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

抽象的。口腔健康问题和未满足的牙科需求在感染艾滋病毒的妇女中很普遍（WWH）。为 WWH在整个生命周期中，引起激素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 炎症忽视牙齿护理和消极的口腔修复学可以发挥重要作用， 通过影响日常功能，例如，吃东西和参与社交活动。口腔健康相关 生活质量（OHRQOL）是一个重要的多维结构，用于评估未经治疗的 牙科疾病对生活质量和幸福的影响。WWH的OHRQOL不仅受到口腔健康的影响 条件，但也由健康，年龄和心理健康的社会决定因素。心理 健康挑战，即，抑郁、焦虑、创伤后应激障碍（PTSD）在WWH中很普遍， 与不良的健康结果有关，包括口腔健康状况。抑郁症的并发症 并且HIV感染与自我护理受损有关（例如，口腔卫生减少，被忽视 预防性牙科治疗），以及精神药物对牙齿的副作用。尽管高 在WWH中，口腔和精神健康状况的患病率，还没有研究解决 艾滋病毒、口腔健康和心理健康之间的关系。 WWH的口腔健康研究主要在妇女中心的老年妇女中进行。 机构间艾滋病毒研究（WIHS）是一项关于WWH和艾滋病毒高危妇女的全国前瞻性队列研究， MACS WIHS联合队列研究（MWCCS）。星星是一项前瞻性国家队列研究， 感染艾滋病毒或有感染艾滋病毒风险的育龄妇女，收集与妇女、儿童和社区服务部协调的数据。的 拟议的妇女口腔和心理健康综合研究（皇冠）研究将利用 利用他们共享的研究基础设施和数据， 中心CROWN将招募一个较小的星星/MWCCS女性队列（N=400），年龄，艾滋病毒状态， 和心理健康诊断学。参与者将参加两次CROWN研究访问， 牙科检查和牙周检查。从正在进行的星星/MWCCS研究访视和 将对CROWN研究访视进行分析，以：1）评估心理健康诊断学的独立影响 (e.g.,抑郁、焦虑、PTSD）对OHRQOL的影响以及HIV和年龄对这种关系的交互作用; 2)为了评估精神健康行为学的独立影响（例如，抑郁、焦虑、创伤后应激障碍） 口腔健康的临床结果和艾滋病毒和年龄对这种关系的交互作用;和3）评估 口腔健康临床结果在心理健康诊断学和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.