain sensitivity measures in response to the CPT, although there was a positive and significant correlation between pain tolerance and cortisol response to the CPT in the whole sample.
Given the associations between ALEs and PND and their individual effect on HPA axis stress reactivity, future studies on PND should include a larger sample of Latinas to test the mediating effects of HPA axis reactivity on associations between ALEs and PND.
拉丁裔女性受围产期抑郁症（PND）和不良生活事件（ALEs）的影响不成比例，后者是 PND 的独立预测因素。在非拉丁裔女性中，无论是患有 PND 的女性还是有 ALEs 病史的女性，都存在下丘脑-垂体-肾上腺（HPA）轴失调的情况。尽管有一些证据表明，HPA 轴失调可能介导 ALEs 与 PND 之间的联系，但这一假设尚未得到广泛关注，也没有研究探讨过拉丁裔女性中的这些途径。本研究的主要目的是在拉丁裔女性样本中探讨 ALEs、PND 和 HPA 轴对身体应激源——冷加压试验（CPT）的应激反应之间的关系。次要目的是探讨 HPA 轴反应性和 PND 是否与 CPT 的疼痛敏感性相关。
34 名拉丁裔女性在妊娠晚期入组，并在产后 4 周和 8 周进行访谈。使用爱丁堡产后抑郁量表（≥10 分）确定抑郁状态。产后 8 周，27 名女性接受了 CPT 的实验室诱导性疼痛测试。在 CPT 前后采集血浆促肾上腺皮质激素和皮质醇样本，以生成应激反应评分（后-前）。还评估了疼痛敏感性和 ALEs。
入组时，26%的女性患有抑郁，8 周时 18%的女性患有抑郁。52%的人报告至少有一次儿童时期的 ALE。任何儿童时期 ALE 与产前抑郁评分呈显著正相关（p=.025）。与婴儿相关的 ALEs 与 CPT 时促肾上腺皮质激素反应显著相关（p=.030）。有儿童时期 ALE 病史的女性对 CPT 的皮质醇反应迟钝（p=.045）。产后 4 周时患有 PND 的女性对 CPT 的促肾上腺皮质激素应激反应更大（p=.027）。尽管在整个样本中，疼痛耐受力与 CPT 时皮质醇反应呈正相关，但未观察到 PND 对 CPT 疼痛敏感性测量的影响。
鉴于 ALEs 与 PND 之间的关联及其对 HPA 轴应激反应的单独影响，未来关于 PND 的研究应纳入更多的拉丁裔女性样本，以检验 HPA 轴反应性对 ALEs 与 PND 之间关联的中介作用。
