Evidence-Based Social Intervention and Policy Evaluation

背景：COVID-19给全球精神卫生带来了极大的压力，迫切需要增加支持。生活在贫困中的人特别容易受到伴随这一流行病而来的心理负担的影响。许多障碍继续阻碍发展中国家获得心理健康服务（Andrade et al.，2014; Saraceno等人，2007年），但数字技术为支持处于危机中的人提供了新的途径，可能有助于改善获得支持的机会。世界卫生组织（2013年）强调发展中国家精神卫生资源的稀缺;在低收入国家，76%至85%的严重精神障碍患者得不到治疗。迫切需要经验证据来促进心理健康决策（Deady等人，2017年）。世卫组织指出："在缺乏全面文件和严格评估的情况下，我们对什么是有效的知之甚少。除非服务模式可以证明提供有效的治疗，否则没有理由相信宣传工作将扩大精神卫生服务，以服务不足的人群。"（Cohen，2000年，第32页），目的：评估发展中国家数字化心理健康干预措施的有效性。通过提供有关数字支持的经验证据，这项研究将有助于政策努力，扩大在服务不足人群中提供心理健康服务，并有助于减少低收入国家获得心理健康资源的障碍。研究问题：数字社会心理干预对改善发展中国家的心理健康是否有效？方法：将与心理健康创新公司合作开发一种可在任何移动终端上使用的数字心理健康工具，用于这一实地实验。在随机对照试验中，一半的参与者将被分配到早期干预组，其余参与者将被分配到等待名单延迟干预组。据推测，心理健康结果（使用EQ-5D和HDRS等工具测量）将在干预后相对于对照组有所改善。由于医疗资源可用性的差异和文化在治疗可接受性方面的相关性，有必要制定与特定环境相一致的干预措施（Garcia，2018）。这项研究将有助于制定文化上适当的、以证据为基础的心理社会干预措施，改善最需要支持的社区的心理健康。

Background: COVID-19 has placed extreme pressure on mental health globally, uncovering an imperative need for increased support. Those living in poverty are particularly vulnerable to the psychological burdens accompanying the pandemic. Numerous barriers continue to impede access to mental health services in the developing world (Andrade et al., 2014; Saraceno et al.,2007), however digital technologies offer fresh avenues for supporting people in crisis and may be helpful in improving access to supports. The World Health Organisation (2013) emphasises the scarcity of mental health resources in developing countries; 76% to 85% of people with severe mental disorders receive no treatment in low-income countries. Empirical evidence is urgently required for progress in mental health policymaking (Deady et al., 2017). The WHO notes: "In the absence of thorough documentation and rigorous evaluation of programmes we have too little knowledge about what works. Unless service models can be demonstrated to deliver effective treatments, there is little reason to believe that advocacy efforts will expand mental health services to underserved populations." (Cohen, 2000 p. 32).Aim: To evaluate the effectiveness of digital mental health interventions in the developing world. By contributing empirical evidence on digital supports, this research will aid policy efforts to expand mental health service provision in underserved populations and help to reduce barriers to mental health resources in low-income countries. Research Question: Are digital psychosocial interventions effective for improving mental health in developing countries? Method: A digital mental health tool usable on any mobile device will be developed in collaboration with Mental Health Innovations for this field experiment. In a randomized control trial, half of participants will be assigned to an early intervention group with remaining participants assigned to a wait-list delayed intervention group. It is hypothesised that mental health outcomes (measured using instruments such as EQ-5D and HDRS) will be improved following the intervention relative to the control group. Due to differences in healthcare resource availability and the relevance of culture in the acceptability of treatments, it is necessary to develop interventions congruent with the context of specific settings (Garcia, 2018). This research will contribute to the development of culturally appropriate, evidence-based, psychosocial interventions improving mental health in communities most in need of support.