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

COMBO 中孕产妇心理健康、发病率和不平等的结构和社会决定因素

基本信息

批准号：
10393379
负责人：
DANI DUMITRIU
金额：
$ 88.15万
依托单位：
COLUMBIA UNIVERSITY HEALTH SCIENCES
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-04-12 至 2026-01-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10393379
关键词：
2019-nCoV Acculturation Administrative Supplement Affect Antibodies Anxiety Bioinformatics Brain Brain imaging Buffers COVID-19 COVID-19 diagnosis COVID-19 pandemic Color Communities Data Diagnosis Discipline of Nursing Discipline of obstetrics Discrimination Distress Economics Electronic Health Record Elements Emergency department visit Employment Enrollment Epidemic Ethnic Origin Event Face Food Health Housing Human Rights Income Infant Infrastructure Institution Insurance Coverage Intervention Interview Language Latinx Laws Leadership Magnetic Resonance Imaging Maternal Health Maternal Mortality Measures Medical center Mental Depression Mental Health Methods Minority Morbidity - disease rate Mothers National Institute of Mental Health Neighborhoods Neurosciences New York City Newborn Infant Outcome Parents Perinatal Personal Satisfaction PhenX Toolkit Policies Postpartum Period Postpartum Women Pregnancy Pregnant Women Psychoses Public Health Quality of Care Race Research Risk SARS-CoV-2 exposure SARS-CoV-2 infection SARS-CoV-2 positive Sampling Social Discrimination Social support Socioeconomic Status Structural Racism Structure Surveys Techniques Testing Time Time trend Translations United States National Institutes of Health Universities Vaccines Woman Women Status Women&apos s Health adverse outcome brain behavior cohort community based participatory research coping data harmonization ethnic minority population experience food insecurity health disparity indexing low socioeconomic status maternal morbidity mortality risk multidisciplinary neuroimaging novel pandemic disease patient oriented perceived stress perinatal mental health pregnant prenatal prenatal exposure programs psychiatric emergency psychological distress racial and ethnic resilience social social determinants social disadvantage social disparities social epidemiology social exclusion social health determinants social stigma statistics stress management theories

项目摘要

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.

摘要