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

• 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
• 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' 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

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 大流行凸显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问题社会决定因素（SDOH）。孕 产后妇女面临着与这一流行病相关的独特的社会和健康脆弱性，包括感染风险 耻辱、住房、食品、收入和就业不稳定、心理困扰，甚至死亡——风险 以及对有色人种和低等女性来说极其严重和不利的后果 社会经济地位（SES）。然而，这些多重交叉的21世纪公共卫生问题的碰撞 尚未针对孕产妇心理健康方面的不平等和严重的危机进行实证或严格的研究。 发病率。 COVID-19 母婴结局 (COMBO) 计划是一项大型多学科协作计划 哥伦比亚大学欧文医学中心成立，旨在跟踪 SARS-CoV-2 暴露的产妇和 他们的新生儿，并将他们的长期健康和福祉与没有进行产前检查的病例匹配的二人组进行比较 接触。母体 NIMH ‘COMBO’ R01 MH126531 的重点是了解 SARS-CoV-的影响 2 关于 100 个 COMBO 注册二人组中母婴大脑行为功能的研究 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 强大的基础设施，该行政补充文件 (PA-20-272) 扩展了母版 R01 的研究范围 SRD/SDOH 和 SARS-CoV-2 对孕产妇心理不平等的独立和交互影响 健康，利用 COMBO 的独特环境（第一个大流行震中）和社会研究不足 弱势样本（迄今为止已登记超过 600 名母婴组合，其中 63% 的母亲认为自己是弱势群体） 少数种族/族裔和/或社会经济地位低的女性）。通过扩大母体 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 SRD/SDOH 和 SARS-CoV-2 独立且相加地增加孕产妇精神不良的风险 健康结果，其中对社会弱势妇女的负面影响最大 健康差距在大流行期间和之后持续扩大。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 纽约市及其他地区社会弱势女性的 CoV-2 及其心理健康后遗症。