ASHA 2: An Ethnographic Study Embedded in a Depression Treatment Trial

ASHA 2：抑郁症治疗试验中的人种学研究

• 批准号: 10746492
• 负责人: ALISON KARASZ
• 金额: $ 34.81万
• 依托单位: UNIV OF MASSACHUSETTS MED SCH WORCESTER
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-01 至 2025-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10746492
• 关键词: Address; Affect; Anthropology; Attention; Attitude; BRAIN initiative; Bangladesh; Bangladeshi; Clinic; Clinical; Clinical Trials; Clinical Trials Design; Complex; Data; Data Analyses; Data Collection; Decision Making; Depressed mood; Disease remission; Dose; Economics; Employment; Employment Opportunities; Epidemic; Ethnic Origin; Ethnography; Failure; Floods; Focus Groups; Funding; Future; Gender; Gender Role; Generations; Goals; Government; Health; Household; Individual; Intervention; Intervention Studies; Interview; Knowledge; Life; Link; Local Government; Low income; Manuals; Manuscripts; Marketing; Maternal Health; Mediating; Mediator; Mental Depression; Mental Health; Mentors; Methods; Modeling; National Institute of Mental Health; Neighborhoods; Outcome; Participant; Perception; Phase; Play; Politics; Positioning Attribute; Poverty; Preparation; Process; Productivity; Psychologist; Psychotherapy; Randomized; Recovery; Research; Research Design; Research Personnel; Resources; Risk; Role; Rural; Schools; Security; Social Environment; Source; Specialist; Structure; Students; Supervision; Surveys; Symptoms; Testing; Time; Training; Transportation; Universities; Village Health Workers; Woman; arm; career; comparative; comparison group; contextual factors; cultural values; depressive symptoms; disability; experience; indexing; insight; life history; low and middle-income countries; member; participant observation; patient engagement; poverty alleviation; programs; psychologic; randomized, clinical trials; recruit; reduce symptoms; research study; responders and non-responders; rural poverty; social capital; social culture; sociocultural determinant; syndemic; tool; treatment arm; treatment group; treatment responders; treatment response; treatment trial

A leading cause of global disability, depression is widespread among women in low- and middle-income countries (LMIC). Poverty is a major cause of depression, while depression worsens poverty, compromising economic productivity. Funded by NIMH’s Global Brain Initiative, the ASHA Project is a groundbreaking research study that seeks to address the poverty-depression syndemic among rural Bangladeshi women using an integrated intervention model with both psychological and economic treatment. The project is a two-arm cluster randomized clinical trial carried out in villages in the Rangpur district of northern Bangladesh—a flood prone region with high rates of rural poverty. Treatment groups of 12-15 women, led by village health workers, will be cluster-randomized into the integrated intervention arm (cash/asset transfer plus Problem Management (PM)+--a group-based, manualized psychotherapy) or to PM+ alone. This application proposes to embed an ethnographic study inside the ASHA RCT. Led by an interdisciplinary team of psychologists, anthropologists, and maternal health specialists in the US and Bangladesh, the study will investigate the complex relationships between ASHA intervention processes and outcomes, and social contexts at the individual, household, neighborhood, and village levels. Although ethnographic inquiry—the holistic study of local sociocultural contexts—is well suited to the generation of new knowledge, ethnographic studies are rarely integrated into mental health treatment trials. The research team will use a rapid ethnography (RE) approach to conduct qualitative interviews, focus groups, and structured observations, including salient local attributes such as presence of schools, clinics, and roads, alongside observations about how everyday life and governance is organized. A comparative analysis will examine differences across study arms (integrated vs psychotherapy alone), participant engagement (retention/vs attrition) and clinical outcomes (treatment response vs none). This will allow for the generation of hypotheses about key moderating and mediating variables affecting outcomes. A capacity building program will train three young graduates in anthropology from a local university in Rangpur, providing both didactic training in Dhaka as well as hands on supervision in data collection in the field. Fellows will receive training in data collection, clinical trial design, research ethnics and data analysis. Fellows will receive mentoring and support in obtaining research positions.

抑郁症是全球残疾的主要原因，在低收入和中等收入女性中普遍存在 贫困是抑郁症的主要原因，而抑郁症会加剧贫困，损害健康。 ASHA 项目由 NIMH 全球大脑计划资助，是一项开创性的项目。 旨在利用一种方法解决孟加拉国农村妇女的贫困抑郁综合症的研究 该项目是一个双臂集群的综合干预模式。 在孟加拉国北部朗布尔地区的村庄进行的随机临床试验——洪水易发地区 农村贫困率较高的地区，将由 12 至 15 名妇女组成的治疗小组，由乡村卫生工作者领导。 整群随机分配到综合干预部门（现金/资产转移加上问题管理 (PM)+--a 基于小组的手动心理治疗）或单独进行 PM+。 该申请建议在 ASHA 随机对照试验中嵌入一项人种学研究。 由美国和美国的心理学家、人类学家和孕产妇健康专家组成的跨学科团队 孟加拉国，该研究将调查 ASHA 干预过程与 个人、家庭、邻里和村庄层面的结果和社会背景。 民族志调查——对当地社会文化背景的整体研究——非常适合新的一代的产生 研究小组将很少将人种学研究纳入心理健康治疗试验。 使用快速民族志 (RE) 方法进行定性访谈、焦点小组和结构化访谈 观察结果，包括显着的当地特征，例如学校、诊所和道路的存在，以及 对日常生活和治理如何组织的观察将进行比较分析。 研究组之间的差异（综合与单独治疗）、参与者参与度（保留/与流失） 和临床结果（治疗反应与无反应）这将允许产生关于关键的假设。 调节和调节影响结果的变量。 一项能力建设计划将培训来自当地一所大学的三名人类学年轻毕业生 朗布尔，在达卡提供教学培训，并在达卡提供数据收集的实际监督 研究员将接受数据收集、临床试验设计、研究种族和数据分析方面的培训。 研究员将在获得研究职位方面获得指导和支持。