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

项目概要/摘要 在美国，许多新兴的成年人（18-25岁）患有未被识别和/或未经治疗的抑郁症， 焦虑新兴成年人的精神疾病（MI）发病率最高（26%），治疗率最低 寻求（38%），与所有其他年龄组相比。未经治疗的抑郁症和焦虑症尤其普遍 在新兴成人中，是发展物质使用障碍、心血管疾病和其他疾病的关键风险因素。 疾病和成年后的慢性健康状况，以及过早死亡。有效的MI治疗 但是MI的耻辱感是识别和治疗抑郁症和焦虑症的一个实质性障碍。新兴 由于认知、生物和社会发生了强烈的变化，成年人特别容易受到MI的耻辱感的影响 在这些年里。虽然科学家们已经开始收集和完善一个基于证据的耻辱减少， 工具箱，污名干预措施未能完全解决MI污名，部分原因是它们采取了“一个 “一刀切”的做法。如果在以下情况下解决污名化机制，污名化干预措施可能更有效： 它们是最明显的，针对对治疗结果最有害的具体成见机制， 并为那些对耻辱缺乏抵抗力的人提供额外的支持。我们的长期目标是定制MI耻辱 为新生成人提供干预措施，以促进积极的治疗结果和终身福祉。为了 为定制这些干预措施提供信息，我们需要更好地了解耻辱感的演变和影响 在成年期的治疗结果。本提案的目的是审查纵向 MI耻辱和治疗结果之间的关系，在一个大的，国家样本的新兴成年人。 我们的具体目标是：（1）描述MI污名机制的轨迹，并确定 经历抑郁和/或焦虑的新兴成年人的轨迹;（2）检查 随着时间的推移，MI的污名机制、MI识别和MI治疗参与;以及（3）识别潜在特征 MI污名机制，个人如何随着时间的推移在个人资料之间过渡，以及个人资料与 治疗参与。我们提出了一个全国性的，纵向研究新兴的成年人（18-25岁），调查 4000名参与者，每年4次，为期3年，内容涉及污名机制、调节因素、心理健康， 和治疗参与。根据流行病学估计，我们预测约30%（n=1200）的参与者 在研究期间将经历新的抑郁或焦虑发作。将使用多水平分析数据 建模、缓和分析、潜在轮廓和潜在过渡分析。研究结果将使研究人员能够 更好地确定：（1）污名干预的理想时机，以最大限度地扩大对新生成年人的影响，（2）世卫组织 在新兴的成年人中，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，以改善终身健康和福祉，以及（4）如何联合收割机减少耻辱的工具 对于新生儿的亚群。该提案符合NIMH和NICHD的战略目标， 确定何时、何地以及如何进行干预，以改善向成年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.