Development of Mental Health Treatment for Obstetric Fistula Patients

描述（由申请人提供）：产科瘘是膀胱或直肠与阴道之间的一个洞，当难产未通过剖宫产缓解时发生，导致无法控制的尿液和/或粪便泄漏。产科瘘的唯一治疗方法是手术修复。多项研究记录了产科瘘的社会和心理影响，包括社会孤立、耻辱、抑郁和精神健康功能障碍。手术修复设置可以是一个机会的窗口，以解决生活与瘘管积累的精神健康困扰。然而，到目前为止，还没有干预研究评估了经验支持的治疗方法，以帮助瘘患者的心理愈合。拟议的研究旨在通过为接受产科手术修复的妇女开发和试点测试一种理论上知情的心理健康干预措施来填补这一空白

DESCRIPTION (provided by applicant): Obstetric fistula is a hole between the bladder or rectum and the vagina, which develops when obstructed labor is not relieved by cesarean section and results in uncontrollable leaking of urine and/or feces. The only cure for obstetric fistula is surgical repair. Multiple studies have documented the social and psychological impact of obstetric fistula, which includes social isolation, stigma, depression, and mental health dysfunction. The surgical repair setting can be a window of opportunity to address the accumulated mental health distress of living with a fistula. However, to date no intervention studies have evaluated empirically-supported therapies to assist in psychological healing among fistula patients. The proposed study aims to fill this gap by developing and pilot-testing a theoretically informed mental health intervention for women receiving surgical repair for obstetric fistula at KCMC Hospital in Moshi, Tanzania. The study has three specific aims: 1) To develop the nurse-delivered mental health intervention, built on theories of coping and cognitive behavioral therapy, 2) To assess feasibility and acceptability of implementing the intervention in the KCMC fistula ward, considering: intervention fidelity, patient satisfaction, provider feedback and cost of delivery, 3) To assess effectiveness of the intervention by comparing immediate and short term outcomes in 30 women who receive the experimental intervention with 30 women receiving the standard of care counseling, examining differences in primary outcomes (depression, PTSD and somatic symptoms) and secondary outcomes (coping, perceived stigma, social support, social participation, efficacy to engage with providers, adherence to clinical recommendations and social reintegration). The proposed research directly responds to the needs specified by NIH because it expands the "evidence base for improving social outcomes" of women with obstetric fistula and develops a "sustainable intervention" that complements existing local care (PA-11-143). At the completion of this study, it is our expectation that we will have a structured intervention curriculum and supportive preliminary data to inform an R01 application to conduct a multi-site evaluation of the intervention, which, if effective, can be disseminated to fistula repair clinics internationally.