Pathways to mental health care: Examining the longitudinal impact of stigma mechanisms on treatment engagement in emerging adults

项目摘要/摘要 美国许多新兴成年人(18-25岁)患有未被发现和/或未经治疗的抑郁症， 焦虑。新兴成年人的精神疾病发病率最高(26%)，而治疗率最低 与所有其他年龄段相比，寻求(38%)。未经治疗的抑郁症和焦虑症尤其普遍。 是物质使用障碍、心血管疾病的关键危险因素。 疾病，成年后的慢性健康状况，以及过早死亡。有效的心肌梗死治疗 是可用的，但心肌梗死污名是认识和治疗抑郁症和焦虑的实质性障碍。新兴 鉴于正在发生的剧烈的认知、生物和社会变化，成年人特别容易受到心肌梗死的污名 在这些年里。尽管科学家们已经开始组装和提炼一种基于证据的耻辱减少 工具箱，污名干预未能完全解决心肌梗死污名，部分原因是他们采取了 “大小适合所有人”的方法。如果在以下情况下解决污名机制，污名干预可能会更有效 它们是最明显的，针对对治疗结果最有害的特定污名机制(S)， 并为那些对污名缺乏韧性的人提供额外的支持。我们的长期目标是定制MI的污名 针对新兴成人的干预措施，以促进积极的治疗结果和终身幸福。为了 告知这些干预措施的量身定做，我们需要更好地了解耻辱如何演变和影响 成年初期的治疗结果。当前提案的目标是纵向审查 在全国范围内的新兴成人大样本中，心肌梗死污名与治疗结果之间的关系。 我们的具体目标是：(1)描述心肌梗死污名机制的轨迹，并确定 新兴成年人经历抑郁和/或焦虑的轨迹；(2)检查 随时间推移的MI污名机制、MI识别和MI治疗参与；以及(3)识别潜在的特征 MI污名机制，个人如何随着时间的推移在配置文件之间过渡，以及配置文件和 治疗约定。我们建议对新兴成年人(18-25岁)进行全国性的纵向研究，调查 4000名参与者每年4次，为期3年，讨论污名机制、调节因素、心理健康、 和治疗承诺。根据流行病学估计，我们预计~30%(n=1200)的参与者 在研究过程中会经历新的抑郁或焦虑。数据将使用多级别进行分析 建模、缓和分析、潜伏期分析和潜伏期分析。这些发现将使研究人员能够 更好地确定：(1)污名干预的理想时机，以最大限度地提高新兴成年人的影响，(2)谁 在初出茅庐的成年人中最容易受到污名的影响，(3)污名机制应该是什么 有针对性的干预措施，以改善终身健康和福祉，以及(4)如何结合减少耻辱的工具 针对新兴成年人的亚群。这项提议响应了NIMH和NICHD的战略目标 确定何时、何地和如何进行干预，以改善成人过渡期间的医疗保健。

PROJECT SUMMARY/ABSTRACT Many emerging adults (aged 18-25) in the U.S. are living with unrecognized and/or untreated depression and anxiety. Emerging adults have the highest rates (26%) of mental illness (MI) and lowest rates of treatment seeking (38%), compared to all other age groups. Untreated depression and anxiety are particularly prevalent among emerging adults and are key risk factors for the development of substance use disorders, cardiovascular disease, and chronic health conditions later in adulthood, as well as premature death. Efficacious MI treatments are available, but MI stigma is a substantial barrier to recognizing and treating depression and anxiety. Emerging adults are particularly vulnerable to MI stigma given intense cognitive, biological, and social changes occurring during these years. Although scientists have begun to assemble and refine an evidence-based stigma-reduction toolbox, stigma interventions have fallen short of fully addressing MI stigma in part because they take a “one size fits all” approach. Stigma interventions may be more efficacious if they address stigma mechanisms when they are most pronounced, target the specific stigma mechanism(s) that are most harmful to treatment outcomes, and provide extra support for people who lack resilience to stigma. Our long-term goal is to tailor MI stigma interventions for emerging adults to promote positive treatment outcomes and lifetime wellbeing. In order to inform the tailoring of these interventions, we need greater understanding of how stigma evolves and impacts treatment outcomes during emerging adulthood. The objective of the current proposal is to examine longitudinal relationships between MI stigma and treatment outcomes among a large, national sample of emerging adults. Our specific aims are to: (1) Characterize trajectories of MI stigma mechanisms and identify moderators of trajectories among emerging adults experiencing depression and/or anxiety; (2) Examine associations between MI stigma mechanisms, MI recognition and MI treatment engagement over time; and (3) Identify latent profiles of MI stigma mechanisms, how individuals transition across profiles over time, and links between profiles and treatment engagement. We propose a national, longitudinal study of emerging adults (aged 18-25), surveying 4000 participants 4 times a year for 3 years regarding stigma mechanisms, moderating factors, mental health, and treatment engagement. Based on epidemiological estimates, we project that ~30% (n=1200) of participants will experience a new onset of depression or anxiety during the study. Data will be analyzed using multilevel modeling, moderation analyses, latent profile and latent transition analyses. Findings will enable researchers to better identify: (1) the ideal timing of stigma interventions to maximize impact among emerging adults, (2) who among emerging adults are most vulnerable to the effects of stigma, (3) which stigma mechanisms should be targeted for intervention to improve lifelong health and wellbeing, and (4) how to combine stigma-reduction tools for subgroups of emerging adults. This proposal responds to NIMH and NICHD’s strategic objectives to determine when, where, and how to intervene to improve healthcare during the transition to adulthood.