Pathways to mental health care: Examining the longitudinal impact of stigma mechanisms on treatment engagement in emerging adults

精神卫生保健之路：研究耻辱机制对新兴成年人治疗参与的纵向影响

• 批准号: 10549745
• 负责人: Valerie Ann Earnshaw
• 金额: $ 47.09万
• 依托单位: UNIVERSITY OF DELAWARE
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-01-12 至 2026-12-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10549745
• 关键词: Address; Adult; Age; Anxiety; Area; Biological; COVID-19 pandemic; Cardiovascular Diseases; Cessation of life; Characteristics; Chronic; Cognitive; Communities; Data; Development; Diabetes Mellitus; Discrimination; Epidemiology; Goals; Health; Health Services Accessibility; Healthcare; Individual; Intervention; Lead; Link; Longitudinal Studies; Mental Depression; Mental Health; Mental Health Services; Mental disorders; National Institute of Child Health and Human Development; National Institute of Mental Health; Onset of illness; Participant; Pathway interactions; Pattern; Personal Satisfaction; Persons; Qualifying; Research; Research Personnel; Resources; Risk; Risk Factors; Role; Sampling; Scientist; Social Change; Stereotyping; Subgroup; Substance Use Disorder; Surveys; Testing; Time; Treatment outcome; age group; aged; anxiety symptoms; barrier to care; care seeking; depressive symptoms; emerging adult; emerging adulthood; evidence base; experience; falls; implementation intervention; improved; individualized medicine; innovation; internalized stigma; longitudinal design; model design; multilevel analysis; physical conditioning; precision medicine; premature; reduce symptoms; resilience; response; social; social stigma; structural determinants; theories; tool

PROJECT SUMMARY/ABSTRACT Many emerging adults (aged 18-25) in the U.S. are living with unrecognized and/or untreated depression and anxiety. Emerging adults have the highest rates (26%) of mental illness (MI) and lowest rates of treatment seeking (38%), compared to all other age groups. Untreated depression and anxiety are particularly prevalent among emerging adults and are key risk factors for the development of substance use disorders, cardiovascular disease, and chronic health conditions later in adulthood, as well as premature death. Efficacious MI treatments are available, but MI stigma is a substantial barrier to recognizing and treating depression and anxiety. Emerging adults are particularly vulnerable to MI stigma given intense cognitive, biological, and social changes occurring during these years. Although scientists have begun to assemble and refine an evidence-based stigma-reduction toolbox, stigma interventions have fallen short of fully addressing MI stigma in part because they take a “one size fits all” approach. Stigma interventions may be more efficacious if they address stigma mechanisms when they are most pronounced, target the specific stigma mechanism(s) that are most harmful to treatment outcomes, and provide extra support for people who lack resilience to stigma. Our long-term goal is to tailor MI stigma interventions for emerging adults to promote positive treatment outcomes and lifetime wellbeing. In order to inform the tailoring of these interventions, we need greater understanding of how stigma evolves and impacts treatment outcomes during emerging adulthood. The objective of the current proposal is to examine longitudinal relationships between MI stigma and treatment outcomes among a large, national sample of emerging adults. Our specific aims are to: (1) Characterize trajectories of MI stigma mechanisms and identify moderators of trajectories among emerging adults experiencing depression and/or anxiety; (2) Examine associations between MI stigma mechanisms, MI recognition and MI treatment engagement over time; and (3) Identify latent profiles of MI stigma mechanisms, how individuals transition across profiles over time, and links between profiles and treatment engagement. We propose a national, longitudinal study of emerging adults (aged 18-25), surveying 4000 participants 4 times a year for 3 years regarding stigma mechanisms, moderating factors, mental health, and treatment engagement. Based on epidemiological estimates, we project that ~30% (n=1200) of participants will experience a new onset of depression or anxiety during the study. Data will be analyzed using multilevel modeling, moderation analyses, latent profile and latent transition analyses. Findings will enable researchers to better identify: (1) the ideal timing of stigma interventions to maximize impact among emerging adults, (2) who among emerging adults are most vulnerable to the effects of stigma, (3) which stigma mechanisms should be targeted for intervention to improve lifelong health and wellbeing, and (4) how to combine stigma-reduction tools for subgroups of emerging adults. This proposal responds to NIMH and NICHD’s strategic objectives to determine when, where, and how to intervene to improve healthcare during the transition to adulthood.

项目摘要/摘要 美国许多新兴成年人（18-25岁）都生活在未识别和/或未经治疗的抑郁症和/或 焦虑。新兴的成年人的精神疾病率最高（26％），治疗率最低 与所有其他年龄段相比，寻求（38％）。未经处理的抑郁和动画尤其普遍 在新兴的成年人中，是发展疾病的主要风险因素，心血管 疾病和慢性健康状况在成年后期以及过早死亡。有效的MI治疗 可用，但是MI污名是识别和治疗抑郁症和动画的重大障碍。新兴 鉴于发生的强烈认知，生物学和社会变化，成年人特别容易受到MI污名 在这些年中。尽管科学家已经开始组装和完善基于证据的污名 工具箱，污名干预措施不足以完全解决mi污名，部分原因是他们采用了“一个 大小适合所有“方法” 它们是最明显的，针对对治疗结果有害的特定污名机制， 并为缺乏污名的人提供额外的支持。我们的长期目标是量身定制MI污名 新兴成年人的干预措施促进阳性治疗结果和终生健康。为了 告知这些干预措施的裁缝，我们需要对污名演变和影响的方式有更深入的了解 成年后的治疗结果。当前建议的目的是检查纵向 大型全国新兴成年人样本之间的MI污名与治疗结果之间的关系。 我们的具体目的是：（1）表征MI污名机制的轨迹，并确定 在抑郁和/或动画的新兴成年人中的轨迹； （2）检查之间的关联 随着时间的流逝，MI污名机制，MI识别和MI治疗参与； （3）确定潜在概况 MI污名机制，个人如何随着时间的推移过渡以及轮廓之间的联系 治疗参与。我们提出了一项针对新兴成年人的全国性纵向研究（18-25岁），调查 关于污名机制，调节因素，心理健康，4000名参与者，每年4次，3年 和治疗参与。根据流行病学的估计，我们预测约30％（n = 1200）的参与者 在研究过程中将经历新的抑郁或焦虑发作。数据将使用多级分析 建模，适度分析，潜在轮廓和潜在过渡分析。调查结果将使研究人员能够 更好的识别：（1）污名干预措施的理想时机，以最大程度地影响新兴成年人的影响，（2） 在新兴的成年人中，最容易受到污名的影响，（3）污名机制应为 针对干预措施，以改善终身健康和福祉，以及（4）如何结合污名工具 用于新兴成年人的亚组。该提案对NIMH和NICHD的战略目标做出了回应 确定在过渡到成年期间的何时，何处以及如何干预以改善医疗保健。