Pathways to mental health care: Examining the longitudinal impact of stigma mechanisms on treatment engagement in emerging adults

精神卫生保健之路：检查耻辱机制对新兴成年人治疗参与的纵向影响

• 批准号: 10364174
• 负责人: Valerie Ann Earnshaw
• 金额: $ 65.32万
• 依托单位: UNIVERSITY OF DELAWARE
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-01-12 至 2026-12-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10364174
• 关键词: Address; Adult; Age; Anxiety; Area; Biological; COVID-19 pandemic; Cardiovascular Diseases; Cessation of life; Characteristics; Chronic; Cognitive; Communities; Data; Development; Diabetes Mellitus; Discrimination; Epidemiology; Goals; Health; Health Services Accessibility; Healthcare; Individual; Intervention; Lead; Link; Longitudinal Studies; Mental Depression; Mental Health; Mental Health Services; Mental disorders; National Institute of Child Health and Human Development; National Institute of Mental Health; Onset of illness; Participant; Pathway interactions; Pattern; Personal Satisfaction; Persons; Research; Research Personnel; Resources; Risk; Risk Factors; Role; Sampling; Scientist; Social Change; Stereotyping; Subgroup; Substance Use Disorder; Surveys; Testing; Time; Treatment outcome; age group; aged; barrier to care; base; care seeking; depressive symptoms; emerging adult; emerging adulthood; evidence base; experience; implementation intervention; improved; individualized medicine; innovation; internalized stigma; longitudinal design; model design; multilevel analysis; physical conditioning; precision medicine; premature; reduce symptoms; resilience; response; social; social stigma; theories; tool

PROJECT SUMMARY/ABSTRACT Many emerging adults (aged 18-25) in the U.S. are living with unrecognized and/or untreated depression and anxiety. Emerging adults have the highest rates (26%) of mental illness (MI) and lowest rates of treatment seeking (38%), compared to all other age groups. Untreated depression and anxiety are particularly prevalent among emerging adults and are key risk factors for the development of substance use disorders, cardiovascular disease, and chronic health conditions later in adulthood, as well as premature death. Efficacious MI treatments are available, but MI stigma is a substantial barrier to recognizing and treating depression and anxiety. Emerging adults are particularly vulnerable to MI stigma given intense cognitive, biological, and social changes occurring during these years. Although scientists have begun to assemble and refine an evidence-based stigma-reduction toolbox, stigma interventions have fallen short of fully addressing MI stigma in part because they take a “one size fits all” approach. Stigma interventions may be more efficacious if they address stigma mechanisms when they are most pronounced, target the specific stigma mechanism(s) that are most harmful to treatment outcomes, and provide extra support for people who lack resilience to stigma. Our long-term goal is to tailor MI stigma interventions for emerging adults to promote positive treatment outcomes and lifetime wellbeing. In order to inform the tailoring of these interventions, we need greater understanding of how stigma evolves and impacts treatment outcomes during emerging adulthood. The objective of the current proposal is to examine longitudinal relationships between MI stigma and treatment outcomes among a large, national sample of emerging adults. Our specific aims are to: (1) Characterize trajectories of MI stigma mechanisms and identify moderators of trajectories among emerging adults experiencing depression and/or anxiety; (2) Examine associations between MI stigma mechanisms, MI recognition and MI treatment engagement over time; and (3) Identify latent profiles of MI stigma mechanisms, how individuals transition across profiles over time, and links between profiles and treatment engagement. We propose a national, longitudinal study of emerging adults (aged 18-25), surveying 4000 participants 4 times a year for 3 years regarding stigma mechanisms, moderating factors, mental health, and treatment engagement. Based on epidemiological estimates, we project that ~30% (n=1200) of participants will experience a new onset of depression or anxiety during the study. Data will be analyzed using multilevel modeling, moderation analyses, latent profile and latent transition analyses. Findings will enable researchers to better identify: (1) the ideal timing of stigma interventions to maximize impact among emerging adults, (2) who among emerging adults are most vulnerable to the effects of stigma, (3) which stigma mechanisms should be targeted for intervention to improve lifelong health and wellbeing, and (4) how to combine stigma-reduction tools for subgroups of emerging adults. This proposal responds to NIMH and NICHD’s strategic objectives to determine when, where, and how to intervene to improve healthcare during the transition to adulthood.

项目总结/文摘