Advancing Stepped Care for Women's Common Mental Disorders in an LMIC

在全球范围内，年轻女性承受着不成比例的常见精神障碍的负担，特别是包括 抑郁和焦虑。在低收入和中等收入国家(LMIC)减轻这一负担需要分担任务， 这需要使用非专家和非专业人员来提供精神健康服务。任务的几个试验 LMIC的分享干预措施显示出了适度的改善。取得进一步进展的障碍包括缺乏 关于应该治疗哪些疾病、采取什么干预措施、由谁治疗以及如何克服的证据 进入障碍。此R21应用程序通过开发和测试 采用初级护理(PC)护士和心理健康同伴进行治疗的LMICs分级护理模式的可行性 抑郁和焦虑。它还整合了基于神经科学的预测模型，研究如何低成本、 简要研究领域标准(RDoC)工具可以帮助评估和确定分级护理的目标。RDoC是一种 NIMH计划使用维度、疾病不可知性、基于大脑的工具来更好地了解 精神疾病。这项研究在塔吉克斯坦进行，这是一个低收入国家，韦恩博士目前在那里 资助R01、K24和D43关于移民与心理健康和健康的研究。在塔吉克斯坦，妇女是 暴露于与移民丈夫的分离，家庭内外的暴力，性传播感染 由配偶传播，以及高度的精神疾病污名，服务机会受限，并严重 治疗资源有限。目标1更好地描述了心理健康需求、支持、资源和 从一个初级保健中心招募的抑郁症(包括伴发焦虑)妇女的护理障碍 杜尚别诊所，通过定性访谈和焦点小组。AIM 2组建干预设计团队 它建立在通过目标1获得的知识和两个现有干预措施(桥梁和人际关系)的基础上 心理疗法)开发一种新的阶梯式护理模式，包括：1)PC护士和医生引导的筛查 和分诊；2)同伴和专科护士共同领导心理教育和支持小组；3)同辈或专科护士领导 人际心理治疗；4)PC内科医生主导的药物治疗。目标3评估可行性 阶梯式护理模式对45名抑郁症患者(包括伴发抑郁症患者)的可接受性 焦虑)从杜尚别的一家初级保健诊所招募，以及评估RDoC的简要工具 急性威胁和认知控制的亚结构，预测或适度的岗位变化。它建立在Dr。 Weine与塔吉克精神卫生和卫生领域的领导人和研究人员建立了强有力的合作伙伴关系 位于杜尚别的Prisma研究中心，以及塔吉克斯坦卫生部和共和国 精神科中心。这项研究将产生一种适应并试行的阶梯式护理模式，我们希望在 随后的R01研究。它还将导致心理健康研究能力的增加，这将增强 Weine的K24和D43研究培训计划。这项研究解决了全球心理上的重大挑战 健康目标C促进将精神健康纳入初级保健，NIMH战略目标3通过制定 新的更好的干预措施，结合了精神障碍患者的不同需求和情况 生病了。这将有助于建立一个循证的计划，然后可以引入公共卫生服务 在塔吉克斯坦。

Globally, young women bear a disproportionate burden of common mental disorders especially including depression and anxiety. Lifting this burden in low- and middle-income countries (LMICs) requires task sharing, which entails using non-specialists and laypersons to deliver mental health services. Several trials of task sharing interventions in LMICs have shown modest improvement. Obstacles to further progress include lack of evidence regarding what conditions should be treated, with what interventions, by whom, and how to overcome access obstacles. This R21 application advances knowledge about task sharing by developing and testing for feasibility a stepped care model for LMICs using primary care (PC) nurses and mental health peers to treat depression and anxiety. It also integrates neuroscience-based prediction models by investigating how low-cost, brief Research Domain Criteria (RDoC) tools can assist in evaluating and targeting stepped care. RDoC is an NIMH initiative to use dimensional, disease agnostic, brain based tools to better understand the key features of mental illness. The research takes place in Tajikistan, a low-income country, where Dr. Weine has currently funded R01, K24, and D43 research on migration and mental health and health. In Tajikistan, women are exposed to separation from their migrant husbands, violence both within and outside of the home, STIs transmitted by their spouses, as well as high mental illness stigma, restricted service access, and severely limited treatment resources. Aim 1 better characterizes the mental health needs, supports, resources, and barriers to care of women with depression (including with co-occurring anxiety) recruited from one primary care clinic in Dushanbe, through qualitative interviews and focus groups. Aim 2 forms an intervention design team that builds on knowledge gained through Aim 1 and on two existing interventions (BRIDGES and Interpersonal Psychotherapy) to develop a novel stepped care model that includes: 1) PC nurse and physician led screening and triage; 2) peer and PC nurse co-led psycho-education and support groups; 3) peer or PC nurse led Interpersonal Psychotherapy, and; 4) PC physician led medication treatment. Aim 3 assesses the feasibility and acceptability of the stepped care model with 45 women who have depression (including with co-occurring anxiety) recruited from a primary care clinic in Dushanbe, and whether brief tools assessing RDoC subconstructs of acute threat and cognitive control, predict or moderate pre-post changes. It builds on Dr. Weine’s strong collaborative partnerships with Tajik mental health and health leaders and researchers at the Prisma Research Center in Dushanbe, as well as the Tajikistan Ministry of Health and the Republican Psychiatric Center. This study will result in an adapted and piloted stepped care model that we hope to test in a subsequent R01 study. It will also result in increased capacity for mental health research that will augment Weine’s K24 and D43 research training program. The study addresses Grand Challenges in Global Mental Health Goal C to foster integration of mental health into primary care, and NIMH Strategic Aim 3 by developing new and better interventions that incorporate the diverse needs and circumstances of people with mental illness. It will help to build an evidence-based program that can then be introduced into public health services in Tajikistan.