The CROWN study: Comprehensive Research on Oral and mental health among WomeN

抽象的。口腔健康问题和未得到满足的牙齿需求在感染艾滋病毒(WWH)的妇女中很普遍。为 WWH跨越寿命，引起荷尔蒙水平波动的生理变化(例如，青春期， 怀孕、衰老)也会显著影响口腔健康，最常见的是通过夸大牙周 发炎。被忽视的牙科护理和负面的口腔症状学在总体上可能起到重要作用 通过影响日常功能，例如进食和参与社交活动，从而影响健康。口腔健康相关 生活质量(OHRQOL)是一个重要的多维结构，用于评估未治疗的影响 牙病对生活质量和福祉的影响。WWH的OHRQOL不仅受到口腔健康的影响 疾病，但也由社会决定因素的健康，年龄和精神健康症状。精神性 健康挑战，即抑郁、焦虑、创伤后应激障碍(PTSD)在WWH和 与不良的健康结果有关，包括口腔健康状况。抑郁症的并存 艾滋病毒感染与自我护理受损有关(例如，口腔卫生降低，被忽视 预防性牙科治疗)，以及精神药物的牙科副作用。尽管有很高的 在WWH中口腔和精神健康疾病的流行率，还没有研究解决 艾滋病毒、口腔健康和心理健康在一生中的关系。 WWH的口腔健康研究主要是在妇女协会的老年妇女中进行的 机构间艾滋病毒研究(WIHS)，一项关于WWH和有艾滋病毒风险的妇女的全国性前瞻性队列研究，现在 命名为MACS WIHS联合队列研究(MWCCS)。STAR是一项预期的全国性队列研究 居住在艾滋病毒携带者或处于艾滋病毒风险中的育龄妇女收集的数据与MWCCS一致。这个 拟议的女性口腔和心理健康综合研究(Crown)研究将利用 来自这两个队列的牙科和心理健康数据，利用他们共享的研究基础设施和数据 中间。Crown将招募一小部分与年龄、艾滋病毒状况相匹配的STAR/MWCCS女性(N=400)， 和心理健康症状学。参与者将参加两次皇冠学习访问，包括改编的 牙科检查和牙周检查。从正在进行的STAR/MWCCS研究访问和 皇冠研究访问将被分析为：1)评估精神健康症状学的独立影响 (例如，抑郁、焦虑、创伤后应激障碍)对人事厅生活质量的影响以及艾滋病毒和年龄对这种关系的交互影响； 2)评估心理健康症状学(如抑郁、焦虑、创伤后应激障碍)对 口腔健康临床结果以及艾滋病毒和年龄对这种关系的交互影响；以及3)评估 口腔健康临床结局在心理健康症状学与OHRQOL和OHRQOL之间的中介作用 这些变量之间潜在的双向关系。

Abstract. Oral health problems and unmet dental needs are prevalent in women living with HIV (WWH). For WWH across the lifespan, physiological changes that induce fluctuating hormone levels (e.g., puberty, pregnancy, aging) can also significantly impact oral health, most commonly through exaggerated periodontal inflammation. Neglected dental care and negative oral symptomatology can play a significant role in overall health by impacting everyday function, e.g., eating and engaging in social interactions. Oral health related quality of life (OHRQOL) is an important multidimensional construct used to evaluate the impact of untreated dental disease on quality of life and well-being. OHRQOL in WWH is impacted not only by oral health conditions, but also by the social determinants of health, age, and mental health symptomatology. Mental health challenges, i.e., depression, anxiety, post-traumatic stress disorder (PTSD), are prevalent in WWH and are associated with poor health outcomes, including oral health conditions. The co-occurrence of depression and HIV infection has been associated with impaired self-care (e.g., reduced oral hygiene, neglected preventive dental treatment), as well as dental side effects from psychotropic medication. Despite the high prevalence of oral and mental health conditions among WWH, there have been no studies addressing the relationship between HIV, oral health, and mental health over the lifespan. Oral health studies of WWH have primarily been conducted among older women in the Women’s Interagency HIV Study (WIHS), a national prospective cohort study of WWH and women at risk for HIV, now named the MACS WIHS Combined Cohort Study (MWCCS). STAR is a prospective national cohort study of women of reproductive age living with or at risk for HIV, collecting data harmonized with the MWCCS. The proposed Comprehensive Research on Oral and mental health among WomeN (CROWN) study will leverage dental and mental health data from these two cohorts utilizing their shared research infrastructure and data center. CROWN will enroll a smaller cohort of STAR/MWCCS women (N=400) matched on age, HIV status, and mental health symptomatology. Participants will attend two CROWN study visits consisting of an adapted dental survey and periodontal examination. Data collected from ongoing STAR/MWCCS study visits and the CROWN study visits will be analyzed to: 1) evaluate the independent effects of mental health symptomatology (e.g., depression, anxiety, PTSD) on OHRQOL and the interactive effects of HIV and age on this relationship; 2) to evaluate the independent effects of mental health symptomatology (e.g., depression, anxiety, PTSD) on oral health clinical outcomes and the interactive effects of HIV and age on this relationship; and 3) to evaluate the mediational role of oral health clinical outcomes between mental health symptomatology and OHRQOL and the potential bidirectional relationships among these variables.