Posttraumatic Stress Disorder Intervention for People with Severe Mental Illness in Low- and Middle-Income Country Primary Care Settings

项目总结 背景：低收入和中等收入国家(LMIC)的精神卫生专业人员非常少。考虑到慢性病 由于精神障碍的性质，初级保健诊所可能是解决低收入群体精神健康问题的最佳选择。然而， 对影响实际服务提供、获取、质量和心理健康可持续性的因素知之甚少 LMIC初级保健的干预措施。研究是否以及如何可行和有效地提供精神卫生服务 在LMIC初级保健中提供服务是NIMH的优先事项，也是全球精神卫生领域的一项重大挑战。严重的精神疾病 (SMI)是LMIC初级保健诊所中最常见的精神疾病形式，是导致 疾病的负担。患有SMI的人患创伤后应激障碍(PTSD)的风险很高，这是 与更严重的精神症状、功能障碍和更差的治疗结果相关。特定的 目标：本研究建议制定和评估一项 心理治疗干预在埃塞俄比亚农村初级保健诊所治疗重度精神障碍患者的PTSD。目标1：半- 对患者、照顾者、提供者和社区成员(n=48)进行了结构化定性访谈，以 确定人群的临床和文化相关特征，并确定障碍和促进者的特征 干预措施的采纳、实施和可持续性。结果是用来评估适合性和发展的 干预；目标2：进行一项混合方法的可行性试验，以完善干预并探索初步治疗 效果(n=40名患者)；目标3：进行混合方法多利益相关者过程评估以评估干预措施 按照RE-AIM实施框架衡量的实施情况(n=40，12个提供者)。应聘者：这个 以患者为导向的导师研究职业发展奖(K23)建立在候选人的 低收入国家以创伤为重点的全球精神卫生研究。候选人的长期职业目标是成为一名 LMICs中创伤后应激障碍和SMI循证干预的独立调查者。培训目标：K23 提供以下方面的培训和指导：(1)创伤后应激障碍和精神分裂症的病程、患病率和治疗；(2)健康 服务研究，包括评估埃塞俄比亚初级保健如何提供和获得医疗保健的方法， 以及可能影响创伤后应激障碍的心理社会干预的因素；以及(3)实施科学 减少LMIC初级保健中“科学与服务”差距的方法，包括混合型初级保健 有效性--实施试验。培训活动。培训将通过专家的指导实现(博士。 Cindy Yee-Bradbury、David Henderson、Abebaw Fekadu、Charlotte Hanlon和Kim Mueser)，现场经验 埃塞俄比亚、正规课程、研讨会、培训以及出席会议和研讨会。

PROJECT SUMMARY Background: Low- and middle-income countries (LMICs) have very few mental health professionals. Given the chronic nature of mental disorders, primary care clinics may be best positioned to address mental health in LMICs. However, little is known about factors that influence real-world service delivery, access, quality, and sustainability of mental health interventions in LMIC primary care. Researching whether and how mental health services can be feasibly and effectively delivered in LMIC primary care is a NIMH priority and a grand challenge in global mental health. Severe mental illness (SMI) is the most common form of mental illness seen in primary care clinics in LMICs, and is a top contributor to the burden of disease. People with SMI are at high risk of developing posttraumatic stress disorder (PTSD), which is associated with more severe psychiatric symptoms, functional impairment, and worse treatment outcomes. Specific aims: The current study proposes to develop and assess the feasibility, effectiveness and implementation of a psychotherapy intervention to treat PTSD in patients with SMI in primary care clinics in rural Ethiopia. Aim 1: Semi- structured qualitative interviews were conducted with patients, caregivers, providers and community members (n=48) to identify clinically and culturally relevant characteristics of the population and characterize barriers and facilitators to intervention adoption, implementation and sustainability. Results were used to assess the fit and development of the intervention; Aim 2: To conduct a mixed methods feasibility trial to refine the intervention and explore initial treatment effects (n=40 patients); Aim 3: To conduct a mixed methods multi-stakeholder process evaluation to assess intervention implementation as measured by the RE-AIM implementation framework (n=40, 12 providers). Candidate: This Mentored Patient-Oriented Research Career Development Award (K23) builds upon the candidate's experience in trauma-focused global mental health research in low-income countries. The candidate's long-term career goal is to be an independent investigator of evidence-based interventions for PTSD and SMI in LMICs. Training objectives: The K23 provides training and mentorship in (1) the course, prevalence and treatment of comorbid PTSD and SMI; (2) health services research, including methods to evaluate how healthcare is delivered and accessed in Ethiopian primary care, and factors that might influence delivery of a psychosocial intervention for PTSD; and (3) implementation science methods to decrease “science-to-service” gaps in providing mental health care in LMIC primary care, including hybrid effectiveness-implementation trials. Training activities. Training will be achieved through mentorship by experts (Drs. Cindy Yee-Bradbury, David Henderson, Abebaw Fekadu, Charlotte Hanlon, and Kim Mueser), field-based experience in Ethiopia, formal coursework, and seminars, trainings, and conference and workshop attendance.