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：检查耻辱机制对新兴成年人治疗参与的纵向影响

• 批准号: 10364174
• 负责人: Valerie Ann Earnshaw
• 金额: $ 65.32万
• 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/10364174
• 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; 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; barrier to care; base; care seeking; depressive symptoms; emerging adult; emerging adulthood; evidence base; experience; 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; 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.

项目概要/摘要 美国许多新兴成年人（18-25 岁）患有未被识别和/或未经治疗的抑郁症，并且 新兴成年人患精神疾病 (MI) 的比例最高 (26%)，而治疗率最低。 与所有其他年龄组相比，寻求治疗的抑郁症和焦虑症尤为普遍。 在新兴成年人中，是发生物质使用障碍、心血管疾病的关键危险因素 疾病、成年后的慢性健康问题以及有效的心肌梗死治疗。 是可用的，但 MI 耻辱是识别和治疗新出现的抑郁症和焦虑症的重大障碍。 鉴于发生了剧烈的认知、生物和社会变化，成年人特别容易受到 MI 耻辱感的影响 尽管科学家们已经开始收集和完善基于证据的耻辱减少方法。 工具箱中，耻辱干预措施未能完全解决 MI 耻辱问题，部分原因是它们采取了“单一 如果污名干预能够解决污名机制，那么“放之四海而皆准”的方法可能会更有效。 它们是最明显的，针对对治疗结果最有害的特定耻辱机制， 并为缺乏污名适应能力的人提供额外支持 我们的长期目标是消除 MI 污名。 对新兴成年人进行干预，以促进积极的治疗结果和终生福祉。 为了制定这些干预措施，我们需要更好地了解耻辱是如何演变和影响的 当前提案的目的是纵向检查成年期的治疗结果。 在大量全国新兴成年人样本中，MI 耻辱与治疗结果之间的关系。 我们的具体目标是：（1）描述 MI 耻辱机制的轨迹并确定其调节因素 经历抑郁和/或焦虑的新兴成年人的轨迹；（2）检查之间的关联； 随着时间的推移，MI 耻辱机制、MI 识别和 MI 治疗参与度；以及 (3) 识别潜在特征； MI 耻辱机制、个人如何随着时间的推移在个人资料之间进行转变，以及个人资料和个人资料之间的联系 我们提议对新兴成年人（18-25 岁）进行一项全国性纵向研究，进行调查。 4000 名参与者，每年 4 次，持续 3 年，内容涉及耻辱机制、调节因素、心理健康、 根据流行病学估计，我们预计约 30% (n=1200) 的参与者。 在研究期间将经历新的抑郁或焦虑发作 数据将使用多层次进行分析。 建模、调节分析、潜在概况和潜在转变分析的结果将使研究人员能够 更好地确定：(1) 耻辱干预的理想时机，以最大程度地提高对新兴成年人的影响，(2) 哪些人 新兴成年人最容易受到耻辱的影响，(3) 应该采用哪些耻辱机制 以改善终生健康和福祉为目标的干预措施，以及 (4) 如何结合减少耻辱工具 该提案响应了 NIMH 和 NICHD 的战略目标： 确定在向成年过渡期间何时、何地以及如何进行干预以改善医疗保健。