Development of an Integrated Microfinance and Depression Care Program for Women

描述（由申请人提供）：据估计，到2030年，抑郁症将成为世界卫生保健负担的最大单一贡献者。有效的治疗方法已经存在，但并不能覆盖到很多抑郁症患者，特别是在资源贫乏的社区——少数民族、美国的农村居民和大多数发展中国家的个体。治疗的诸多障碍包括：缺乏训练有素的专业人员、精神健康问题带来的耻辱、缺乏对精神健康资源的了解，以及人们认为治疗的价值不高，尤其是在其他生存需求似乎更为紧迫的情况下。尤其是妇女，面临抑郁和贫困的风险。整合治疗抑郁症和解决生计问题的项目可能会提高抑郁症治疗的参与度，改善资源匮乏地区患者的心理健康和功能。拟议中的R-34项目将把抑郁症治疗与现有的“小额信贷”项目结合起来，后者为妇女提供包括小额贷款、储蓄项目和职业培训在内的扶贫服务。该项目以大西洋慈善基金会2009年资助的250万美元项目为基础，通过扩大合作护理团队，将妇女联盟的非专业卫生工作者纳入其中，并在社区实施该项目，在越南岘港省和庆化省的初级保健系统中开发一种治疗抑郁症的合作护理模式。越南妇女联盟在成功地向越南妇女提供小额信贷项目方面取得了令人印象深刻的成就。该项目将1)对妇女成功利用现有抑郁症护理和小额信贷项目的障碍和促进因素进行定性研究；2)对抑郁症护理和小额信贷服务进行调整和整合；3)培训妇女联盟辅导员提供综合抑郁症护理和小额信贷方案；4)对综合方案进行随机先导试验，评估可接受性、可行性和初步有效性。这些发现将为未来的R01建议提供信息，以开展一项全面的随机对照研究，以检验综合模型的有效性和干预变化的机制。拟议的项目对在资源贫乏的社区提供抑郁症治疗具有重要的公共卫生意义，它提供了一种创新的方法，以协作护理模式解决性别、抑郁症和贫困重叠的脆弱性，这可能适用于美国和国外其他资源贫乏的环境。该项目与NIH将全球健康列为五大研究重点之一的指定是一致的。

DESCRIPTION (provided by applicant): It is estimated that by the year 2030, depression will be the single largest contributor to the world's health care burden. Effective treatments exist, bu they do not reach many depressed individuals, especially in resource-poor communities--ethnic minorities, rural residents in the United States, and individuals in most of the developing world. Among the many barriers for treatment are lack of trained professionals, stigma attached to mental health issues, lack of knowledge about mental health resources, and the low perceived value of treatment, particularly when other survival needs seem more pressing. Women, in particular, are at risk for depression and poverty. Integrating programs that treat depression and address livelihood concerns may improve engagement in depression treatment and improve mental health and functioning for patients in low-resource settings. The proposed R-34 project would integrate depression care with existing "microfinance" programs, which provide poverty-alleviation services including small loans, savings programs, and vocational training to women. This project builds on a $2.5 million project funded by Atlantic Philanthropies in 2009 to develop a collaborative care model for the treatment of depression in the primary care systems of Danang and Khanh Hoa provinces in Vietnam by extending the collaborative care team to include the Women's Union lay health workers and delivering the program in the community. The Vietnam Women's Union has an impressive record of accomplishment for successful delivery of microfinance programs to Vietnamese women. This project will 1) conduct qualitative studies of barriers and facilitators of women's successful use of existing depression care and microfinance programs; 2) adapt and integrate the depression care and microfinance services; 3) train Women's Union facilitators to deliver the integrated depression care and microfinance program; and 4) conduct randomized pilot testing of the integrated program to assess acceptability, feasibility, and preliminary effectiveness. These findings will inform a future R01 proposal to conduct a full-scale randomized control study examining the effectiveness of the integrated model and the mechanism of change in the intervention. The proposed project has significant public health implications for providing depression treatment in resource-poor communities and it offers an innovative approach to addressing overlapping vulnerabilities of gender, depression, and poverty in a collaborative care model, which may be applicable to other resource- poor settings in the United States and abroad. The project is consistent with the designation of global health as one of NIH's top five research priorities.