Design and Feasibility of a Mobile Mental Health Stigma Reducing Intervention towards Optimization of Care for Black Adults with Depression and Anxiety

移动心理健康耻辱减少干预措施的设计和可行性，以优化患有抑郁和焦虑的黑人成人的护理

• 批准号: 10525051
• 负责人: Aderonke Bamgbose Pederson
• 金额: $ 19.65万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-16 至 2027-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10525051
• 关键词: Address; Adherence; Adult; Affect; Anxiety; Anxiety Disorders; Applications Grants; Attitude; Award; Behavior; Belief; Black Populations; Black race; Caring; Characteristics; Chronic; Chronic Disease; Clinical Trials; Conduct Clinical Trials; Country; Data; Diagnosis; Disease; Ethnic Origin; Foundations; Future; Goals; Health; Health Knowledge Attitudes Practice; Health Services Accessibility; Healthcare; Healthcare Systems; Individual; Institution; Intervention; Intervention Trial; Literature; Major Depressive Disorder; Measures; Mediating; Mediation; Medical; Mental Depression; Mental Health; Mental Health Services; Mental disorders; Mentors; Mentorship; Meta-Analysis; Methodology; Mission; Morbidity - disease rate; National Institute of Mental Health; Outcome; Participant; Patients; Persons; Premature Mortality; Process; Public Health; Qualitative Research; Race; Randomized; Randomized Controlled Trials; Recording of previous events; Recovery; Research; Research Methodology; Research Personnel; Role; Self Administration; Stigmatization; Symptoms; Testing; Training; Treatment outcome; United States; Waiting Lists; acceptability and feasibility; base; care providers; clinical trial analysis; community building; community engaged research; design; digital mental health; disability; experience; feasibility testing; health disparity; health inequalities; health service use; help-seeking behavior; improved; innovation; internalized stigma; intervention effect; mHealth; mobile application; mortality; novel; personal narratives; personalized intervention; post intervention; preference; primary outcome; racism; randomized trial; recruit; satisfaction; secondary outcome; service engagement; service utilization; skills; social stigma; therapy design; therapy development; treatment arm; trial design; uptake; usability; user centered design

Project Summary/Abstract This K23 proposal is designed to help Dr. Pederson achieve her long-term goal of becoming an independent investigator with expertise in developing and testing interventions that reduce mental health stigma, increase engagement in mental health services, and improve mental health outcomes. The candidate and her mentors have developed a comprehensive training plan: 1) to build her expertise in user-centered design and digital mental health intervention development, so that she can engage end-users early in the intervention design process both in this study and in future trials; 2) to expand her training in community engaged research to address health disparities and promote engagement in mental health services; and 3) to bolster her skills in the conduct of clinical trials and quantitative analysis of clinical trial data for a future R01 application centered on implementing and testing a fully powered anti-stigma contact intervention. The efficacy and precision of anti- stigma interventions to improve mental health outcomes among underserved Black adults are grossly limited and represent a critical public health gap. Studies show stigma compounds disabilities related to the primary symptoms of mental illness, and increases morbidity and premature mortality related to mental illness. Compared with white adults, Black adults with mental illness have more chronic disease, and more severe illness at presentation. Meta-analyses have consistently shown that both face-to-face and video based contact with individuals with mental illness can reduce stigma. Recent studies that distinguished contact delivery showed effect size for video-based contact to be comparable to face-to-face contact. Digital mental health also offers a platform to overcome barriers to early access, implementation, and scalability. Strong preliminary data identify mental illness stigma and medical mistrust as critical intervention targets that should be addressed in order to increase mental health service utilization among Black adults. To address these gaps in the literature, the following specific aims are proposed: 1) a user-centered design approach will be used to develop a self- administered, video-based mobile app to reduce stigma and medical mistrust among Black adults; 2) a pilot randomized trial design will be used to assess the feasibility and acceptability, and test the preliminary efficacy, of a self-administered, video-based mobile app in reducing mental illness stigma among Black adults with moderate to severe depression or anxiety; and 3) a causal mediation analysis will be used to estimate the extent to which changes in anticipated/enacted/internalized stigma and medical mistrust mediate the intervention’s effect on the primary and secondary outcomes. The key innovation of this proposal is that it will be the first mobile health intervention focused on mental health stigma reduction using a targeted approach by integrating user characteristics (such as race, ethnicity and religiosity), while addressing medical mistrust using a robust user-centered design approach and targeting service utilization.

项目总结/摘要 这个K23提案旨在帮助佩德森博士实现她成为一个独立的长期目标， 具有开发和测试干预措施专门知识的调查人员， 参与心理健康服务，改善心理健康结果。候选人和她的导师 我已经制定了一个全面的培训计划：1）建立她在以用户为中心的设计和数字化方面的专业知识 心理健康干预开发，以便她可以在干预设计早期与最终用户接触 在这项研究和未来的试验过程中; 2）扩大她在社区参与研究方面的培训， 解决健康差距，促进参与精神卫生服务; 3）提高她在 开展临床试验并对临床试验数据进行定量分析，以用于未来的R 01应用， 实施和测试一项全面的反污名接触干预措施。抗- 在服务不足的黑人成年人中，改善心理健康结果的耻辱干预措施非常有限 这是一个严重的公共卫生缺口。研究表明，污名化合物残疾有关的主要 这一现象加剧了精神疾病的症状，并增加了与精神疾病有关的发病率和过早死亡率。 与白色成年人相比，黑人成年人精神疾病的慢性化程度更高，且更严重 疾病介绍荟萃分析一致表明，面对面和视频接触 与精神疾病患者的沟通可以减少耻辱感。最近的研究区分接触交付 显示基于视频的接触的效果大小与面对面接触相当。数字心理健康也 提供了一个平台来克服抢先体验、实施和可扩展性方面的障碍。强劲的初步数据 将精神疾病污名化和医疗不信任确定为关键干预目标， 以提高黑人成年人的心理健康服务利用率。为了填补文献中的这些空白， 提出了以下具体目标：1）以用户为中心的设计方法将用于开发自我 管理，基于视频的移动的应用程序，以减少黑人成年人之间的耻辱和医疗不信任; 2）试点 将采用随机试验设计，评估可行性和可接受性，并检验初步疗效， 一个自我管理的，基于视频的移动的应用程序在减少黑人成年人的精神疾病耻辱， 中度至重度抑郁或焦虑;以及3）因果中介分析将用于估计 预期/实施/内化的污名和医疗不信任的变化在多大程度上介导了 干预对主要和次要结局的影响。该提案的主要创新之处在于， * 成为第一个采用有针对性的方法，以减少心理健康污名为重点的移动的健康干预措施， 整合用户特征（如种族、民族和宗教信仰），同时使用 一个强大的以用户为中心的设计方法和目标服务利用率。