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

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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.