The impact of changes in social determinants of health on adolescent and young adult mental health during the COVID-19 pandemic: A longitudinal study of the Asenze cohort in South Africa

健康的社会决定因素(SDOH)，如教育、就业、住房和粮食安全，都是 受新冠肺炎大流行和相关封锁的影响。SDOH的这些变化是特别的 在低收入和中等收入国家(LMIC)有影响，如南非，在这些国家人口风险很高 暴露在因新冠肺炎封锁而加剧的逆境中(例如，经济不稳定、暴力、 家庭分离和丧失)。尽管在大流行期间进行的几项研究将封锁和 SDOH的变化对不良心理健康结果的影响，这些研究主要是横断面研究， 无法评估：i)SDOH随时间变化对心理健康的影响；ii)最初 新冠肺炎的影响将长期存在；以及iii)SDOH值变化影响心理健康的机制 健康，这是确定潜在干预点所必需的。此外，青少年和青壮年 (阿雅；18-25岁)一直不是新冠肺炎心理健康研究的主要重点，这是一个差距，因为 这是一个年龄范围，在此期间个人完成教育并过渡到新的角色，包括专业和 私人恩怨。这一时期也是突发心理健康障碍最早发生的时期，并塑造了这种可能性 他们将继续这样做。这项研究通过利用现有的基于人群的大型队列来解决这些差距 在南非的1100多名Aya和他们的照顾者中，Asenze队列。四次数据收集浪潮 到2022年，捕获了对心理、行为和身体健康结果的纵向测量 以及SDOH的相关性。这为研究阿雅以前的心理健康变化提供了难得的机会， 在疫情最严重的时期，以及在受到新冠肺炎严重影响的低收入国家之后- 南非是新冠肺炎病例、死亡和超额死亡率最高的国家，原因是 非洲的大流行。在这项混合方法研究中，我们将调查新冠肺炎相关SDOH的影响 阿森泽队列中阿雅人心理健康状况的变化。具体地说，我们将模拟精神健康方面的变化 新冠肺炎前期和新冠肺炎急性阶段的结果(阿森泽浪潮3，收集2020-2021年和浪潮 4)到急性COVID后阶段(浪潮5,2024-2025)，以及这些变化可能是如何 受SDOH的影响(例如，获得教育、就业、医疗保健的可获得性、粮食安全、接触 暴力)。我们将研究SDOH和心理之间潜在的机制(中介) 健康和关键人群(主持人)，以培养复原力。定性数据建立在先前的定性和 量化数据，将提供对阿雅心理健康的深入、补充和背景了解 期间和新冠肺炎以及对干预措施可接受性和适当性的看法 量化数据中确定的机制和关键人群。这些发现将在短期内提供 关于SDOH在COVID背景下影响精神健康的可能干预点的信息-- 19和长期信息，为未来突发公共卫生事件的干预方法提供信息。

Social determinants of health (SDOH), such as education, employment, housing, and food security, were all impacted by the COVID-19 pandemic and associated lockdowns. These changes to SDOH were particularly impactful in low-and-middle-income countries (LMIC) such as South Africa in which populations have a high risk of exposure to adversities that were exacerbated by COVID-19 lockdowns (e.g., economic instability, violence, family separation and loss). Although several studies conducted during the pandemic linked lockdowns and changes in SDOH to adverse mental health outcomes, these studies were predominantly cross-sectional, which precludes the ability to evaluate: i) the impact of changes in SDOH on mental health over time; ii) whether initial impacts of COVID-19 persist long-term; and iii) the mechanisms through which changes in SDOH impact mental health, which are necessary for identifying potential intervention points. Further, adolescents and young adults (AYA; ages 18-25) have not been a major focus of COVID-19 mental health research, which is a gap because this is an age range during which individuals finish education and transition into new roles, both professional and personal. This period is also when incident mental health disorders often first occur and shapes the probability that they will continue. This study addresses these gaps by leveraging an existing large, population-based cohort of over 1100 AYA and their caregivers in in South Africa, the Asenze cohort. Four waves of data collection through 2022 have captured longitudinal measurements on mental, behavioral, and physical health outcomes as well as SDOH correlates. This provides a rare opportunity to investigate changes in AYA mental health before, during, and after the height of the pandemic in a LMIC that has been substantially impacted by COVID-19 – South Africa has experienced the highest number of COVID-19 cases, deaths, and excess mortality due to the pandemic in Africa. In this mixed methods study, we will investigate the impact of COVID-19-related SDOH changes on mental health among AYA in the Asenze cohort. Specifically, we will model changes in mental health outcomes from pre-COVID-19 and the acute COVID-19 phases (Asenze Wave 3, collected 2020-2021 and Wave 4, collected 2022) to the post-acute COVID phase (Wave 5, 2024-2025) and how these changes may have been impacted by SDOH (e.g., access to education, employment, availability of health care, food security, exposure to violence). We will examine mechanisms (mediators) underlying the relationship between SDOH and mental health and key populations (moderators) to foster resilience. Qualitative data building on prior qualitative and quantitative data, will provide an in-depth, complementary, and contextual understanding on AYA mental health during and COVID-19 and perceptions on the acceptability and appropriateness of interventions that target mechanisms and key populations identified in the quantitative data. The findings will provide near-term information on possible intervention points through which SDOH impacts mental health in the context of COVID- 19, and long-term information to inform intervention approaches in future public health emergencies.