产后抑郁症通常始于产前

A large new study has documented unexpected links in the timing and severity of symptoms of maternal depression, which could help mothers and doctors better anticipate and treat the condition.

一项新的大型研究记录了孕产妇抑郁症的发作时间与症状严重性之间出人意料的联系，这能帮助产妇和医生更好地预测和治疗这种疾病。

The study of more than 8,200 women from 19 centers in seven countries, published last month in Lancet Psychiatry, found that in those with the severest symptoms — suicidal thoughts, panic, frequent crying — depression most often began during pregnancy, not after giving birth, as is often assumed.

该研究上月发表在《柳叶刀精神病学》杂志(Lancet Psychiatry)上，它调查了七个国家19个中心的8200多名妇女。研究发现，症状最严重的抑郁症——自杀念头、恐慌、经常大哭——最常在怀孕期间开始，而非人们通常认为的分娩之后。

Moderately depressed women often developed their symptoms postpartum, and were more likely than severely depressed women to have experienced complications during pregnancy like pre-eclampsia, gestational diabetes or hypertension.

中度抑郁的孕产妇通常在产后出现症状，而且与重度抑郁的孕产妇相比，她们更多地在怀孕期间经历过先兆子痫、孕期糖尿病或高血压等并发症。

Severely depressed women, however, more often reported complications during delivery.

不过，患有重度抑郁症的产妇更常在分娩时出现并发症。

“This is the largest study to date on postpartum depressive symptoms,” said Leah Rubin, an assistant professor in the Women’s Mental Health Research Program at University of Illinois at Chicago, a co-author of a commentary about the study. “This is definitely a first step in the right direction, knowing that depression isn’t one-size-fits-all.”

“这是迄今为止关于产后抑郁症状的最大型研究，”伊利诺伊大学芝加哥分校女子精神健康研究项目的助理教授利亚·鲁宾(Leah Rubin)说，他曾与人合写了一篇关于这项报告的评论文章，“知道抑郁症有多种情况，这无疑是通往正确研究方向的第一步。”

Ten to 20 percent of mothers experience depression, anxiety, bipolar disorder or other symptoms at some point from pregnancy to a year after giving birth. The study could aid efforts to find causes and treatments.

10%至20%的孕产妇在怀孕至产后一年的某个时候出现过抑郁、焦虑、躁郁或其他症状。这项研究可以帮助找到原因和治疗方法。

The study participants were all mothers. Some had been found to have postpartum depression by clinicians, while others were assessed via a widely used questionnaire. (Some participants fell into both groups.)

这项研究的参与者都是孕产妇。其中一些人的产后抑郁症是临床医生发现的，还有一些是通过被普遍采用的问卷调查评估出来的（有些参与者上述两种情况兼有）。

Each group could be separated into three subgroups representing women with severe, moderate, and either mild or clinically insignificant depression, said Dr. Samantha Meltzer-Brody, the director of University of North Carolina’s perinatal psychiatry program and the study’s corresponding author.

这项研究的通讯作者、北卡罗来纳大学围产期精神病研究项目的负责人萨曼莎·梅尔策-布罗迪博士(Samantha Meltzer-Brody)说，每组可以分成三个小组，分别代表患有重度、中度以及轻度或无临床症状的抑郁症的孕产妇。

Dr. Meltzer-Brody said the finding that two-thirds of severe depression began during pregnancy raised scientific questions. The biological factors at work could differ from those affecting women with classic postpartum depression, which scientists think may be linked to plummeting hormone levels after delivery.

梅尔策-布罗迪博士说，三分之二的重度抑郁是在怀孕期间开始的，这个发现引出了一些科学问题。导致怀孕期间出现抑郁症的生物因素可能与导致典型产后抑郁症的生物因素不同，科学家们认为后者的影响因素可能是分娩后激素水平骤降。

She also wondered whether the finding that 60 percent of moderately depressed women reported issues like diabetes suggested that immune system problems might underlie their symptoms.

她还说，患有中度抑郁症的产妇60%出现过糖尿病等问题。她想弄清，这一发现是否说明免疫系统问题是抑郁症的诱因。

Dr. Meltzer-Brody and her colleagues will begin seeking answers this year by collecting DNA from thousands of women through an international online registry.

梅尔策-布罗迪博士和她的同事们今年将开始寻找这个问题的答案，他们计划通过国际在线登记收集上万名妇女的DNA。

“Ideally, you could determine who’s at risk,” she said. “What we do now is wait for people to get sick.”

“如果一切顺利，我们将能确定哪些人存在风险，”她说，“我们现在在做的事就是等人们生病。”