RISE Study ("Resist, Intervene, Support, Empower"): Feasibility/Acceptability of MHealth Intervention targeting Transgender Women facing gender-based violence and mental health disorders in Brazil

RISE 研究（“抵抗、干预、支持、赋权”）：针对巴西面临性别暴力和精神健康障碍的跨性别妇女的 MHealth 干预措施的可行性/可接受性

• 批准号: 9978227
• 负责人: Monica Malta
• 金额: $ 16.27万
• 依托单位: CENTRE FOR ADDICTION AND MENTAL HEALTH
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-01 至 2022-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9978227
• 关键词: Accounting; Address; Appointment; Area; Brazil; Car Phone; Caring; Cessation of life; Child; Cities; Collaborations; Community Health Aides; Continuing Education; Counseling; Country; Data; Discrimination; Enrollment; Environment; Esthetics; European Union; Face; Family; Feedback; Focus Groups; Fostering; General Population; Generalized Anxiety Disorder; Goals; Health; Health Sciences; Health Surveys; Healthcare; High Prevalence; Homelessness; Homicide; Improve Access; Informal Social Control; International; Intervention; Interview; Life Cycle Stages; Link; Location; Major Depressive Disorder; Maps; Mental Health; Mental disorders; Methods; Mobile Health Application; Murder; National Institute of Mental Health; Notification; Outcome; Participant; Police; Population; Post-Traumatic Stress Disorders; Prevalence; Public Health; Reporting; Research; Research Personnel; Resources; Risk; Safety; Sampling; Schedule; Schools; Self Efficacy; Services; Sexual Health; Sexual and Gender Minorities; Standardization; Substance Use Disorder; Suicide; Suicide attempt; Supervision; Surveys; Testing; Time; Training; Violence; Visit; behavior change; bullying; community based participatory research; cost; cost efficient; crowdsourcing; design; experience; gender nonconforming; gender-based violence; hate crimes; high risk population; implementation science; improved; innovation; interest; mHealth; mental health education; mobile application; novel; outcome forecast; post intervention; prevent; primary outcome; recruit; response; scale up; screening; sexual violence; social cognitive theory; successful intervention; systematic review; transgender; transgender women; uptake; violence prevention

Transgender women (TGW) disproportionately experience physical/sexual violence when compared with the general population and with other sexual and gender minorities (SGMs). A recent systematic review identified a high prevalence of lifetime physical (68%) or sexual violence (49%) among TGW. Frequent experiences of violence contributes to high levels of posttraumatic stress disorder (PTSD), generalized anxiety disorder (GAD), suicidality, substance use disorder (SUD) and might influence the onset, progression, and prognosis of major depressive disorder (MDD) among TGW. Since 2008 Brazil is responsible for more than 40% of all transgender homicides reported worldwide. In 2016/17 we conducted a survey with 2,846 TGW from twelve Brazilian cities, identifying 60% prevalence of lifetime violence (physical and/or sexual), 60% of participants screened positive for MDD, 38% for GAD, and 35% attempted suicide. The majority of violent incidents were not reported to the police (91%) and most victims did not receive any counseling or mental health (MH) treatment (82%). On this resubmission, we will utilize community-based participatory research (CBPR) to adapt the “UNI-FORM” app and online platform (https://uni-form.eu) to TGW from Brazil. The study specific aims are: (1) Refine and adapt the “UNI-FORM” mHealth intervention to Brazil (RISE), including MH screening and link to MH care; (2) Pilot test RISE to prevent violence, improve MH screening and treatment; and (3) Evaluate the feasibility and acceptability of RISE. This R21 exploratory project proposes to recruit 200 TGW from Rio de Janeiro, Brazil to study the implementation of RISE. Consistent with NIMH goal to enhance research capacity, the proposal is led by an early stage investigator and includes a close collaboration with researchers from Duke who will provide constant supervision from researchers with senior expertise in SGM mHealth (Dr. Legrand), SGM MH international research (Dr. Whetten), MH and implementation science (Dr. Belden). This proposal is innovative in several ways: it will adapt to Brazil an existing mHealth intervention addressing SGM-related violence (UNI-FORM), to include additional features to increase MH screening and linkage to MH care. The proposed app, RISE, has the potential to improve crises response and promote timely MH care among a high-risk population: TGW. It has significance and impact: The intervention will prevent and respond to violence against TGW, in a country with the highest rate of transgender murders in the world. It will also develop an innovative strategy to identify and link to care TGW who need MH care, a population with high prevalence of PTSD, GAD, MDD, SUD and suicidality. Those mental disorders are underscreened, underdiagnosed, and undertreated among TGW. If successful, the intervention could be scaled up and adapted to other populations and countries. This research will yield the crucial first steps in developing a lower cost and efficacious mHealth intervention that we plan to evaluate with an RCT in a subsequent R01. RISE addresses all three NIMH priorities identified in the Notice of Special Interest in Research on Health of SGM Populations (NOT-MD-19-001), Grand Challenges in Global Mental Health and NIMH Strategic Aim 3.

跨性别女性(TGW)经历身体/性暴力的比例高于 与普通人群和其他性少数群体和性别少数群体(SGM)的关系。最近的一项系统评估发现， TGW中终生身体暴力(68%)或性暴力(49%)的患病率很高。经常体验到 暴力导致高水平的创伤后应激障碍(PTSD)和广泛性焦虑症 (GAD)，自杀，物质使用障碍(SUD)，并可能影响疾病的发生、发展和预后 TGW中的主要抑郁障碍(MDD)。自2008年以来，巴西承担了超过40%的责任 据报道，全球范围内发生了变性人杀人案。在2016/17年度，我们进行了一项调查，调查对象为2846名TGW，其中 巴西城市，发现60%的终生暴力(身体和/或性暴力)，60%的参与者 MDD筛查阳性，38%GAD筛查阳性，35%自杀未遂筛查阳性。大多数暴力事件都是 未向警方报告(91%)，大多数受害者没有接受任何咨询或精神健康(MH) 治疗(82%)。在这次重新提交时，我们将利用基于社区的参与性研究(CBPR)来适应 “Uni-Form”应用和在线平台(从巴西的https://uni-form.eu)到TGW。这项研究的具体目标是： (1)完善和改编巴西统一形式的mHealth干预措施(RISE)，包括MH筛查和链接 (2)开展预防暴力、改善MH筛查和治疗的试点试验；以及(3)评估 提高的可行性和可接受性。该R21勘探项目拟从里约热内卢招聘200 TGW 巴西里约热内卢研究实施RISE。与NIMH提高研究能力的目标一致， 该提案由一名早期研究人员领导，并包括与来自 杜克博士将从在SGM mHealth(Dr。 SGM MH国际研究(Wetten博士)、MH和实施科学(Belden博士)。这 该提案在几个方面具有创新性：它将适应巴西现有的移动健康干预解决方案 SGM相关暴力(Uni-Form)，包括其他功能，以增加MH筛查和与MH的联系 关心。拟议中的APP Rise有可能改善危机应对并促进及时的MH护理 在高危人群中：TGW。它有意义和影响：干预将预防和应对 针对TGW的暴力，在一个世界上变性人谋杀率最高的国家。它还将 制定创新战略，以确定并链接到需要MH护理的TGW护理人员，这是一个高风险人群 PTSD、GAD、MDD、SUD和自杀倾向的患病率。这些精神障碍没有得到充分的筛查， 在TGW中，诊断不足，治疗不足。如果成功，干预措施可能会扩大，并 适应其他人口和国家。这项研究将为开发更低的 成本和有效的mHealth干预，我们计划在随后的R01中用随机对照试验进行评估。崛起 阐述了特别关注SGM健康研究的通知中确定的所有三个NIMH优先事项 人口(非-MD-19-001)，全球精神卫生的重大挑战和NIMH战略目标3。