Structural and Social Determinants of Maternal Mental Health, Morbidity, and Inequities in COMBO

摘要 新冠肺炎大流行突出并加剧了与结构性种族主义和 歧视(SRD)、经济边缘化和其他健康的社会决定因素(SDOH)。怀孕了 产后妇女面临着与大流行有关的独特的社会和健康脆弱性，包括 耻辱、住房、食物、收入和就业不安全、心理痛苦，甚至死亡--风险 以及对有色人种和低收入女性来说不成比例的重大和不利的后果 社会经济地位(SES)。然而，这些交织在21世纪的公共卫生的多重碰撞 对于产妇心理健康方面的不平等和严重的危机，尚未进行经验或严格的研究 发病率。新冠肺炎母婴成果(COMBO)倡议是一个大型的多学科合作项目 在哥伦比亚大学欧文医学中心建立，跟踪接触SARS-CoV-2的分娩母亲和 他们的新生儿，并将他们的长期健康和幸福感与没有产前检查的病例匹配的双胞胎进行比较 曝光。NIMH母株R01 MH126531的重点是了解SARS冠状病毒的影响- 2关于母婴大脑--100个有和没有联合登记的双胞胎的子集的行为功能 产前感染SARS-COV-2。响应NOSI NOT-OD-21-071的关键优先事项并利用 COMBO强大的基础设施，此管理补充(PA-20-272)扩展了父R01以研究 SRD/SDOH和SARS-CoV-2对母亲心理不平等的独立和交互作用 健康，利用Combo的独特环境(第一个大流行中心)和社会研究不足 弱势样本(&gt；600名母婴迄今已登记在册，其中63%的母亲认为 种族/少数族裔和/或社会保障地位低的妇女)。通过扩展母公司R01脑成像、调查、半 结构化访谈和电子健康记录(EHR)提取，我们将检验总体假设 SRD/SDOH和SARS-CoV-2独立和相加增加母亲不良心理风险 健康结果，对处于社会不利地位的妇女的负面影响最大 健康差距在大流行期间不断扩大，并在大流行后持续存在。调查结果将告知 以患者为中心的多层次干预措施，以改善SRD/SDOH和SARS的交叉流行- CoV-2及其对纽约市及其他地区社会弱势女性的心理健康后遗症。

ABSTRACT The COVID-19 pandemic has highlighted and exacerbated health disparities related to structural racism and discrimination (SRD), economic marginalization, and other social determinants of health (SDOH). Pregnant and postpartum women face unique social and health vulnerabilities related to the pandemic, including risk for stigma, housing, food, income and employment insecurity, psychological distress, and even mortality – risks and consequences which are disproportionately significant and adverse for women of color and low socioeconomic status (SES). However, the collision of these multiple intersecting 21st century public health crises have not yet been empirically or rigorously studied for inequities in maternal mental health and severe morbidity. The COVID-19 Mother Baby Outcome (COMBO) initiative is a large multidisciplinary collaborative established at Columbia University Irving Medical Center to follow SARS-CoV-2 exposed laboring mothers and their newborns and compare their long-term health and wellbeing to case-matched dyads without prenatal exposure. The focus of the parent NIMH ‘COMBO’ R01 MH126531 is to understand the effects of SARS-CoV- 2 on mother-infant brain-behavior functioning in a subset of 100 COMBO-enrolled dyads with and without prenatal SARS-COV-2 infections. Responding to key priorities of NOSI NOT-OD-21-071 and leveraging COMBO’s robust infrastructure, this administrative supplement (PA-20-272) expands the parent R01 to study the independent and interactive effects of SRD/SDOH and SARS-CoV-2 on inequities in maternal mental health, taking advantage of COMBO’s unique setting (first pandemic epicenter) and understudied socially disadvantaged sample (>600 mother-infant dyads enrolled to-date, with 63% mothers identifying as racial/ethnic minority and/or low-SES women). By expanding parent R01 brain imaging, surveys, semi- structured interviews, and electronic health record (EHR) extraction, we will test the overarching hypothesis that SRD/SDOH and SARS-CoV-2 independently and additively increase risk of adverse maternal mental health outcomes, with the magnitude of the negative impact being greatest for women of social disadvantage and the health disparity gap ballooning during – and persisting post – the pandemic. Findings will inform patient-centered, multi-level interventions to ameliorate the intersecting epidemics of SRD/SDOH and SARS- CoV-2 and their mental health sequelae for women of social disadvantage in NYC and beyond.