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

摘要 2019冠状病毒病大流行凸显并加剧了与结构性种族主义有关的健康差距， 歧视（SRD）、经济边缘化和其他健康的社会决定因素（SDOH）。怀孕 产后妇女面临着与大流行病有关的独特的社会和健康脆弱性，包括 耻辱、住房、粮食、收入和就业不安全、心理困扰，甚至死亡-风险 和后果是不成比例的重大和不利的妇女的颜色和低 社会经济地位（SES）。然而，这些多重交叉的碰撞，使21世纪世纪的公共卫生 危机尚未得到经验或严格的研究，产妇心理健康和严重的不平等， 发病率COVID-19母婴成果（COMBO）倡议是一项大型多学科合作项目， 在哥伦比亚大学欧文医学中心建立，跟踪SARS-CoV-2暴露的分娩母亲， 他们的新生儿，并比较他们的长期健康和福祉的情况下匹配的二对没有产前 exposure. NIMH“COMBO”R 01 MH 126531的重点是了解SARS-CoV的影响， 2对100个COMBO入组的二元组的母婴脑行为功能进行了研究， 产前SARS-COV-2感染。响应NOSI NOT-OD-21-071的关键优先事项并利用 COMBO的强大基础设施，本管理补充（PA-20-272）扩展了父R 01的研究 SRD/SDOH和SARS-CoV-2对孕产妇心理健康不平等的独立和交互作用 健康，利用COMBO独特的环境（第一次大流行震中）和充分的社会研究 弱势样本（迄今为止招募了超过600对母婴，其中63%的母亲认为自己是 种族/少数民族和/或社会经济地位低的妇女）。通过扩展父R 01脑成像，调查，半- 结构化访谈和电子健康记录（EHR）提取，我们将测试总体假设 SRD/SDOH和SARS-CoV-2独立地和相加地增加了母亲不良精神疾病的风险， 健康结果，对处于社会不利地位的妇女的负面影响最大 以及在大流行期间和之后持续不断的健康差距。调查结果将告知 以患者为中心，多层次干预，改善SRD/SDOH和SARS的交叉流行- CoV-2及其在纽约市及其他地区社会弱势妇女的心理健康后遗症。

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.