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：
10001626
负责人：
Mahbat Bahromov
金额：
$ 64.11万
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/10001626
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 Healthcare 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 Pharmaceutical Preparations Play Post-Traumatic Stress Disorders Poverty Primary Care Physician Primary Health Care Primary Nursing Care Provider Psyche structure Research Research Activity Research Domain Criteria Research Personnel Research Training Resources 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 design effectiveness implementation study effectiveness testing evidence base executive function experience 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 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.

通过在测试中推进任务共享，该新的R01应用程序对PAR-18-835的响应 LMICS阶梯护理模型的有效性和实施。它使用护士和心理健康的同龄人治疗女性的抑郁症和潜在的同时发生动画初级保健。为了改善实施，本研究检查了诊所的影响实施团队准备诊所和服务提供商。拟议的项目是自2009年以来，位于塔吉克斯坦（Tajikistan）进行了NIH资助研究。它建立并扩展了Weine博士的R01，K24和D43关于移民和健康的研究和心理健康，尤其是他最近的全球R21研究适应和测试的阶梯护理可行性。 AIM 1评估与420名患有抑郁症和潜在同时发生动画的女性的阶梯护理模型，与标准护理Plus相比，从塔吉克斯坦的12家初级保健诊所招募提供健康的生活方式材料，另外210名妇女从6个初级保健中招募诊所，包括评估调解人和主持人（例如，执行控制效率，创伤接触）。 AIM 2评估诊所实施团队是否适度减少妇女的减少干预后的抑郁症以及诊所级别（领导力支持和程度实施）和提供者级别（动机和忠诚）主持人。 AIM 3建立一个国家心理健康研究网络，重点是改善心理标准通过建立心理健康实施研究能力，医疗保健和服务获得。通过这项研究产生的知识将为阶梯式护理模型提供有关心理健康的模型塔吉克斯坦（Tajikistan）和美国低资源环境中的LMIC。