ASHA Bangladesh--An Integrated Intervention to Address Depression in Low Income Rural Women

ASHA 孟加拉国——解决低收入农村妇女抑郁问题的综合干预措施

• 批准号: 10299300
• 负责人: ALISON KARASZ
• 金额: $ 56.1万
• 依托单位: ALBERT EINSTEIN COLLEGE OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-02 至 2026-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10299300
• 关键词: Address; Advocate; Affect; Agriculture; Asia; Bangladesh; Caring; Child; Clinical; Cluster randomized trial; Collaborations; Country; Decision Making; Depressed mood; Development; Disease remission; Dose; Economic Development; Economics; Effectiveness; Evaluation; Family; Fellowship; Generations; Government; Government Agencies; Health; Health Care Costs; Health Personnel; High Prevalence; Individual; International; Interruption; Intervention; Intervention Studies; Interview; Investigation; Link; Low income; Mediating; Mediator of activation protein; Medicine; Mental Depression; Mental Health; Methods; Modeling; Outcome; Participant; Pathway interactions; Patients; Perception; Personal Satisfaction; Persons; Pilot Projects; Play; Policies; Policy Developments; Policy Maker; Poverty; Process; Productivity; Randomized; Relapse; Research; Research Personnel; Research Training; Resources; Role; Rural; Scientist; Social support; Structure; Testing; Universities; Well in self; Woman; Work; arm; career development; college; contextual factors; cost; depressive symptoms; design; disability; doctoral student; economic outcome; empowerment; evidence base; experience; fighting; graduate student; hands on research; health economics; implementation outcomes; implementation process; implementation research; implementation study; improved; insight; low and middle-income countries; men; novel; pandemic disease; policy implication; poverty alleviation; programs; psychosocial; recruit; skills; treatment arm; treatment effect; treatment trial; university student; uptake

A leading cause of global disability, depression is widespread among women in low and middle income countries (LMIC). Poverty plays a major role in depression via multiple pathways, while depression worsens poverty, compromising economic productivity. Efforts to increase access to depression treatment in LMIC have been hampered by low treatment uptake/engagement and weak treatment effects. Recently, researchers & policy makers have pointed to the importance of poverty alleviation in the fight again the global depression pandemic. We propose to implement an integrated poverty alleviation/depression treatment intervention for low income women in rural Bangladesh, designed to break the toxic cycle of poverty and depression. A capacity building component will build skills and support career development in qualitative implementation research for young scientists and establish a year-long research fellowship for graduate students at the University of Dhaka. Our project builds on an established partnership between Albert Einstein College of Medicine and the ICDDRB in Dhaka. Following our successful pilot study, we will implement a cluster randomized trial of an integrated intervention, recruiting 1200 low income women with depression from 80 villages. Villages will be randomized into one of four treatment arms: 1) evidence based depression treatment; 2) poverty alleviation through an agricultural asset transfer; 3) combined depression treatment/poverty alleviation, and 4) no-treatment control. Participants will be followed for 24 months. We hypothesize: improved depression outcomes at 6 and 24 months in the combined arm, compared to depression treatment or poverty alleviation alone. A detailed, mixed methods process evaluation, designed to generate new hypotheses regarding program and contextual factors influencing outcomes, will include in-depth qualitative interviews with program participants and staff, conducted by ASHA fellows. The proposed project will generate findings with significant implications for policy makers. To date, the work of depression researchers and economic development groups has included little collaboration. Programs that seek to reduce depression do not address the devastating impact of poverty; while, similarly poverty alleviation programs do not address the role of mental health in economic productivity. Results of this study, if promising, will generate evidence to guide collaborations among development agencies, researchers, policy-makers, and treatment providers. Our team’s dissemination efforts will bring government agencies, international and national health and economic development NGOS to consider the potential for a new generation of collaborative, integrated intervention approaches.

作为全球残疾的主要原因，抑郁症在中低收入妇女中普遍存在， 收入国家（LMIC）。贫困通过多种途径在抑郁症中发挥着重要作用， 经济萧条使贫困加剧，损害了经济生产力。努力改进 LMIC的抑郁症治疗受到低治疗吸收/参与和弱 治疗效果最近，研究人员和政策制定者指出了贫困的重要性， 在抗击全球性大萧条的过程中，我们建议实施一项综合 针对孟加拉国农村低收入妇女的扶贫/抑郁症治疗干预， 旨在打破贫穷和萧条的恶性循环。能力建设部分将建立 技能和支持青年科学家在定性实施研究方面的职业发展， 为达卡大学的研究生设立为期一年的研究金。 我们的项目建立在阿尔伯特·爱因斯坦医学院和 达卡的ICDDRB。在我们的试点研究成功后，我们将实施一项群集随机试验 在80个村招募了1 200名低收入妇女抑郁症患者。 村庄将被随机分为四个治疗组之一：1）基于证据的抑郁症治疗; 2)通过农业资产转让减轻贫困; 3）抑郁症治疗/贫困相结合 缓解; 4）不治疗对照。参与者将被跟踪24个月。我们假设： 与抑郁症相比，联合组在6个月和24个月时改善了抑郁症结局 治疗或减轻贫困。详细的混合方法过程评估，旨在 产生关于影响结果的计划和背景因素的新假设，将包括 与项目参与者和工作人员进行深入的定性访谈，由阿莎研究员进行。 拟议的项目将产生对决策者有重大影响的调查结果。到目前为止， 抑郁症研究人员和经济发展组织的工作几乎没有包括 协作寻求减少抑郁症的计划并没有解决 贫困;同时，类似的扶贫计划并没有解决心理健康在 经济生产力。这项研究的结果，如果有希望，将产生证据，以指导 发展机构、研究人员、政策制定者和治疗提供者之间的合作。 我们团队的传播努力将使政府机构、国际和国家卫生 和经济发展的非政府组织考虑新一代合作的潜力， 综合干预措施。