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.

抽象的 COVID-19大流行强调了与结构性种族主义和歧视（SRD），经济边缘化和其他卫生社会决定者（SDOH）。孕产后妇女面临与大流行有关的独特社会和健康脆弱性，包括污名，住房，食物，收入和就业不安全，心理困扰甚至死亡率 - 风险以及对有色女性和低妇女的不成比例意义和不利的后果社会经济地位（SES）。但是，这些多个与21世纪公共卫生相交的碰撞危机尚未在经验或严格研究孕产妇心理健康和严重的不平等现象上发病率。 Covid-19-19 在哥伦比亚大学欧文医学中心成立，遵循SARS-COV-2暴露的劳动母亲和他们的新生儿，将他们的长期健康和福祉与没有产前的病例匹配的二元组进行比较接触。父母NIMH“组合” R01 MH126531的重点是了解SARS-COV的影响 - 2在有或没有的100个组合元素的子集中，有和产前SARS-COV-2感染。响应Nosi Not-OD-21-071的关键优先事项并利用组合的强大基础设施，这种行政补充（PA-20-272）扩展了父母R01进行研究 SRD/SDOH和SARS-COV-2对材料不平等的精神不平等的独立和互动影响健康，利用组合的独特环境（第一个大流行中心）并在社会上理解处境不利的样本（> 600个母亲二元组，待办事项，有63％的母亲确定为种族/族裔少数民族和/或低级女性）。通过扩展父r01脑成像，调查，半结构化访谈和电子健康记录（EHR）提取，我们将测试总体假设该SRD/SDOH和SARS-COV-2独立增加了不良对象的风险健康结果，负面影响的程度对社会灾难的妇女来说是最大的以及在持续存在的大流行期间的健康差异差距激增。调查结果将告知以患者为中心的多层干预措施来改善SRD/SDOH和SARS-的相交发作 COV-2及其对纽约市社会灾难妇女的心理健康后遗症。