ESSENCE (Enabling translation of Science to Service to ENhance Depression CarE) Scale-Up

项目摘要（按比例放大组件） 抑郁症是全球疾病负担的主要心理健康原因，占全球疾病负担的37%。 残疾调整生命年（Disability Adjusted Life Years，DADs）但尽管 对循证临床治疗和提供模式的了解，农村地区的治疗差距超过90% 地区为了解决科学与服务之间的差距，我们的目标是在最重要的领域产生知识。 可持续地扩大ESSENCE“一揽子计划”的有效和具有成本效益的方法（协作 两种循证临床治疗中重度抑郁症的阶梯式护理 初级保健护理人员）到中央邦的四个区（人口约530万） Pradesh，分娩完全由政府资助的现有卫生工作者进行。 ESSENCE由两项互补的序贯随机对照试验组成， （a）制定和评估有效性和成本， 在线培训（奥尔特）干预（有和没有指导）与面对面培训相比的有效性， 面对面（F2 F）培训认可的社会卫生活动家（阿莎工作人员）的能力， 部署在印度国家卫生使命的社区卫生工作者，提供健康活动 计划（HAP），一个基于证据的短期心理治疗抑郁症的初级保健 参与者;和B）制定和评估两个层面的有效性和成本效益 实施支持干预措施，以解决协作式阶梯式护理的主要障碍 提供基于证据的抑郁症临床治疗（HAP和抗抑郁药物） 与目前单独训练的策略相比， 初级保健中的抑郁症 ESSENCE建立在研究国家的大量证据基础上，由项目PI领导， 利用我们的研究计划的强有力参与所提供的独特和及时的机会 与卫生部、中央邦政府合作，解决关键的知识差距 关于扩大循证教育所需的培训和执行支助战略， 在低资源环境下治疗抑郁症。研究最具创新性的方面是使用 提供培训和执行支助干预措施的技术平台， 提高今后扩大这些干预措施的可能性。获得的知识将是第一个 任何低收入或中等收入国家提供此类培训和实施干预措施， 从而有助于影响研究国家以外的精神卫生政策议程。

PROJECT ABSTRACT (SCALE UP COMPONENT) Depression is the leading mental health cause of the Global Burden of Disease and accounts for 37% of the mental health related Disability Adjusted Life Years (DALYs) in India. However, despite the knowledge of evidence-based clinical treatments and delivery models, treatment gaps exceed 90% in rural areas. In order to address this science to service gap, our aim is to generate knowledge on the most effective and cost-effective approaches to sustainably scale up the ESSENCE `package' (collaborative stepped care delivery of two evidence-based clinical treatments for moderate to severe depression in primary care attenders) to four districts (population of approximately 5.3 million) in the state of Madhya Pradesh with delivery entirely carried out by existing health workers funded by the government. ESSENCE consists of two complementary, sequential randomized control trials, conducted over five years to address following specific aims: a) the development and evaluation of the effectiveness and cost- effectiveness of On-Line Training (OLT) interventions (with and without guidance) compared with Face- to-Face (F2F) training on the competence of Accredited Social Health Activists (ASHA workers), community health workers deployed in India's National Health Mission, to deliver the Healthy Activity Program (HAP), an evidence-based brief psychological treatment for depression in primary care attenders; and b) the development and evaluation of the effectiveness and cost-effectiveness of two levels of implementation support interventions to address the key barriers to the collaborative stepped care delivery of evidence-based clinical treatments for depression (the HAP and antidepressant medication) compared with the current strategy of training alone, on outcomes in patients with moderate to severe depression in primary care. ESSENCE builds on a substantial body of evidence in the study country, led by the program PIs, to capitalize on the unique and timely opportunity offered by the strong engagement of our research program with the Ministry of Health, Government of Madhya Pradesh to address the critical knowledge gaps regarding the training and implementation support strategies necessary to scale-up evidence-based treatments for depression in a low resource setting. The most innovative aspect of research is the use of technology platforms for delivery of both the training and implementation support interventions to enhance the likelihood of future scaling up of these interventions. The knowledge gained will be the first from any low or middle income country for such training and implementation interventions and could thus be instrumental in influencing the mental health policy agenda beyond the study country.