International evaluation of modifiable social determinants of health on COVID-related mental health outcomes

摘要 大量研究表明，新冠肺炎大流行导致了发病率的上升 精神健康问题，而不考虑既往的精神诊断史。这其中的一个重要驱动因素 现象似乎是由政府的政策反应引起的社会孤立和孤独，例如 社交距离建议，呆在家里的命令，以及旅行限制。然而，到目前为止，结果 在不同的队列和地理区域，以及背后的社会和个人因素 分歧仍然鲜为人知。此外，现有的努力主要集中在高收入国家。 (HIC)，这可能不会推广到研究不足的低收入和中等收入国家(LMIC)，大多数地区 受大流行影响，世界85%的人口居住在这里。缓解未来风险的关键机遇 心理健康的影响及边缘化群体在新冠肺炎心理健康研究中的地位上升 是利用现有队列中协调的个人层面的纵向数据来开发一种强大的、 对与大流行相关的心理健康结果进行大规模的全球评估。 我们的建议利用现有的大型国际队列，建立COVID全球精神卫生 财团(CGMHC)，以增加我们对可更改的社会和个人风险因素预测的了解 应对大流行时精神健康状况不佳，并建立基础设施以回答更广泛的问题 与精神疾病结局相关的本地和全球新冠肺炎决定因素，最终为公共政策提供信息， 干预措施和预防策略。为了实现这一目标，我们将整合：(1)来自23个国际组织的数据 由心理健康、社会人口和社会健康决定因素(SDoH)组成的队列来自近2.8 进行大流行前和大流行后评估的100万人；(2)新的目标试验仿真框架，以 促进对具体的大流行政策战略对精神健康结果的影响的因果推断； 以及(3)时间序列建模和新的风险预测方法的最新进展 在不同的国家，应对社会限制的精神健康结果的异质性。 我们的具体目标是：(1)收集全球队列中的纵向数据，协调数据，以便 下游分析并为科学界开发数据可视化平台；(2)表征 大流行心理健康轨迹及其调节者，并评估因果影响的证据 社会遏制政策对精神结果的影响。(3)建立CGMHC并将其正规化，以便继续 新冠肺炎大流行对全球心理健康和SDOH影响研究。成功完成 这些目标将为与COVID相关的调查提供独特的大规模全球队列资源 心理健康结果，告知干预措施和政策战略，以减轻未来的不利影响，并创造 一个持续的合作研究引擎(CGMHC)，可以通过未来的资金来维持。

Abstract A substantial body of research suggests that the COVID-19 pandemic has contributed to a rising incidence of mental health issues, irrespective of prior history of psychiatric diagnosis. One important driver of this phenomenon appears to be social isolation and loneliness induced by governmental policy responses such as social distancing recommendations, stay-at-home orders, and restrictions on travel. However, results thus far have been mixed across cohorts and geographic regions, and the social and individual factors underlying these differences remain poorly understood. Moreover, existing efforts have largely focused on high-income countries (HIC), which may not generalize to understudied low- and middle-income countries (LMIC), regions most impacted by the pandemic and where 85% of the world population lives. A key opportunity for mitigating future mental health impacts and increasing representation of marginalized groups in COVID-19 mental health research is to leverage individual-level longitudinal data harmonized across existing cohorts to develop a well-powered, large, global evaluation of pandemic-related mental health outcomes. Our proposal capitalizes on existing large international cohorts, establishing a COVID Global Mental Health Consortium (CGMHC) to increase our understanding of the modifiable social and individual risk factors predicting poor mental health in response to the pandemic, and to build an infrastructure to answer broader questions about the local and global determinants of COVID-19 related psychiatric outcomes, ultimately informing public policy, intervention, and prevention strategies. To accomplish this, we will integrate: (1) data from 23 international cohorts comprising mental health, sociodemographic, and social determinants of health (SDoH) from nearly 2.8 million individuals with pre- and post-pandemic assessments; (2) a novel target trial emulation framework to facilitate causal inference about the impact of specific pandemic policy strategies on mental health outcomes; and (3) recent advances in time-series modeling and novel risk prediction methods to understand the heterogeneity of mental health outcomes in response to social restrictions across a diverse range of countries. Our specific aims are to: (1) assemble longitudinal data across global cohorts, harmonizing data for downstream analyses and develop a data visualization platform for the scientific community; (2) characterize pandemic mental health trajectories along with their moderators and evaluate the evidence for a causal impact of social containment policies on psychiatric outcomes. (3) establish and formalize the CGMHC for continued research on the impact of the COVID-19 pandemic on global mental health and SDoH. Successful completion of these aims would provide a unique large-scale global cohort resource for the investigation of COVID-related mental health outcomes, inform intervention and policy strategies to mitigate future adverse impacts, and create an ongoing engine (the CGMHC) for collaborative research that can be sustained through future funding.