A brief, task-shifted treatment to improve father depression and child outcomes in Kenya: A pilot effectiveness-implementation trial

在肯尼亚，一项旨在改善父亲抑郁症和儿童结局的简短、任务转移治疗：试点有效性实施试验

• 批准号: 10704666
• 负责人: Ali Giusto
• 金额: $ 19.31万
• 依托单位: NEW YORK STATE PSYCHIATRIC INSTITUTE DBA RESEARCH FOUNDATION FOR MENTAL HYGIENE, INC
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-15 至 2027-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10704666
• 关键词: Address; Adult; Adverse event; Age; Automobile Driving; Award; Behavior; Behavioral; Caregivers; Case Series; Child; Child Mental Health; Child Rearing; Clinical; Clinical Trials; Communities; Competence; Control Groups; Data; Dedications; Development; Economic Factors; Economics; Educational process of instructing; Effectiveness; Equation; Family; Family member; Fathers; Focus Groups; Future; Gender; Goals; Health; Health Policy; Home; Hospital Referrals; Hybrids; Impairment; Intervention; Interview; Kenya; Knowledge; Learning; Link; Masculine; Mediator; Mental Depression; Mental Health; Mental Health Services; Mental disorders; Mentorship; Meta-Analysis; Methods; Modeling; National Institute of Mental Health; Outcome; Parents; Participant; Partnership Practice; Pathway interactions; Patients; Pattern; Personal Satisfaction; Persons; Poverty; Professional counselor; Provider; Public Health; Publications; Questionnaires; Randomized; Randomized, Controlled Trials; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Reporting; Research; Research Personnel; Resource-limited setting; Services; Stress; Surveys; Testing; Training; Transcript; Waiting Lists; Woman; Work; Youth; acceptability and feasibility; career; caregiver interventions; clinical outcome assessment; depressive symptoms; design; disability; drinking; drinking behavior; effectiveness testing; effectiveness/implementation design; effectiveness/implementation hybrid; effectiveness/implementation trial; efficacious intervention; efficacious treatment; hybrid type 1 design; implementation facilitators; implementation outcomes; implementation science; implementation strategy; implementation/effectiveness; improved; knowledge of results; low and middle-income countries; maladaptive behavior; men; motivational enhancement therapy; peer; pressure; primary outcome; process evaluation; response; retention rate; satisfaction; scale up; secondary outcome; skills; social health determinants; social stigma; symposium

PROJECT SUMMARY Globally, depression is the leading cause of disability world worldwide, yet over 75% of people in low and middle-income countries (LMIC) do not receive treatment. This gap is especially large for men. Treating men is essential to reducing the global burden of depression given its impact on families and children with men’s mental health (MH) predicting poor parenting and child MH. Although treating parent depression has been shown to improve parental MH, parenting, and child MH; men and fathers have been missing MH care and clinical trials. MH care relevant to fathers that address common barriers to MH, such as masculine norms and economic factors, are needed. The goal of the K23 is to expand the candidate’s skillset and prepare her to conduct independent research on scalable interventions for adult MH to improve child MH in low-resource settings. Through a combination of coursework and seminars, scientific conferences, collaborative publications, and mentorship from leading experts, the candidate will develop competency in 1) execution of randomized control trials using implementation science designs; 2) exploration of mechanism of change on MH using mixed methods; 3) understanding social determinant of health (SDH) on implementation. The candidate will apply knowledge and skills gained through training to conduct a pilot randomized control trial (RCT) using an effectiveness-implementation design in Kenya. The candidate will leverage existing partnerships with AMPATH and Moi Teaching and Referral Hospital (MTRH) in Kenya. She will also build on collaborative preliminary work with AMPATH/MTRH that showed promising proof-of-concept for ‘Learn, Act, Engage, Dedicate’ (LEAD), a 5-session task-shifted behavioral activation intervention with motivational interviewing and masculinity discussion strategies for fathers in Kenya. Proof-of-concept findings with nine fathers and families were promising with high participant satisfaction and improvements in father depression, parenting, and child MH. This supports pursuit of a pilot RCT, proposed here, using an effectiveness- implementation Hybrid Type I design to explore preliminary effectiveness and its implementation. Specifically, the candidate will conduct a pilot RCT with fathers randomized to either LEAD or a waitlist control group to (Aim1) explore change in fathers’ MH; (Aim 2) explore drivers of change in father MH, father parenting, and child MH (or non-response); and (Aim 3) explore the feasibility and acceptability of implementing a task-shifted MH treatment for fathers in a low-resource setting. Results will inform the development of an R01 proposal for a Hybrid trial to assess clinical outcomes of father and child MH and the impact of implementation strategies. Together, the training, research, and partnerships in the proposed award will support testing of a scalable MH treatment delivered by peer-father counselors with potential for engaging men and improving father and child MH in a low-resource setting, contributing to the NIMH’s goal of maximizing public health impact of research.

项目概要 在全球范围内，抑郁症是全世界残疾的主要原因，但超过 75% 的人处于低收入和低收入人群 中等收入国家（LMIC）没有接受治疗，这一差距对于男性来说尤其大。 鉴于抑郁症对患有男性抑郁症的家庭和儿童的影响，这对于减轻全球抑郁症负担至关重要 心理健康 (MH) 预示着不良养育方式和儿童 MH。 研究表明，男性和父亲一直缺乏 MH 护理和治疗，以改善父母 MH、养育子女和儿童 MH 的情况； 与父亲相关的 MH 护理，解决 MH 的常见障碍，例如男性规范和 K23 的目标是扩展候选人的技能并让她做好准备。 对成人 MH 的可扩展干预措施进行独立研究，以改善资源匮乏的儿童 MH 通过课程作业和研讨会、科学会议、协作的结合。 出版物和领先专家的指导，候选人将发展以下方面的能力：1) 执行 采用科学设计的随机对照试验；2）探索 MH 的变化机制； 使用混合方法；3）了解实施过程中的健康社会决定因素（SDH）。 候选人将运用通过培训获得的知识和技能进行随机试点 候选人将利用肯尼亚现有的有效性实施设计进行对照试验（RCT）。 她还将与 AMPATH 和肯尼亚 Moi 教学和转诊医院 (MTRH) 建立合作伙伴关系。 与 AMPATH/MTRH 的合作初步工作显示了“学习、行动、 “参与，奉献”（LEAD），一个为期 5 次的任务转移行为激活干预措施，具有激励性 针对肯尼亚父亲的访谈和男性气概讨论策略，对九名父亲进行了概念验证研究。 父亲和家庭都充满希望，参与者满意度高，父亲抑郁症有所改善， 这支持本文提出的试验性随机对照试验，使用有效性- 实施混合类型 I 设计以探索初步效果及其实施。 候选人将进行一项试点随机对照试验，父亲们被随机分配到 LEAD 组或候补名单对照组，以 （目标 1）探索父亲 MH 的变化；（目标 2）探索父亲 MH 变化的驱动因素、父亲养育方式以及 儿童 MH（或无反应）；以及（目标 3）探索实施任务转移的可行性和可接受性 对资源匮乏环境中的父亲进行 MH 治疗的结果将为 R01 提案的制定提供信息。 一项混合试验，旨在评估父亲和孩子 MH 的临床结果以及实施策略的影响。 拟议奖项中的培训、研究和合作伙伴关系将共同支持可扩展 MH 的测试 由同伴父亲辅导员提供的治疗有可能吸引男性并改善父亲和孩子的状况 MH 在资源匮乏的环境中，为 NIMH 最大限度地提高研究对公共卫生的影响的目标做出了贡献。