To address objective one, we have established two sub-cohorts of participants, one for postpartum psychosis and one for premenstrual dysphoric disorder. So far, 1133 participants have been recruited and screened for inclusion. For the postpartum psychosis project, out of 104 participants meeting the inclusion criteria, 30 completed the study, including the provision of samples for genetic analyses. For the premenstrual dysphoric disorder (PMDD) project, out of the 342 participants meeting the inclusion criteria, 127 completed the study. To improve uptake, we have developed a new mobile phone application for the assessment of PMDD
For objective two, we have made progress in three main areas:
1) Before we are able to explore how genetics affects psychiatric vulnerability to reproductive events, we must first isolate the effect of genetics on females with relevant psychiatric disorders i.e. bipolar disorder. We have therefore run genetic analyses of bipolar disorder separately in males and females.
2) We are exploring how the inclusion of people who have experienced postpartum psychosis affects clinical sex differences in bipolar disorder using previously collected data. We are also conducting genetic studies of postpartum psychosis. We are cleaning and quality controlling the data to collate the largest ever genetic study of postpartum psychosis. As part of this, we have been collaborating with other researchers who have agreed to contribute data. From this data, we have shown for the first time that the genetic architecture between bipolar disorder and postpartum psychosis differ by their genetic risk for pre-eclampsia, a hypertensive disorder that affects people during pregnancy. This suggests subtle differences in the biological underpinning between these two conditions of similar presentation.
3) Analyses of the UK Biobank database have been run to test the association between menopause and psychiatric disorders. This study investigated whether the perimenopause (i.e. the years around the final menstrual period) is associated with increased risk of developing psychiatric disorders compared to the late reproductive stage (part of this is funded by a further grant from the Medical Research Council). Incidence rates of psychiatric disorders during the perimenopause (4 years surrounding the final menstrual period) were compared with the reference premenopausal period (6 to 10 years before the final menstrual period). Compared to the reference reproductive period, incidence rates of psychiatric disorders significantly increased during the perimenopause and decreased back down to that observed in the premenopausal period in the postmenopause. The effect was primarily driven by increased incidence of major depressive disorder, but the largest risk increase was observed for mania.
