Preventing Depression in Later Life: A Model for Low and Middle Income Countries

描述（由申请人提供）：在低收入和中等收入国家（LMICs）预防老年人常见精神障碍（重度抑郁症和焦虑症）是全球精神卫生研究的一个主要挑战。制定预防中低收入国家晚年抑郁和焦虑战略的公共卫生必要性包括印度等国家的快速人口转型和老龄化，老年人越来越多地暴露于抑郁风险因素（残疾、经济和社会资源枯竭、丧亲之痛、护理和慢性失眠），以及劳动力问题（如缺乏精神卫生专家）。专家资源的缺乏，加上目前的抑郁症治疗避免多年残疾的能力有限，突出表明需要由非专业卫生工作者在非卫生保健或初级卫生保健环境中提供预防性干预措施。这样的发展也有利于美国的政策和实践，明确非专业工作者和非专业工作者在心理健康资源匮乏的人群中预防抑郁和焦虑方面的适当角色。在本修订后的R34申请（R34 MH096997-01A1）中，我们建议以在印度果阿进行的MANAS试验为基础。鉴于中低收入国家缺乏心理健康专家，MANAS（在Konkani语中意为“促进心理健康项目”）采用了任务转移战略，即在卫生工作队伍之间合理重新分配任务，以便更有效地利用非专业卫生人力资源。MANAS表明，使用非专业健康咨询师（LHCs）作为协作式阶梯护理干预的一部分，可以提高公共初级保健设施中常见精神障碍（抑郁和焦虑）的康复率。此外，初步证据表明，在逐步护理协作干预中使用lhc的MANAS模型也可能减少最初出现阈下（亚综合征）抑郁和焦虑症状的患者的常见精神障碍发生率。我们建议研究通过非专业的递送系统将抑郁和焦虑预防策略转化为中低收入国家。这项修订后的R34申请的目标是在印度果阿邦开发并试点一项由lhg主导的抑郁症和焦虑症预防策略（“MANAS/DP”），以MANAS治疗试验（“MANAS/RX”）的经验为基础。该应用程序代表了NIMH赞助的匹兹堡大学（Reynolds, Anderson）的ACISR晚年抑郁症预防（P30 MH090333）；以及由nimh赞助的Sangath/果阿医学院（Patel, Cohen， Dias和Chowdhary）和伦敦卫生和热带医学学院（Patel, Cohen, Chowdhary）的全球精神卫生研究中心SHARE；以及阿姆斯特丹自由大学心理学系。

DESCRIPTION (provided by applicant): Prevention of common mental disorders in older adults (major depression and anxiety disorders) in Low and Middle Income Countries (LMICs) is a major challenge in global mental health research. The public health imperative for devising strategies to prevent late life depression and anxiety in LMICs includes the rapid demographic transition and aging in countries like India, increased exposure of older adults to risk factors fo depression (disability, depletion of economic and social resources, bereavement, care giving, and chronic insomnia), and workforce issues (such as a dearth of mental health specialists). The dearth of specialist resources, together with the limited ability of current depression treatments to avert years lived with disability, underscores the need for preventive interventions that can be delivered by lay health workers in non-health care or primary care settings. Such development could also benefit policy and practice in the US by clarifying appropriate roles for lay and non-specialist workers in depression and anxiety prevention for populations with few mental health resources. In this revised R34 application (R34 MH096997-01A1), we propose to build upon the MANAS trial conducted in Goa, India. Given the shortage of mental health specialists in LMICs, MANAS (which means "project to promote mental health" in the Konkani language) employed the strategy of task-shifting, that is, the rational redistribution of tasks among health workforce teams to make more efficient use of lay human resources for health. MANAS demonstrated that the use of lay health counselors (LHCs), as part of a collaborative stepped- care intervention, increases rates of recovery from common mental disorders (depression and anxiety) in public primary care facilities. In addition, preliminary evidence indicated that the MANAS model of using LHCs in a stepped-care collaborative intervention may also reduce the incidence of common mental disorders in those who initially present with subthreshold (subsyndromal) depressive and anxiety symptoms. We propose to investigate translation of depression and anxiety prevention strategies to LMICs through non-specialist delivery systems. The goal of this revised R34 application is to develop and pilot test in Goa, India an LHC-led depression and anxiety disorder prevention strategy ("MANAS/DP"), building upon the experience of the MANAS treatment trial ("MANAS/RX")1. The application represents a collaboration between the NIMH sponsored ACISR in Late-Life Depression Prevention (P30 MH090333) at the University of Pittsburgh (Reynolds, Anderson); and SHARE, the NIMH-sponsored Hub for research in global mental health at Sangath/Goa Medical College (Patel, Cohen, Dias, and Chowdhary) and the London School of Hygiene and Tropical Medicine (Patel, Cohen, Chowdhary); and the Department of Psychology at the Free University in Amsterdam (Cuijpers).