Posttraumatic Stress Disorder Intervention for People with Severe Mental Illness in Low- and Middle-Income Country Primary Care Settings

项目摘要 背景：低收入和中等收入国家（LMICs）的精神卫生专业人员很少。鉴于慢性 由于精神障碍的性质，初级保健诊所可能最适合解决中低收入国家的精神健康问题。然而，在这方面， 人们对影响现实世界服务提供、获得、质量和精神卫生可持续性的因素知之甚少 对低收入国家初级保健的干预。研究精神卫生服务是否可行和有效，以及如何可行和有效 LMIC初级保健是NIMH的优先事项，也是全球精神卫生的重大挑战。严重精神疾病 (SMI)是中低收入国家初级保健诊所中最常见的精神疾病形式，也是导致 疾病负担。患有重度精神障碍的人患创伤后应激障碍（PTSD）的风险很高， 与更严重的精神症状、功能障碍和更差的治疗结果相关。具体 目的：目前的研究建议制定和评估一项 在埃塞俄比亚农村的初级保健诊所，对重度精神障碍患者进行心理治疗干预，以治疗创伤后应激障碍。目标1：开展 对患者、护理人员、提供者和社区成员进行半结构化定性访谈（n=60）， 社区咨询委员会（n=17）确定人群的临床和文化相关特征， 描述干预措施的采用、实施和可持续性的障碍和促进因素。结果将用于 评估干预的适合性和发展;目标2：进行混合方法开放试验，以完善 干预和探讨初步治疗效果（n=20例患者，20名照顾者）;目的3：进行混合方法 多方利益相关者过程评价，以评估RE-AIM实施情况所衡量的干预措施实施情况 框架（n=20例患者，20名护理人员，7名提供者）。候选人：这种指导以患者为导向的研究生涯 发展奖（K23）建立在候选人在创伤为重点的全球心理健康研究的经验， 低收入国家。候选人的长期职业目标是成为一名独立的循证医学调查员。 对中低收入国家的PTSD和SMI进行干预。培训目标：K23提供以下方面的培训和指导： 共病PTSD和SMI的病程、患病率和治疗;（2）卫生服务研究，包括 评估埃塞俄比亚初级保健如何提供和获得医疗保健，以及可能影响提供医疗保健的因素。 创伤后应激障碍的心理社会干预;（3）实施科学方法，以减少“科学与服务”的差距， 在LMIC初级保健中提供精神卫生保健，包括混合有效性实施试验。培训 活动培训将通过专家（大卫、亨德森、阿贝鲍·费卡杜、夏洛特博士）的指导进行 Hanlon，Kim Mueser和Graham Thornicroft），在埃塞俄比亚的实地经验，哈佛的正式课程， 波士顿大学，并参加研讨会，培训，会议和讲习班。

PROJECT SUMMARY Background: Low- and middle-income countries (LMICs) have very few mental health professionals. Given the chronic nature of mental disorders, primary care clinics may be best positioned to address mental health in LMICs. However, little is known about factors that influence real-world service delivery, access, quality, and sustainability of mental health interventions in LMIC primary care. Researching whether and how mental health services can be feasibly and effectively delivered in LMIC primary care is a NIMH priority and a grand challenge in global mental health. Severe mental illness (SMI) is the most common form of mental illness seen in primary care clinics in LMICs, and is a top contributor to the burden of disease. People with SMI are at high risk of developing posttraumatic stress disorder (PTSD), which is associated with more severe psychiatric symptoms, functional impairment, and worse treatment outcomes. Specific aims: The current study proposes to develop and assess the feasibility, effectiveness and implementation of a psychotherapy intervention to treat PTSD in patients with SMI in primary care clinics in rural Ethiopia. Aim 1: To conduct semi-structured qualitative interviews with patients, caregivers, providers and community members (n=60) and one community advisory board (n=17) to identify clinically and culturally relevant characteristics of the population and characterize barriers and facilitators to intervention adoption, implementation and sustainability. Results will be used to assess the fit and development of the intervention; Aim 2: To conduct a mixed methods open trial to refine the intervention and explore initial treatment effects (n=20 patients, 20 caregivers); Aim 3: To conduct a mixed methods multi-stakeholder process evaluation to assess intervention implementation as measured by the RE-AIM implementation framework (n=20 patients, 20 caregivers, 7 providers). Candidate: This Mentored Patient-Oriented Research Career Development Award (K23) builds upon the candidate's experience in trauma-focused global mental health research in low-income countries. The candidate's long-term career goal is to be an independent investigator of evidence-based interventions for PTSD and SMI in LMICs. Training objectives: The K23 provides training and mentorship in (1) the course, prevalence and treatment of comorbid PTSD and SMI; (2) health services research, including methods to evaluate how healthcare is delivered and accessed in Ethiopian primary care, and factors that might influence delivery of a psychosocial intervention for PTSD; and (3) implementation science methods to decrease “science-to-service” gaps in providing mental health care in LMIC primary care, including hybrid effectiveness-implementation trials. Training activities. Training will be achieved through mentorship by experts (Drs. David Henderson, Abebaw Fekadu, Charlotte Hanlon, Kim Mueser, and Graham Thornicroft), field-based experience in Ethiopia, formal coursework at Harvard and Boston Universities, and seminars, trainings, and conference and workshop attendance.