Development of an Integrated Microfinance and Depression Care Program for Women

为妇女制定综合小额信贷和抑郁症护理计划

• 批准号: 8463623
• 负责人: Victoria Khanh Ngo
• 金额: $ 24.24万
• 依托单位: RAND CORPORATION
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-04-27 至 2016-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8463623
• 关键词: Address; Behavior; Behavioral; Caring; Client; Clinic; Communities; Country; Data; Depressed mood; Developed Countries; Developing Countries; Development; Effectiveness; Employment; Enrollment; Evidence based treatment; Failure; Funding; Future; Gender; General Practitioners; Goals; Health; Health Resources; Health Services; Health Services Accessibility; Healthcare; Income Generation Programs; Individual; Intervention; Knowledge; Life; Maintenance; Medication Management; Mental Depression; Mental Health; Modeling; Nurses; Participant; Patients; Population; Poverty; Primary Health Care; Program Effectiveness; Provider; Province; Psychiatrist; Public Health; Randomized; Randomized Clinical Trials; Randomized Controlled Trials; Research; Research Priority; Resources; Risk; Running; Rural; Rural Population; Savings; Services; Social Work; Specialist; Testing; Training; Training Support; United States; United States National Institutes of Health; Vietnam; Woman; Work; World Health; base; care burden; care systems; collaborative care; commune; cost; design; effective therapy; ethnic minority population; evidence base; experience; global health; health disparity; high risk; improved; innovation; multidisciplinary; poverty alleviation; poverty reduction; programs; psychoeducation; rural area; screening; social stigma; stressor; tool; treatment as usual; treatment program; trial comparing

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.

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单一最大贡献者。有效的治疗方法是存在的，但它们并没有达到许多抑郁症患者，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人。治疗的许多障碍包括缺乏训练有素的专业人员，心理健康问题的耻辱感，缺乏对心理健康资源的了解，以及治疗的价值低，特别是当其他生存需求似乎更紧迫时。 妇女尤其容易患抑郁症和贫穷。整合治疗抑郁症和解决生计问题的计划可能会改善抑郁症治疗的参与度，并改善低资源环境中患者的心理健康和功能。拟议中的R-34项目将把抑郁症护理与现有的“小额信贷”计划结合起来，后者提供扶贫服务，包括小额贷款、储蓄计划和妇女职业培训。该项目建立在2009年大西洋慈善基金会资助的250万美元项目的基础上，该项目旨在通过扩大合作护理团队，将妇女联盟的非专业卫生工作者包括在内，并在社区实施该方案，在越南岘港和庆和省的初级保健系统中开发治疗抑郁症的合作护理模式。越南妇女联合会在成功向越南妇女提供小额供资方案方面成绩斐然。该项目将：（1）对妇女成功利用现有抑郁症护理和小额信贷方案的障碍和促进因素进行定性研究;（2）调整和整合抑郁症护理和小额信贷服务;（3）培训妇女联盟促进人员，以提供综合抑郁症护理和小额信贷方案;（四）对综合项目进行随机试点，评估其可接受性、可行性和初步效果。这些发现将为未来的R 01提案提供信息，以进行全面的随机对照研究，检查综合模型的有效性和干预措施的变化机制。 拟议的项目对在资源贫乏的社区提供抑郁症治疗具有重大的公共卫生影响，它提供了一种创新的方法来解决性别，抑郁症和贫困的重叠脆弱性的合作护理模式，这可能适用于其他资源贫乏的环境在美国和国外。该项目符合全球健康作为NIH五大研究重点之一的指定。