Reducing stress, anxiety, and depressive symptoms via a family-centered preventative intervention for immigrants: A randomized controlled feasibility trial

总结 生活在美国的移民比普通人群更容易受到心理健康问题的影响， 心理健康疾病在最昂贵的医疗条件中位居榜首。压力与试图 融入一个社会孤立和交流有限的新文化与心理健康结果有关 在移民中。现有的针对移民的心理健康干预措施主要基于治疗模式 改善被诊断出有精神健康问题的人获得护理的机会和质量， 旨在减轻移民压力的专门预防性行为干预措施有限。为 预防、针对文化的干预措施，解决心理-社会-文化压力源，最有希望。 我们在这个应用程序中的目标是：a）适应和文化修改问题管理加（PMP）， 世界卫生组织制定的循证干预措施，以发展问题管理+ 作为一种以家庭为基础的预防性干预措施，以及B）测试 和初步结果（压力，焦虑，抑郁症状）的PMP-I与训练有素的社区促进者。 我们计划调整PMP，以包括多个组成部分，心理教育，行为激活，身心 采取适当干预措施，减轻移民的长期压力。我们将适应并改变文化 PMP通过增加关于压力管理和沟通技巧的教育课程来发展我们的PMP-I， 应对机制的行为激活，提供社会支持和瑜伽。PMP-I是一个同行领导的， 在家庭中提供适合文化的心理教育、行为激活、呼吸和瑜伽干预 设置超过5周的时间。该项目将在马萨诸塞州西部的一个不丹社区进行， 他们因情绪困扰和社会孤立而提出的要求和确定的需要， 我们的试点社区参与式研究。我们强大的社区网络和跨学科研究 已成立一个小组，授权社区成员担任干预者、监督员和研究助理 通过提供广泛的培训。经过培训的社区干预人员将向感兴趣的人提供为期5周的PMP-I 并会向另外58个家庭派发支援服务小册子， 随机分配。研究助理将收集有关结果和其他变量的信息 在基线、干预后和干预后三个月。我们会采集头发样本检测皮质醇 测量（基线，干预后3个月），并在马萨诸塞大学阿默斯特实验室处理。的 将使用多层次模型分析干预措施对结果的初步影响。我们将讨论 并对干预者和参与者进行访谈，以衡量PMP-I的可行性和可接受性。在 完成这一项目后，我们将开发和试点测试以家庭为基础的预防性心理健康 对移民的干预。实现这一目标将对改善心理健康产生重大的积极影响。 这将有助于改善移民及其家庭的健康状况，并使社区能够发挥主导作用。

Summary Immigrants living in the U.S. are more vulnerable to mental health problems than the general population, and mental health disorders top the list of the most costly medical conditions. Stress associated with attempts to integrate into a new culture with social isolation and limited communication is linked to mental health outcomes among immigrants. Existing mental health interventions for immigrants are largely based on treatment models to improve the access and quality of care for those with diagnosed mental health problems, however culturally tailored preventative behavioral interventions aimed at reducing stress among immigrants are limited. For prevention, culturally-tailored interventions that address psycho-socio-cultural stressors hold the most promise. Our objectives in this application are: a) to adapt and culturally modify Problem Management Plus (PMP), an evidence-based intervention developed by World Health Organization, to develop Problem Management Plus for Immigrants (PMP-I) as a family-based preventative intervention and b) to test the feasibility, acceptability, and preliminary outcomes (stress, anxiety, depressive symptoms) of PMP-I with trained community facilitators. We plan to adapt PMP to include multi-component, psychoeducation, behavioral activation, and mind-body intervention that are appropriate to reduce chronic stress of immigrants. We will adapt and culturally modify PMP to develop our PMP-I by adding an educational session on stress management and communication skills, behavioral activation on coping mechanisms, provision of social support, and yoga. PMP-I is a peer-led, culturally-tailored psychoeducation, behavioral activation, breathing and yoga intervention delivered in family settings over a 5-week period. This project will take place with a Bhutanese community in Western, MA upon their request and identified need of mental health problem due to their emotional distress and social isolation in our pilot community based participatory research. Our strong community network and interdisciplinary research team is in place to empower community member as interventionists, supervisors, and research assistants through providing extensive training. Trained community interventionists will deliver 5-week PMP-I to interested adults aged 18 and older in 58 families and will distribute support services pamphlets to another 58 families, which will be allocated randomly. Research assistants will collect information on outcomes, and other variables at baseline, post-intervention, and three-month after intervention. We will collect hair samples for cortisol measurement (baseline, 3-mth post intervention) and process it at the UMass Amherst laboratory. The preliminary effect of the intervention on outcomes will be analyzed using multilevel modelling. We will discuss and interview interventionists and participants to measure the feasibility and acceptability of PMP-I. At the completion of this project, we will have developed and pilot tested family-based preventative mental health intervention for immigrants. Achieving this aim will have a significant positive impact on improving the mental health of immigrants and their families and will also empower the community to take a leading role.