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

描述(由申请人提供)：在中低收入国家预防老年人常见的精神障碍(严重的抑郁症和焦虑症)是全球心理健康研究的主要挑战。制定预防LMIC晚年抑郁和焦虑的战略的公共卫生当务之急包括印度等国家的快速人口结构转型和老龄化，老年人更多地暴露在抑郁症风险因素(残疾、经济和社会资源枯竭、丧亲、护理和慢性失眠)以及劳动力问题(如缺乏心理健康专家)。专家资源的匮乏，加上目前抑郁症治疗避免残疾年限的能力有限，突显了非保健或初级保健环境中的非专业卫生工作者可以提供的预防性干预的必要性。这种发展还可能有利于美国的政策和实践，因为它澄清了非专业工作者和非专业工作者在为精神卫生资源很少的人群预防抑郁症和焦虑方面的适当角色。在这份修订的R34申请(R34 MH096997-01A1)中，我们建议在印度果阿进行的MANAS试验的基础上再接再厉。鉴于LMIC缺乏精神卫生专家，Manas(在Konkani语言中的意思是“促进精神健康的项目”)采用了任务转移战略，即在卫生工作人员团队之间合理重新分配任务，以更有效地利用卫生领域的非专业人力资源。Manas证明，使用非专业健康顾问(LHC)作为合作分步护理干预的一部分，可以提高公共初级保健设施中常见精神障碍(抑郁和焦虑)的恢复率。此外，初步证据表明，在阶梯式护理协作干预中使用LHC的MANAS模式也可以减少那些最初出现阈值下(综合症下)抑郁和焦虑症状的人的常见精神障碍的发生率。我们建议研究通过非专业的传递系统将抑郁和焦虑预防策略翻译到LMICs。这一修订的R34应用程序的目标是在印度果阿开发和试行LHC领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1。该应用程序是匹兹堡大学(雷诺兹，安德森)NIMH赞助的老年抑郁症预防ACISR(P30 MH090333)与伦敦卫生与热带医学院(Patel，Cohen，Chowdhary)的全球精神健康研究中心Share之间的合作；和阿姆斯特丹自由大学(Cuijpers)的心理学系。

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).