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.

摘要 据估计，莫桑比克的自杀率在非洲最高。 全球建模练习 据估计，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， 抑郁症往往得不到识别或治疗。 鉴于有限的专业人力资源和目前的 在精神卫生系统中，卫生部的目标是将精神卫生服务与初级保健相结合， 一个高优先级。然而，目前还没有初级保健整合，所有的精神保健都发生在 县级专门精神病服务。该奖项的目标是扩大候选人的专业知识， 开展独立的心理健康系统研究，重点是全球心理健康的整合 初级保健机构。通过研究，课程，结构化的导师，和会议出席， 候选人将在精神卫生系统研究方面发展新的能力，包括：（1）内容知识 将精神卫生保健纳入初级保健的证据基础;（2） 混合方法 技术 低收入和中等收入国家（LMIC）卫生系统中的实用随机试验;（3） LMIC的临床研究;和（4）专业发展，成为一个独立的NIH资助的调查员。 Drs. Deepa Rao、Kenneth Sherr、Jürgen Unützer、Inge Petersen、帕尔米拉多斯桑托斯和Vasco Cumbe将 在这四个目标上指导和建议候选人。这项研究将在莫桑比克的索法拉进行 与莫桑比克卫生部合作。候选人将决定最佳筛选- 关闭患者健康问卷-9，并进行有史以来第一次流行率，相关因素， 索法拉初级保健患者中因抑郁症状（包括自杀意念）而寻求护理， 莫桑比克（目标1）。 这些数据，结合现有做法的半结构化关键线人访谈 以及对供应/需求方障碍的看法（目标2），将用于为设计和实施提供信息 心理健康整合指南和决策支持工具。 最后，候选人将实施和试点- 测试抑郁症护理整合在莫桑比克索法拉的公共诊所的可行性。 候选人将 收集输入变量、实施结果和患者结果的混合方法试点数据， 实施研究综合框架（CFIR），系统评估干预措施 特征、外部/内部设置和过程（目标3）。试验有效性数据，沿着CFIR分析 影响实施的结构，将有助于确定区分设施实现高， 实施成功率低，并为后续NIH赠款测试影响提供实施策略， 在一个有足够把握度的群集随机试验中的实施策略。在莫桑比克，这项研究将 有助于可扩展的心理健康整合模式，促进抑郁症状的综合护理。 更一般地说，我们预期我们的混合方法数据，包括实现的CFIR构造 成功，将是更大的全球社会的兴趣，希望缩小精神卫生治疗差距在中低收入国家。