RISE Study ("Resist, Intervene, Support, Empower"): Feasibility/Acceptability of MHealth Intervention targeting Transgender Women facing gender-based violence and mental health disorders in Brazil

RISE 研究（“抵抗、干预、支持、赋权”）：针对巴西面临性别暴力和精神健康障碍的跨性别妇女的 MHealth 干预措施的可行性/可接受性

• 批准号: 9978227
• 负责人: Monica Malta
• 金额: $ 16.27万
• 依托单位: CENTRE FOR ADDICTION AND MENTAL HEALTH
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-01 至 2022-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9978227
• 关键词: Accounting; Address; Appointment; Area; Brazil; Car Phone; Caring; Cessation of life; Child; Cities; Collaborations; Community Health Aides; Continuing Education; Counseling; Country; Data; Discrimination; Enrollment; Environment; Esthetics; European Union; Face; Family; Feedback; Focus Groups; Fostering; General Population; Generalized Anxiety Disorder; Goals; Health; Health Sciences; Health Surveys; Healthcare; High Prevalence; Homelessness; Homicide; Improve Access; Informal Social Control; International; Intervention; Interview; Life Cycle Stages; Link; Location; Major Depressive Disorder; Maps; Mental Health; Mental disorders; Methods; Mobile Health Application; Murder; National Institute of Mental Health; Notification; Outcome; Participant; Police; Population; Post-Traumatic Stress Disorders; Prevalence; Public Health; Reporting; Research; Research Personnel; Resources; Risk; Safety; Sampling; Schedule; Schools; Self Efficacy; Services; Sexual Health; Sexual and Gender Minorities; Standardization; Substance Use Disorder; Suicide; Suicide attempt; Supervision; Surveys; Testing; Time; Training; Violence; Visit; behavior change; bullying; community based participatory research; cost; cost efficient; crowdsourcing; design; experience; gender nonconforming; gender-based violence; hate crimes; high risk population; implementation science; improved; innovation; interest; mHealth; mental health education; mobile application; novel; outcome forecast; post intervention; prevent; primary outcome; recruit; response; scale up; screening; sexual violence; social cognitive theory; successful intervention; systematic review; transgender; transgender women; uptake; violence prevention; Accounting; Address; Appointment; Area; Brazil; Car Phone; Caring; Cessation of life; Child; Cities; Collaborations; Community Health Aides; Continuing Education; Counseling; Country; Data; Discrimination; Enrollment; Environment; Esthetics; European Union; Face; Family; Feedback; Focus Groups; Fostering; General Population; Generalized Anxiety Disorder; Goals; Health; Health Sciences; Health Surveys; Healthcare; High Prevalence; Homelessness; Homicide; Improve Access; Informal Social Control; International; Intervention; Interview; Life Cycle Stages; Link; Location; Major Depressive Disorder; Maps; Mental Health; Mental disorders; Methods; Mobile Health Application; Murder; National Institute of Mental Health; Notification; Outcome; Participant; Police; Population; Post-Traumatic Stress Disorders; Prevalence; Public Health; Reporting; Research; Research Personnel; Resources; Risk; Safety; Sampling; Schedule; Schools; Self Efficacy; Services; Sexual Health; Sexual and Gender Minorities; Standardization; Substance Use Disorder; Suicide; Suicide attempt; Supervision; Surveys; Testing; Time; Training; Violence; Visit; behavior change; bullying; community based participatory research; cost; cost efficient; crowdsourcing; design; experience; gender nonconforming; gender-based violence; hate crimes; high risk population; implementation science; improved; innovation; interest; mHealth; mental health education; mobile application; novel; outcome forecast; post intervention; prevent; primary outcome; recruit; response; scale up; screening; sexual violence; social cognitive theory; successful intervention; systematic review; transgender; transgender women; uptake; violence prevention

Transgender women (TGW) disproportionately experience physical/sexual violence when compared with the general population and with other sexual and gender minorities (SGMs). A recent systematic review identified a high prevalence of lifetime physical (68%) or sexual violence (49%) among TGW. Frequent experiences of violence contributes to high levels of posttraumatic stress disorder (PTSD), generalized anxiety disorder (GAD), suicidality, substance use disorder (SUD) and might influence the onset, progression, and prognosis of major depressive disorder (MDD) among TGW. Since 2008 Brazil is responsible for more than 40% of all transgender homicides reported worldwide. In 2016/17 we conducted a survey with 2,846 TGW from twelve Brazilian cities, identifying 60% prevalence of lifetime violence (physical and/or sexual), 60% of participants screened positive for MDD, 38% for GAD, and 35% attempted suicide. The majority of violent incidents were not reported to the police (91%) and most victims did not receive any counseling or mental health (MH) treatment (82%). On this resubmission, we will utilize community-based participatory research (CBPR) to adapt the “UNI-FORM” app and online platform (https://uni-form.eu) to TGW from Brazil. The study specific aims are: (1) Refine and adapt the “UNI-FORM” mHealth intervention to Brazil (RISE), including MH screening and link to MH care; (2) Pilot test RISE to prevent violence, improve MH screening and treatment; and (3) Evaluate the feasibility and acceptability of RISE. This R21 exploratory project proposes to recruit 200 TGW from Rio de Janeiro, Brazil to study the implementation of RISE. Consistent with NIMH goal to enhance research capacity, the proposal is led by an early stage investigator and includes a close collaboration with researchers from Duke who will provide constant supervision from researchers with senior expertise in SGM mHealth (Dr. Legrand), SGM MH international research (Dr. Whetten), MH and implementation science (Dr. Belden). This proposal is innovative in several ways: it will adapt to Brazil an existing mHealth intervention addressing SGM-related violence (UNI-FORM), to include additional features to increase MH screening and linkage to MH care. The proposed app, RISE, has the potential to improve crises response and promote timely MH care among a high-risk population: TGW. It has significance and impact: The intervention will prevent and respond to violence against TGW, in a country with the highest rate of transgender murders in the world. It will also develop an innovative strategy to identify and link to care TGW who need MH care, a population with high prevalence of PTSD, GAD, MDD, SUD and suicidality. Those mental disorders are underscreened, underdiagnosed, and undertreated among TGW. If successful, the intervention could be scaled up and adapted to other populations and countries. This research will yield the crucial first steps in developing a lower cost and efficacious mHealth intervention that we plan to evaluate with an RCT in a subsequent R01. RISE addresses all three NIMH priorities identified in the Notice of Special Interest in Research on Health of SGM Populations (NOT-MD-19-001), Grand Challenges in Global Mental Health and NIMH Strategic Aim 3.

与跨性别妇女（TGW）相比 普通人群以及其他性别和性别少数族裔（SGM）。最近的系统评论确定了 TGW中终生身体（68％）或性暴力（49％）的高患病率。频繁的经历 暴力导致高水平创伤后应激障碍（PTSD），广泛的动画障碍 （GAD），自杀性，药物使用障碍（SUD），可能会影响发作，进展和发展 TGW中的主要抑郁症（MDD）。自2008年以来，巴西负责超过40％ 跨性别凶杀案报道。在2016/17 巴西城市确定了60％的终身暴力患病率（身体和/或性），有60％的参与者 筛选为MDD阳性，GAD的38％和35％的自杀。大多数暴力事件是 未向警方报告（91％），大多数受害者没有获得任何咨询或心理健康（MH） 治疗（82％）。在此重新提交时，我们将利用基于社区的参与研究（CBPR）适应 来自巴西TGW的“ Uni-Form”应用程序和在线平台（https://uni-form.eu）。该研究的具体目的是： （1）改进并调整“ Uni-Form” MHealth干预措施（Rise），包括MH筛查和链接 护理； （2）试点测试升高以防止暴力，改善MH筛查和治疗； （3）评估 上升的可行性和可接受性。这项R21探索性项目提案旨在从里约热内卢招募200 TGW 巴西珍妮罗（Janeiro）研究崛起的实施。与NIMH目标一致，以增强研究能力， 该提案由早期调查员领导，并与来自的研究人员进行了密切合作 将在SGM MHealth领域提供高级专业知识的研究人员不断监督的杜克（Duke）（博士 Legrand），SGM MH国际研究（Whetten博士），MH和实施科学（Belden博士）。这 提案在几种方面具有创新性：它将适应巴西现有的MHealth干预措施 与SGM相关的暴力（UNI形式），包括增加MH筛选并与MH连接的其他功能 关心。拟议的应用程序Rise具有改善危机反应并促进及时MH护理的潜力 在高风险人口中：TGW。它具有重要意义和影响：干预将预防和回应 在一个世界上跨性别谋杀案率最高的国家中，针对TGW的暴力行为。它也会 制定一种创新的策略来识别需要MH护理的Care TGW，这是一个人口高 PTSD，GAD，MDD，SUD和自杀的患病率。这些精神障碍已被逐渐解决， 诊断不足，在TGW中被诊断不足。如果成功，则可以扩大干预措施，并且 适用于其他人群和国家。这项研究将产生至关重要的第一步 我们计划在随后的R01中使用RCT进行成本和有效的MHealth干预措施。上升 解决了SGM健康研究特别兴趣通知中确定的所有三个NIMH优先事项 人群（非MD-19-001），全球心理健康和NIMH战略目标3。