Scaling-Up Stepped Care for Women's Mental Health in Primary Care in an LMIC

在中低收入国家的初级保健中扩大对妇女心理健康的分级护理

基本信息

批准号：
10477040
负责人：
Mahbat Bahromov
金额：
$ 63.31万
依托单位：
UNIVERSITY OF ILLINOIS AT CHICAGO
依托单位国家：
美国
项目类别：
财政年份：
2019
资助国家：
美国
起止时间：
2019-09-01 至 2024-07-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10477040
关键词：
Address Amitriptyline Anxiety Brain Caring Chicago Clinic Effectiveness Epidemic Evaluation Evidence Based Medicine Exposure to Fostering Funding Gender Health Health Services Accessibility Husband Illinois Individual Inequality Intervention Knowledge Leadership Life Style Lifting Measures Mediator of activation protein Mental Depression Mental Health Mental Health Services Mental disorders Mentorship Migrant Modeling Motivation National Institute of Mental Health Neurosciences New York Nurses Outcome Participant Persons Pharmaceutical Preparations Play Post-Traumatic Stress Disorders Poverty Primary Care Physician Primary Health Care Primary Nursing Care Provider Research Research Activity Research Domain Criteria Research Personnel Research Training Resource-limited setting Risk Role Science Self Management Services Tajikistan Testing Training Training Programs Trauma United States United States National Institutes of Health Universities Ursidae Family Utah Woman base effectiveness evaluation effectiveness implementation design effectiveness implementation study effectiveness testing evidence base executive function experience feasibility testing health care availability health goals healthy lifestyle implementation research implementation science implementation strategy improved interpersonal therapy low and middle-income countries meetings migration novel peer pilot test post intervention prevention service prisma programs recruit research and development scale up service providers social stigma standard care standard of care trauma exposure treatment effect treatment services young woman

项目摘要

This new R01 application responds to PAR-18-835 by advancing task sharing in testing the effectiveness and implementation of a stepped care model for LMICs. It uses nurses and mental health peers to treat depression and potential co-occurring anxiety among women in primary care. To improve implementation, this study examines the impact of clinic implementation teams in readying the clinics and service providers. The proposed project is located in Tajikistan, where the investigators have conducted NIH funded research since 2009. It builds upon and extends Dr. Weine’s R01, K24, and D43 research on migration and health and mental health, and especially his recent Global Brain R21 research which successfully adapted and tested stepped care for feasibility. Aim 1 assesses the effectiveness of the stepped care model with 420 women who have depression and potential co-occurring anxiety, recruited from 12 primary care clinics in Tajikistan, compared with standard of care plus provision of healthy lifestyle materials, with another 210 women recruited from 6 primary care clinics, including assessing mediators and moderators (e.g. executive control efficiency, trauma exposure). Aim 2 assesses whether a clinic implementation team moderates women’s reduction in depression post-intervention, as well as clinic-level (leadership support and degree of implementation) and provider-level (motivation and fidelity) moderators. Aim 3 establishes a national mental health research network that focuses on improving the standard of mental health care and access to services by building mental health implementation research capacity. The knowledge produced through this study will inform stepped care models for mental health in LMICs such as Tajikistan and in low-resource settings in the United States.

这个新的 R01 应用程序通过推进测试中的任务共享来响应 PAR-18-835 中低收入国家阶梯式护理模式的有效性和实施它使用护士和心理健康同行治疗女性抑郁症和潜在的同时发生的焦虑症为了改善初级保健的实施，本研究考察了诊所的影响。实施团队为诊所和服务提供商做好准备。位于塔吉克斯坦，研究人员自 2009 年以来一直在那里进行 NIH 资助的研究。它建立并扩展了 Weine 博士关于移民和健康的 R01、K24 和 D43 研究和心理健康，特别是他最近的 Global Brain R21 研究成功地目标 1 评估了分级护理的有效性。对 420 名患有抑郁症和潜在共存焦虑症的女性采取阶梯式护理模式，从塔吉克斯坦 12 个初级保健诊所招募，与标准护理加相比提供健康生活方式材料，并从 6 个初级保健机构招募了另外 210 名妇女诊所，包括评估中介者和调节者（例如执行控制效率、创伤目标 2 评估诊所实施团队是否调节女性减少在抑郁症干预后以及临床层面（领导支持和程度）实施）和提供者级别（动机和忠诚度）调节者。国家心理健康研究网络，专注于提高心理水平通过建设心理健康实施研究能力来提供医疗保健和获得服务。通过这项研究产生的知识将为心理健康的阶梯式护理模式提供信息塔吉克斯坦等中低收入国家和美国资源匮乏地区。