Pilot evaluation of a telephone-based psychosocial intervention package for perinatal depression in Nigeria

项目摘要 这个拟议的新兴全球领导者奖(K43)的目标是提供密集的指导性研究 为来自低收入或中等收入国家(LMIC)的初级研究科学家提供职业支持和保护时间 使获奖者发展技能，成为独立资助的研究人员。治疗的差距 精神障碍在大多数LMIC中接近90%。弥合这一治疗差距并提高覆盖范围 精神卫生保健将需要建立一支能够开发和测试的研究人员队伍 对心理健康问题的干预是有效的、文化上合适的，并且可以在 这一有限的资源背景；产生证据，为可持续发展所需的政策变化提供信息 发展。候选人的长期职业目标是成为发展和评估方面的领导者 通过将精神卫生服务纳入常规卫生服务，扩大精神卫生服务规模的有效模式 资源受限设置。这项为期4年的补助金的具体培训目标是使应聘者能够 培养(1)高级研究方法方面的专业知识，特别是临床试验的设计和执行 和实施研究，(2)先进的统计方法和(3)定性研究方法需要 适应心理健康干预措施，并将其纳入具体情况。这些目标将在以下项目的指导下实现 LMICs精神病学流行病学和实施研究专家Oye Gureje博士和Ian M。 Bennett是在使用基于团队的护理、远程医疗、mHealth干预措施方面的领导者 围产期。我将利用这些技能和导师的支持来开展一个研究项目。建议数 该项目将采用混合方法试验以电话为基础的心理社会干预方案 护士/助产士在常规产前护理中分娩的围产期抑郁。育龄妇女生育 对抑郁症等常见精神障碍造成不成比例的负担。围产期抑郁症与 产科结局差，婴儿认知发育和生长参数受损。连 尽管有证据支持循证心理社会干预对围产期抑郁症的疗效 由非专业卫生和社区工作者提供，以减轻这些负面后果，一个主要的 限制是后续咨询会议的出席率较低。这项研究的目标是适应 通过移动电话使用的围产期抑郁的心理社会干预，并评估 这一方法的可接受性、可行性和有效性。定性方法，特别是关键信息来源 访谈还将用于探讨妇幼保健机构的组织结构。 作为成功实施心理健康干预措施的障碍/促进者。在此之后， 将对两个妇幼保健机构的助产士进行培训，以识别围产期抑郁症和 根据世卫组织精神卫生差距行动计划的治疗规范提供干预措施 干预指南(MhGAP-IG)。干预措施将在一家妇幼保健诊所每两周通过电话进行一次 和另一家诊所的面对面。两组之间的抑郁结果测量将进行比较，以 探索基于电话的干预措施的有效性。通过K43大奖和 这项试点产生的数据将被用于寻求资金，以进行一项更大规模的随机对照试验 这个策略。

Project Summary The goal of this proposed Emerging Global Leader (K43) Award is to provide intensive mentored research career support and protected time to a junior research scientist from a low- or middle income country (LMIC) to enable the awardee develop skills to become an independently funded researcher. The treatment gap for mental disorders in most LMICs is close to 90%. Bridging this treatment gap and improving coverage for mental health care will require building a critical mass of researchers who are able to develop and test interventions for mental health problems that are effective, culturally appropriate, and could be scaled up within this limited resource context; to generate evidence that could inform policy changes necessary for sustainable development. The candidate’s long term career goal is to become a leader in developing and evaluating effective models for the scaling up mental health care through its integration into routine health care in resource limited settings. The specific training objectives of this 4-year grant are to enable the candidate to develop expertise in (1) advanced research methodology especially the design and execution of clinical trials and implementation research, (2) advanced statistical methods and (3) qualitative research methods needed to adapt and contextualize mental health interventions. These objectives will be achieved with the mentorship of Drs Oye Gureje, an expert in psychiatric epidemiology and implementation research in LMICs, and Ian M. Bennett, a leader in the use of team based care, telemedicine, mHealth interventions for women in the perinatal period. I will utilize these skills and mentorship support to carry out a research project. The proposed project will adopt a mixed methods approach to pilot a telephone-based psychosocial intervention package for perinatal depression delivered by nurse/midwives in routine antenatal care. Women of child bearing age bear a disproportionate burden for common mental disorders such as depression. Perinatal depression is associated with poor obstetric outcomes and impairments in infant cognitive development and growth parameters. Even though evidence supports the efficacy of evidence based psychosocial interventions for perinatal depression delivered by non-specialist health and community workers to alleviate these negative outcomes, a major limitation is the low rate of attendance at follow up counseling sessions. The goal of this research is to adapt psychosocial interventions for perinatal depression for use over the mobile telephone and assess the acceptability, feasibility and the effectiveness of this approach. Qualitative methods, specifically key informant interviews will be used to explore the organizational structure of the maternal and child health facilities as well as barriers/facilitators for the successful implementation of mental health interventions. Following this, midwives in two maternal and child health (MCH) facilities will be trained to identify perinatal depression and deliver interventions based on treatment specifications of the WHO Mental Health Gap Action Program Intervention Guide (mhGAP-IG). Interventions will be delivered fortnightly over the phone in one MCH clinic and in-person at the other clinic. Depression outcome measures will be compared between the two groups to explore the effectiveness of the telephone-based interventions. The skills acquired through this K43 Award and data generated from this pilot will be used to pursue funding to conduct a larger randomized controlled trial of this strategy.