摘要：Objectives. To examine changes in maternal–child health surrounding the April 2015 civil unrest in Baltimore, Maryland, following Freddie Gray’s death while in police custody. Methods. We conducted cross-sectional Children’s HealthWatch surveys January 2014 through December 2015 in pediatric emergency departments and primary care clinics on maternal–child health and June 2015 through October 2015 on daily and community routines. We used trend analysis and piecewise logistic regression to examine effects of time, residential proximity moderation, and mediation analysis to assess proximity and maternal–child health relations via maternal concerns. Results. Participants comprised 1095 mothers, 93% of whom were African American and 100% of whom had public or no insurance; 73% of participants’ children were younger than 24 months. Following the unrest, prevalence of maternal depressive symptoms increased significantly in proximal, but not distal, neighborhoods (b = 0.41; 95% confidence interval [CI] = 0.03, 0.79; P = .03). Maternal concerns were elevated in proximal neighborhoods and associated with depressive symptoms; mediation through maternal concern was not significant. Five months after the unrest, depressive symptoms returned to previous levels. Conclusions. Civil unrest has an acute effect on maternal depressive symptoms in neighborhoods proximal to unrest. Public Health Implications. To mitigate depressive symptoms associated with civil unrest, maintain stability of community routines, screen for maternal depressive symptoms, and provide parent–child nurturing programs. Community violence is a serious threat in many US cities. Although the consequences of community violence affect the entire community, the detrimental effects on maternal–child health are of particular concern. 1–3 Mothers exposed to violence are at increased risk for poor physical and mental health, 1,3 including depression, aggressive behaviors, and negative parenting practices. 3 Violence exposure is associated with negative child health indicators, particularly behavioral and emotional problems that may undermine children’s physical health and academic performance. 2,4 Community violence often occurs in the context of other adversities, increasing the risk for civil unrest. 5,6 Multiple stressful circumstances can have lifelong consequences on physical and psychological health, consistent with stress accumulation theories 7 and illustrated by adults with adverse childhood experiences. 8 Previous studies on community violence have rarely included data before episodes of civil unrest or focused on children younger than 5 years. 4,9 We took advantage of a unique opportunity to track changes in maternal–child health surrounding an episode of civil unrest. On April 12, 2015, Baltimore, Maryland, police officers arrested Freddie Gray, an African American man aged 25 years, who sustained neck and spinal injuries while in a police vehicle. His death led to protests citing racism and social injustice. Baltimore erupted in civil unrest: fires, property destruction, and violence. A state of emergency was declared from April 27 until May 6, 6 police officers were indicted, and 2015 ended with 344 murders, one of the highest rates in the city’s history. In a city experiencing multiple adverse events, 10 families living in neighborhoods proximal to the civil unrest (zip codes where civil unrest occurred) may have experienced disruptions to their daily routines (e.g., sleeping, eating, shopping) and concerns about safety. These disruptions may add stress, increasing the risk for maternal–child health problems. To examine how civil unrest relates to maternal–child health, 7 we tested 3 hypotheses: (1) the prevalence of maternal depressive symptoms and poor physical health, poor child physical health, and material hardships changes over time (before, during, and following civil unrest); (2) residential proximity to civil unrest moderates the relation between time and maternal–child health problems; and (3) maternal concerns regarding daily and community routines and safety mediate the relation between residential proximity to civil unrest and maternal–child health problems.
