Boston University School of Medicine, Department of Pediatrics, 771 Albany Street, Room G509, Boston, MA 02118, United States.
Boston Medical Center, Department of Developmental and Behavioral Pediatrics, 72 E. Concord Street, Vose 426, Boston, MA 02118, United States.
Addict Behav. 2019 Nov;98:106030. doi: 10.1016/j.addbeh.2019.106030. Epub 2019 Jun 20.
While pregnant women in treatment for opioid use disorder (OUD) face considerable challenges, common material hardships- food insecurity and housing instability, known to negatively impact maternal-child health, have been inadequately researched within this population. This study describes food/housing hardships and evaluates associations with key psychosocial factors.
A single-site prospective study, 100 3rd trimester women receiving prenatal care and medication-assisted treatment for OUD were interviewed, including screening for food/housing hardships, depressive symptoms, intimate partner vulnerability; and self-reported post-traumatic stress disorder (PTSD) history. We developed a three-level categorization combining food/housing screening outcomes: 1) "both insecure"; 2) "either secure"; and 3) "both secure". Bivariate analyses and linear path analyses evaluated associations among psychosocial variables using "both secure" as the referent group.
Of 100 women, 56% reported food insecurity; 61% housing instability; 42% "both insecure"; 33% "either insecure"; 25% "both secure". In unadjusted food/housing groups "either insecure" and "both insecure" reported significantly greater depressive symptoms; "both insecure" additionally reported significantly greater intimate partner vulnerability. Path analyses adjusted for PTSD and compared with "both secure" (adjusted mean = 6.2): "either insecure" had greater depressive symptom scores (adjusted means = 9.8, p = .01) while "both insecure" had greater depressive scores (adjusted means 10.5, p = .002). In addition, "both insecure" had a clinically important 5.7 point greater intimate partner vulnerability score. There were no significant interactions between food/housing and PTSD.
Even in women receiving prenatal care and treatment for OUD, food/housing material hardships and associated psychosocial factors are of major concern, requiring screening and remediation.
尽管接受阿片类药物使用障碍（OUD）治疗的孕妇面临着相当大的挑战，但众所周知，会对母婴健康产生负面影响的常见物质困难，如食物不安全和住房不稳定，在这一人群中研究不足。本研究描述了食物/住房困难，并评估了其与关键社会心理因素的关联。
这是一项单站点前瞻性研究，共纳入 100 名处于妊娠晚期且正在接受产前护理和药物辅助治疗 OUD 的女性，对其进行访谈，包括筛查食物/住房困难、抑郁症状、亲密伴侣脆弱性以及自我报告的创伤后应激障碍（PTSD）病史。我们开发了一个三级分类，结合食物/住房筛查结果：1）“两者都不安全”；2）“两者都安全”；3）“两者都安全”。使用“两者都安全”作为参考组，对社会心理变量之间的关联进行了单变量分析和线性路径分析。
在 100 名女性中，56%报告食物不安全；61%住房不稳定；42%“两者都不安全”；33%“两者都安全”；25%“两者都安全”。在未经调整的食物/住房组中，“两者都不安全”和“两者都不安全”报告的抑郁症状明显更严重；“两者都不安全”还报告了更严重的亲密伴侣脆弱性。路径分析调整了 PTSD 并与“两者都安全”进行了比较（调整后的平均值为 6.2）：“两者都不安全”的抑郁症状评分更高（调整后的平均值为 9.8，p=0.01），而“两者都不安全”的抑郁评分更高（调整后的平均值为 10.5，p=0.002）。此外，“两者都不安全”的亲密伴侣脆弱性评分高出了 5.7 分，这具有临床意义。食物/住房和 PTSD 之间没有显著的相互作用。
即使在接受产前护理和治疗 OUD 的女性中，食物/住房物质困难和相关社会心理因素也令人担忧，需要进行筛查和补救。
