Buddhist Monks as Task-Shifting Providers of Depression Treatment in Viet Nam

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PROJECT SUMMARY Depression represents a substantial public health burden. Effective treatments for depression exist but in part because of a scarcity of trained mental health professionals and stigma associated with “mental illness”, the majority of depression patients do not receive treatment, particularly in LMIC. One approach to address these issues is mental health task-shifting, the transfer of mental health services from highly trained mental health professionals to non-mental health professionals or lay people receiving focused training in a particular mental health program. Mindfulness-based (MB) interventions are a depression EBT, using activities to help people become more aware of bodily sensations, feelings, and thoughts without automatically judging them, reducing negative emotional reactivity that precipitates and exacerbates affective mental health problems. This R21 focuses on use of Vietnamese Buddhist monks as task-shifting providers of mindfulness-based intervention for depression. MB interventions are derived from Buddhist meditation practices, developed and applied in a secular manner. Use of Buddhist monks as task-shifting providers of MB interventions may be advantageous as (1) meditation is a central part of Buddhist monks' training and although not mental health professionals, monks have a solid background in underlying techniques being task-shifted; (2) pagoda-based treatment may reduce treatment stigma. Project Specific Aims are: #1. Conduct a capacity development needs assessment with approximately 68 stakeholders, using focus groups and Key Informant interviews, to prepare for this project and more comprehensive future research; #2: Adapt Mindfulness-Based Stress Reduction (MBSR) for task-shifting implementation by monks. Goals of this specific aim are (a) to adapt MBSR for monks (MBSR- 4M) to implement; (b) train the monks in MBSR-4M for implementation under Specific Aim #3; and (c) through the process of collaborative sharing involved in the adaptation, increase our understanding more generally of how our expanded team can most effectively collaborate together; #3: Conduct a Type 2 Hybrid Implementation-Effectiveness evaluation of MBSR-4M. Primary goals are: (a) to gain experience collaborating with the VN Buddhist system conducting implementation research, in order to (b) develop capacity for future collaborative research in this and related areas; (c) identify cultural and other factors potentially influencing IS domains for targeting in future research; and (d) obtain preliminary RCT data to assess the appropriateness and success of our program adaptation. The MBSR-4M evaluation will be conducted in 16 Hanoi and Danang pagoda with 160 participants (half in the treatment condition, half in control) with depression, recruited from pagoda and the general community. #4: Capacity Development: A central function of these specific aims is to develop capacity to support this research, by providing our team with the relevant knowledge, logistic structures, and professional relationships necessary to move forward in these directions. In addition, workshops targeting specific development areas identified in Specific Aim #1 also will be provided.