Importance The COVID-19 pandemic disproportionately affected mental health in socioeconomically disadvantaged children in the US. However, little is known about the relationship of preexisting and time-varying social determinants of health (SDoH) at individual and structural levels, vaccination eligibility/rates, and the racial and ethnic differences to trajectories of child mental health during the COVID-19 pandemic. Objective To estimate the association of trajectories of child mental health to multilevel SDoH and vaccination eligibility/rates. Design, Setting, and Participants This prospective longitudinal cohort study, conducted from May 16, 2020, to March 2, 2021, integrated structural-level, pandemic-related data with the Adolescent Brain Cognitive Development (ABCD) cohort data (release 4.0). The ABCD study recruited 11 878 children (baseline) and conducted 6 COVID-19 rapid response surveys across 21 US sites (in 17 states) from May 16, 2020, to March 2, 2021. Exposures Preexisting individual (eg, household income) and structural (area deprivation) SDoH and time-varying individual (eg, food insecurity, unemployment) and structural (eg, social distancing, vaccination eligibility/rates) SDoH. Main Outcomes and Measures Perceived Stress Scale, the National Institutes of Health-Toolbox emotion measures, and COVID-19-related worry. Results The longitudinal sample included 8493 children (mean [SD] age, 9.93 [0.63] years; 5011 girls [47.89%]; 245 Asian [2.34%], 1213 Black [11.59%], 2029 Hispanic [19.39%], 5851 White [55.93%], and 1124 children of other/multiracial ethnicity [10.74%]). Trajectories of stress, sadness, and COVID-19-related worry decreased after adult vaccination rollout. Compared with younger children, boys, White children, or those living with married parents, those who reported greater perceived stress included older children aged 12 to 15 years (β = 0.26; 95% CI, 0.12-0.41; P < .001); girls (β = 0.75; 95% CI, 0.61-0.89; P < .001); Hispanic children (β = 0.24; 95% CI, 0.01-0.47; P = .04); children living with separated parents (β = 0.50; 95% CI, 0.03-0.96; P = .04); children experiencing disrupted medical health care access (β = 0.19; 95% CI, 0.01-0.36; P = .04); children living in economically deprived neighborhoods (β = 0.28; 95% CI, 0.05-0.51; P = .02); children living in areas with more full-time working-class adults who were unable to social distance (β = 1.35; 95% CI, 0.13-2.67; P = .04); and children living in states with fewer fully vaccinated adults (β = 0.59; 95% CI, 0.16-1.02; P = .007). COVID-19 pandemic-related worry was higher among Asian children (β = 0.22; 95% CI, 0.08-0.37; P = .003), Black children (β = 0.33; 95% CI, 0.22-0.43; P < .001), children of other/multiracial ethnicity (β = 0.17; 95% CI, 0.09-0.25; P < .001), and children with disrupted medical health care (β = 0.15; 95% CI, 0.09-0.21) and disrupted mental health treatment (β = 0.11; 95% CI, 0.06-0.16). Inability to afford food was associated with increased sadness (β = 1.50; 95% CI, 0.06-2.93; P = .04). States with later vaccination eligibility dates for all adults were associated with greater COVID-19-related worry (β = 0.16; 95% CI, 0.01-0.31; P = .03) and decreased positive affect (β = -1.78; 95% CI, -3.39 to -0.18; P = .03) among children. Conclusions and Relevance Results of this study suggest a disproportionately adverse association of the COVID-19 pandemic with child mental health among racial and ethnic minority groups, which may be improved by addressing modifiable individual (food insecurity, unemployment, health services, parental supervision) and structural (area deprivation, job protection, vaccination) SDoH.

中文翻译：

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美国 COVID-19 大流行期间健康和疫苗接种的社会决定因素与儿童心理健康的关联。

重要性 COVID-19 大流行严重影响了美国社会经济弱势儿童的心理健康。然而，人们对 COVID-19 大流行期间个体和结构层面的预先存在和随时间变化的健康问题社会决定因素 (SDoH)、疫苗接种资格/率以及种族和民族差异与儿童心理健康轨迹之间的关系知之甚少. 目的 估计儿童心理健康轨迹与多级 SDoH 和疫苗接种资格/率之间的关系。设计、设置和参与者这项前瞻性纵向队列研究于 2020 年 5 月 16 日至 2021 年 3 月 2 日进行，将结构层面的大流行相关数据与青少年大脑认知发展 (ABCD) 队列数据（4.0 版）相结合。从 2020 年 5 月 16 日到 2021 年 3 月 2 日，ABCD 研究招募了 11878 名儿童（基线），并在美国 21 个地点（17 个州）进行了 6 次 COVID-19 快速反应调查。结构性（区域剥夺）SDoH 和随时间变化的个体（例如，粮食不安全、失业）和结构性（例如，社会距离、疫苗接种资格/率）SDoH。主要结果和测量感知压力量表、美国国立卫生研究院工具箱情绪测量以及与 COVID-19 相关的担忧。结果 纵向样本包括 8493 名儿童（平均 [SD] 年龄，9.93 [0.63] 岁；5011 名女孩 [47.89%]；245 名亚洲人 [2.34%]，1213 名黑人 [11.59%]，2029 名西班牙裔 [19.39%]，5851 名白人[55.93%] 和 1124 名其他/多种族儿童 [10.74%]）。压力、悲伤的轨迹，成人疫苗接种推出后，与 COVID-19 相关的担忧减少了。与年幼的儿童、男孩、白人儿童或与已婚父母同住的儿童相比，报告更大压力的儿童包括 12 至 15 岁的年龄较大的儿童（β = 0.26；95% CI，0.12-0.41；P < .001）；女孩（β = 0.75；95% CI，0.61-0.89；P < .001）；西班牙裔儿童（β = 0.24；95% CI，0.01-0.47；P = .04）；与父母分居的儿童（β = 0.50；95% CI，0.03-0.96；P = .04）；医疗保健服务中断的儿童（β = 0.19；95% CI，0.01-0.36；P = .04）；生活在经济贫困社区的儿童（β = 0.28；95% CI，0.05-0.51；P = .02）；生活在无法保持社交距离的全职工人阶级成年人较多的地区的儿童（β = 1.35；95% CI，0.13-2.67；P = .04）；和生活在完全接种疫苗的成年人较少的州的儿童（β = 0.59；95% CI，0.16-1.02；P = .007）。亚洲儿童（β = 0.22；95% CI，0.08-0.37；P = .003）、黑人儿童（β = 0.33；95% CI，0.22-0.43；P < .001）对 COVID-19 大流行相关的担忧更高)、其他/多种族的儿童 (β = 0.17; 95% CI, 0.09-0.25; P < .001)，以及医疗保健中断 (β = 0.15; 95% CI, 0.09-0.21) 和精神障碍的儿童健康治疗（β = 0.11；95% CI，0.06-0.16）。无法负担食物与悲伤增加有关（β = 1.50；95% CI，0.06-2.93；P = .04）。所有成年人接种疫苗资格日期较晚的州与更大的 COVID-19 相关担忧（β = 0.16；95% CI，0.01-0.31；P = .03）和积极影响减少（β = -1.78；95% CI）相关, -3.39 至 -0.18；P = .03) 在儿童中。