PROJECT SUMMARY/ABSTRACT
After menarche, females are twice as likely to develop depression and sleep problems than males. Ovarian
steroids have been hypothesized to play a role, but prior work has failed to clarify the effect of ovarian steroids
on mood and sleep problems. Hormone sensitivity (neural vulnerability to normal fluctuations in hormones
across the menstrual cycle) is a promising candidate, particularly sensitivity to estrogen withdrawal (E2), but
little is known about hormone sensitivity in adolescents. This work is hindered by traditional statistical
approaches (multilevel modeling (MLM) with phase contrasts), as they rely on the assumption of a regular,
ovulatory cycle, which adolescents often do not have. The proposed study will characterize hormone sensitivity
in adolescents by collecting daily assessments of mood ratings, sleep (via self-report and actigraphy), and
ovarian steroid hormones (via dried urine strips) from 50 female adolescents, aged 11-14, at least one-year
post-menarche, with regular cycles (21-45 days) and elevated depressive symptoms. For adolescents with
ovulatory cycles, multilevel models (MLM) with phase contrasts will be used to evaluate menstrual cycle effects
on symptoms and sleep, and the Carolina Premenstrual Assessment Scoring System (C-PASS) will be used to
identify clinically significant premenstrual exacerbation of symptoms (Aim 1). I hypothesize that depressive
symptoms and sleep problems will be higher in the perimenstrual phase of the cycle compared to all other
phases. Across the full sample, longitudinal network models will be used to address limitations of multilevel
modeling; networks of associations between E2, mood symptoms, and sleep problems across the cycle will be
estimated (Aim 2), with the hypothesis that decreases in E2 will be associated with subsequent increases in
sleep problems followed by increases in mood symptoms. Exploratory analyses estimate the indirect effect of
E2 on mood symptoms via sleep problems (Aim 3). This knowledge could facilitate earlier identification and
prevention efforts and lay the groundwork for future research on the developmental contribution of hormone
sensitivity to sex differences in depression and sleep problems. The training plan closely matches the
proposed research and long-term goals with an emphasis on activities that will facilitate the candidate’s
development as an independent investigator. Specifically, the training goals are to (1) gain immersive training
in research on the menstrual cycle and hormone sensitivity with adolescents, (2) develop competence in the
assessment of sleep via actigraphy and self-report in adolescents, and (3) gain proficiency in idiographic
longitudinal methods for use with menstrual cycle data. A mentorship team with expertise across these areas
has been assembled, and Brown University is a world-renowned clinical research institution with an extensive
history of NIH funding and supporting career development awards. Overall, the broad aim of these research
and training goals is to support the candidate’s development of an independent research program examining
the biological mechanisms of the sex differences in depression and sleep problems that emerge after puberty.