An integrated community and primary healthcare worker intervention to reduce stigma and improve management of common mental disorders in rural India: protocol for the SMART Mental Health programme.
An integrated community and primary healthcare worker intervention to reduce stigma and improve management of common mental disorders in rural India: protocol for the SMART Mental Health programme.
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DOI：
10.1186/s13063-021-05136-5
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发表时间：
2021-03-02
期刊：
影响因子：
2.5
通讯作者：
Peiris D
中科院分区：
文献类型：
--
作者：
Daniel M;Maulik PK;Kallakuri S;Kaur A;Devarapalli S;Mukherjee A;Bhattacharya A;Billot L;Thornicroft G;Praveen D;Raman U;Sagar R;Kant S;Essue B;Chatterjee S;Saxena S;Patel A;Peiris D
在印度，大约七分之一的人受到精神疾病的影响。精神障碍患者的治疗缺口高达75%-95%。卫生保健系统，特别是印度农村地区的卫生保健系统，在解决保健方面的这些差距方面面临重大挑战，需要创新战略。我们假设，包括反耻辱运动和基于移动技术的电子决策支持系统的干预将减少耻辱，并改善常见精神障碍高危成年人的心理健康。它将在为安得拉邦和哈里亚纳邦农村的133个村庄提供服务的44个初级卫生中心群中实施，作为平行分组的随机对照试验。18岁的成年人将根据患者健康问卷(≥ -9)和广泛性焦虑症( -7)分数进行抑郁、焦虑和自杀筛查。将得出两个评价队列--一个是PHQ-9、GAD-7或自杀风险升高的高风险队列，另一个是非高风险队列，包括基于这些分数的相同数量的未处于高风险的人。结果分析将盲目进行干预分配。主要的研究结果是在合并的“高风险”和“非高风险”队列中12个 月的平均行为得分的差异，以及在“高风险”队列中在12个 月的PHQ-9得分的平均差异。次要结果包括6个月和12个 月时高危人群中抑郁和焦虑的缓解率，高危人群在过去12个 月中至少看过一次医生的比例，以及非高危和高危人群合并后的平均污名、心理健康知识和态度得分与基线的变化。审判结果将伴随着详细的经济和进程评估。这些发现可能会为制定一种低成本、可扩展的解决方案的政策提供参考，以消除常见的精神障碍，并缩小低收入和中等收入国家中服务不足人口的治疗差距。临床试验注册印度CTRI/2018年/08/015355。注册日期为2018年8月16日。网上版载有补充材料，可在10.1186/s13063-021-05136-5查阅。
Around 1 in 7 people in India are impacted by mental illness. The treatment gap for people with mental disorders is as high as 75–95%. Health care systems, especially in rural regions in India, face substantial challenges to address these gaps in care, and innovative strategies are needed. We hypothesise that an intervention involving an anti-stigma campaign and a mobile-technology-based electronic decision support system will result in reduced stigma and improved mental health for adults at high risk of common mental disorders. It will be implemented as a parallel-group cluster randomised, controlled trial in 44 primary health centre clusters servicing 133 villages in rural Andhra Pradesh and Haryana. Adults aged ≥ 18 years will be screened for depression, anxiety and suicide based on Patient Health Questionnaire (PHQ-9) and Generalised Anxiety Disorders (GAD-7) scores. Two evaluation cohorts will be derived—a high-risk cohort with elevated PHQ-9, GAD-7 or suicide risk and a non-high-risk cohort comprising an equal number of people not at elevated risk based on these scores. Outcome analyses will be conducted blinded to intervention allocation. The primary study outcome is the difference in mean behaviour scores at 12 months in the combined ‘high-risk’ and ‘non-high-risk’ cohort and the mean difference in PHQ-9 scores at 12 months in the ‘high-risk’ cohort. Secondary outcomes include depression and anxiety remission rates in the high-risk cohort at 6 and 12 months, the proportion of high-risk individuals who have visited a doctor at least once in the previous 12 months, and change from baseline in mean stigma, mental health knowledge and attitude scores in the combined non-high-risk and high-risk cohort. Trial outcomes will be accompanied by detailed economic and process evaluations. The findings are likely to inform policy on a low-cost scalable solution to destigmatise common mental disorders and reduce the treatment gap for under-served populations in low-and middle-income country settings. Clinical Trial Registry India CTRI/2018/08/015355. Registered on 16 August 2018. The online version contains supplementary material available at 10.1186/s13063-021-05136-5.
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影响因子：
3.3
作者：
Joshi, Rohina;Guggilla, Rama;Maulik, Pallab K.
通讯作者：
Maulik, Pallab K.
DOI：
10.1186/1748-5908-6-42
发表时间：
2011-04-23
期刊：
Implementation science : IS
影响因子：
--
作者：
Michie S;van Stralen MM;West R
通讯作者：
West R
影响因子：
3.9
作者：
Maulik, P. K.;Devarapalli, S.;Patel, A.
通讯作者：
Patel, A.
影响因子：
105.7
作者：
Kawamoto, K;Houlihan, CA;Lobach, DF
通讯作者：
Lobach, DF
影响因子：
120.7
作者：
Demyttenaere, K;Bruffaerts, R;Chatterji, S
通讯作者：
Chatterji, S