Strengthening the identification and treatment of depression in primary care in Mozambique

加强莫桑比克初级保健中抑郁症的识别和治疗

• 批准号: 9767282
• 负责人: Bradley Wagenaar
• 金额: $ 15.28万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-08-01 至 2021-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9767282
• 关键词: Accounting; Affect; Africa; Area; Award; Caring; Censuses; Characteristics; Clinic; Clinical; Clinical Research; Cluster randomized trial; Communities; Comorbidity; Competence; Complex; Country; DSM-IV; Data; Development; Educational Curriculum; Effectiveness; Ethics; Evaluation; Exercise; Feasibility Studies; Feeling suicidal; Funding; Goals; Gold; Grant; Guidelines; HIV/TB; Health; Health Personnel; Health Services Accessibility; Health Status; Health financing; Health system; Healthcare; Hospitals; Human Development; Human Resources; Individual; Intervention; Interview; K-Series Research Career Programs; Knowledge; Mental Depression; Mental Health; Mental Health Services; Mental disorders; Mentored Research Scientist Development Award; Mentors; Mentorship; Methods; Modeling; Mozambique; Outcome; Pathway interactions; Patient Care; Patient-Focused Outcomes; Patients; Peer Review; Perception; Pilot Projects; Population; Poverty; Predictive Value; Prevalence; Prevalence Study; Primary Health Care; Process; Province; Psyche structure; Psychiatric therapeutic procedure; Psychiatrist; Public Health; Public Sector; Publications; Questionnaires; Receiver Operating Characteristics; Recommendation; Research; Research Personnel; Research Project Grants; Sensitivity and Specificity; Services; Side; South Africa; Specialist; Structure; Suicide; System; Techniques; Testing; Time; United States; United States National Institutes of Health; Visit; Work; World Health Organization; aged; base; care seeking; community setting; depressive symptoms; design; disability; evidence base; experience; experimental analysis; health care delivery; implementation research; implementation science; implementation strategy; improved; indexing; informant; interest; intervention effect; low and middle-income countries; mental health organization; primary care services; primary care setting; programs; public health relevance; randomized trial; scale up; screening; success; suicide rate; support tools; symposium; systems research; tool; years lived with disability

ABSTRACT Mozambique was recently estimated to have the highest suicide rate in Africa. Global modeling exercises estimate that depression is one of the leading causes of disability nationally, yet our pilot studies suggest depression is not often identified or treated. Given limited specialist human resources and reach of the current mental health system, the Ministry of Health has targeted mental health service integration with primary care as a high priority. However, there is currently no primary care integration, with all mental healthcare occurring at district-level specialized psychiatric services. The goal of this award is to broaden the candidate’s expertise to conduct independent mental health systems research focused on the integration of mental health in global primary care settings. Through research, coursework, structured mentorship, and conference attendance, the candidate will develop new competencies in mental health systems research, including: (1) content knowledge on the evidence-base for integrating mental healthcare in primary care; (2) mixed-methods techniques for pragmatic randomized trials in low- and middle-income country (LMIC) health systems; (3) ethical conduct of clinical research in LMICs; and (4) professional development to become an independent NIH-funded investigator. Drs. Deepa Rao, Kenneth Sherr, Jürgen Unützer, Inge Petersen, Palmira dos Santos, and Vasco Cumbe will mentor and advise the candidate in these four objectives. The research will be conducted in Sofala, Mozambique in partnership with the Mozambican Ministry of Health. The candidate will determine the optimal screening cut- off for the Patient Health Questionnaire-9 and conduct the first-ever study of prevalence, associated factors, and care-seeking for depressive symptoms (including suicidal ideation) among primary care patients in Sofala, Mozambique (Aim 1). These data, combined with semi-structured key-informant interviews of existing practices and perceptions of supply/demand side barriers (Aim 2), will be used to inform the design and implementation of mental health integration guidelines and decision-support tools. Last, the candidate will implement and pilot- test the feasibility of depression care integration within public clinics in Sofala, Mozambique. The candidate will collect mixed-methods pilot data of input variables, implementation outcomes, and patient outcomes, paired with the Consolidated Framework for Implementation Research (CFIR) to systematically assess intervention characteristics, outer/inner setting, and processes (Aim 3). Pilot effectiveness data, along with analyses of CFIR constructs affecting implementation, will help identify factors distinguishing between facilities achieving high and low implementation success, and inform implementation strategies for a follow-on NIH grant testing impact and implementation strategies in an adequately-powered cluster randomized trial. In Mozambique, this research will contribute to scalable mental health integration models that promote integrated care for depressive symptoms. More generally, we anticipate our mixed-methods data, including the CFIR constructs of implementation success, will be of interest to the larger global community looking to close mental health treatment gaps in LMICs.

抽象的 莫桑比克最近估计在非洲的自杀率最高。 全球建模练习 估计抑郁症是全国残疾的主要原因之一，但我们的试点研究表明 抑郁症经常被发现或治疗。 鉴于有限的专业人力资源和当前的范围 心理卫生系统，卫生部已将精神卫生服务与初级保健的融合为目标 优先级。但是，目前尚无初级保健集成，所有心理保健都发生在 地区级专业精神科服务。该奖项的目标是扩大候选人的专业知识 进行独立的心理卫生系统研究，重点是全球心理健康的整合 初级保健设置。通过研究，课程工作，结构化的心态和会议出勤， 候选人将在心理卫生系统研究中发展新的能力，包括：（1）内容知识 关于将心理保健纳入初级保健的证据基础； （2） 混合方法 技术 低收入国家（LMIC）卫生系统的务实随机试验； （3）道德行为 LMIC的临床研究； （4）专业发展成为一名独立NIH资助的研究者。 博士。 Deepa Rao，Kenneth Sherr，JürgenUnützer，Inge Petersen，Palmira Dos Santos和Vasco Cumbe Will 指导并建议这四个目标的候选人。该研究将在莫桑比克的索法拉进行 与莫桑比克卫生部合作。候选人将确定最佳筛选切割 - 为患者健康调查表9，并进行了有史以来的首次研究，相关因素和 在索法拉的初级保健患者中，寻求抑郁症状（包括自杀的想法）， 莫桑比克（AIM 1）。 这些数据，结合了对现有实践的半结构键信息访谈 以及对供求侧壁垒的看法（AIM 2），将用于告知设计和实施 心理健康整合指南和决策支持工具。 最后，候选人将实施和驾驶 测试莫桑比克索法拉公共诊所内抑郁症护理整合的可行性。 候选人会 收集输入变量，实施结果和患者结果的混合方法数据 实施研究（CFIR）的合并框架系统评估干预措施 特征，外部/内部设置和过程（AIM 3）。飞行员有效性数据以及CFIR的分析 影响实施的结构，将有助于确定区分高位设施的因素 较低的实施成功，并为实施策略提供了后续的NIH赠款测试影响和 在充分动力的集群随机试验中实施策略。在莫桑比克，这项研究将 有助于可扩展的心理健康整合模型，以促进抑郁症状的综合护理。 更一般地，我们预计我们的混合方法数据，包括实施的CFIR结构 成功的全球社区希望弥合LMIC的心理健康治疗差距。