Implementing mental health interventions for pregnant adolescents in primary care LMIC contexts

在初级保健中低收入国家中对怀孕青少年实施心理健康干预措施

• 批准号: 9788551
• 负责人: Manasi Kumar
• 金额: $ 10.26万
• 依托单位: UNIVERSITY OF NAIROBI
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-20 至 2023-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9788551
• 关键词: 18 year old; Address; Adolescent; Adolescent Health Services; Adopted; Adult; African; Age; Birth; Caring; Child; Child Health; Child Mental Health; Clinic; Clinical; Collaborations; Community Developments; Development; Economics; Effectiveness; Effectiveness of Interventions; Evidence based intervention; Family; Feasibility Studies; Female Adolescents; Gender; Growth; Guidelines; Health; Health Resources; Health system; Healthcare; High Prevalence; Human Resources; Inequality; Infrastructure; Infusion procedures; Institutes; Intervention; Intervention Studies; Kenya; Knowledge; Lead; Manuals; Marriage; Maternal and Child Health; Maternal-Child Health Services; Mental Depression; Mental Health; Mental Health Services; Mental Tests; Mental disorders; Methods; Modeling; Modification; Mothers; National Institute of Mental Health; Outcome; Palpable; Perinatal; Personal Satisfaction; Population; Poverty; Pregnancy in Adolescence; Prevalence; Primary Health Care; Protocols documentation; Public Health; Research; Resources; Service setting; Services; Site; Social Protection; Strategic Planning; Structure; System; Testing; Time; Training; Unwanted pregnancy; Vision; Vulnerable Populations; Woman; Work; World Health Organization; base; behavioral health; burden of illness; care delivery; child depression; cost effective; effective intervention; effectiveness research; evidence base; global health; implementation research; implementation strategy; improved; infancy; interpersonal therapy; low and middle-income countries; member; mental health organization; novel; offspring; peer; perinatal period; peripartum depression; pregnant teen; primary care setting; programs; reproductive; research study; service delivery; service gap; support tools; teenage mother; tool; vulnerable adolescent

SUMMARY High prevalence of adolescent pregnancies in low-and-middle-income countries (LMICs) has resulted in a tremendous public health burden. Many adolescent pregnancies are unwanted, unplanned, and outside of marriage. When adolescent girls become mothers, their opportunities for economic and educational growth are limited. A burgeoning number of adolescent mothers from LMICs are also marginalized due to poverty or gender-based traditions, which further limit their access to health resources, social protection/ support and personal development. Structural inequalities and adverse circumstances have resulted in high prevalence of depression in adolescent mothers. Despite the enormous mental health needs for adolescent mothers in LMICs, child and adolescent mental health service remains in its’ infancy. There is a need to advance cultural and context-sensitive perinatal depression interventions that can align with adolescents’ living contexts and developmental needs and simultaneously address multiple resource challenges in provision of mental health care in LMIC settings. This application seeks to respond to these adolescent perinatal depression intervention and implementation research gaps by i) utilizing WHO Mental Health Treatment Gap Action Program (mhGAP) and Group Interpersonal psychotherapy (IPT-G) depression care packages that has shown to be efficacious for adult depression, and further test the approaches in adolescents with perinatal depression in Kenyan maternal and child health (MCH) service settings. Three key research questions will be studied: (i) how to improve fit of the mhGAP/IPT-G-depression intervention model for pregnant adolescents in Kenya, (ii) how to effectively integrate task-shifting/sharing and collaborative strategies with MCH clinical workflow to implement mhGAP/IPT-G depression intervention for pregnant adolescents in MCH settings, and (iii) whether the adapted mhGAP/IPT-G are feasible-acceptable-effective in addressing perinatal depression in adolescents. Considering the demand-resource gap, as MCH clinics usually serve high volume of adolescents with perinatal depression but have limited resources, this study will also explore other cost-effective strategies, such as study feasibility of applying long and mini version of IPT-G and other family/adolescent peer co-lead approach of intervention implementation. This study will be carried out using a cross-disciplinary partnership approach. The specific aims of this study are to: 1) explore barriers and strategies to improve mhGAP-IG/IPT-G fit and implementation for adolescent perinatal depression in MCH clinics in Kenya; 2) Develop adapted version of IPT-G/ and mhGAP-IG, and build MCH capacity for implementation; and 3) test feasibility and implementation-effectiveness outcomes for the adapted version of mhGAP-IG/ IPT-G.

概括 低和中等收入国家（LMIC）的青少年怀孕的高龄已导致了巨大 公共卫生伯恩。许多青少年怀孕是不必要的，外的，计划外和婚外之外。青春期 女孩成为母亲，经济和教育增长的机会有限。一个人数 来自LMIC的青春期母亲也因贫困或基于性别的传统而被边缘化，这进一步限制了他们的 获得卫生资源，社会保护/支持和个人发展。结构不平等和逆境 情况导致青春期母亲的抑郁症患病率很高。尽管心理健康很大 在LMIC，儿童和青少年心理健康服务中，青少年母亲的需求仍处于起步阶段。有需要 推进可以与青少年生活保持一致的文化和情境敏感的围产期抑郁干预措施 背景和发展需求，简单地应对精神健康的多种资源挑战 在LMIC环境中进行护理。该申请旨在应对这些青少年的围产期抑郁干预措施和 i）实施研究差距 人际心理治疗（IPT-G）抑郁症护理套件已证明对成人抑郁症有效，并且 进一步测试肯尼亚生物和儿童健康（MCH）服务青少年的青少年的方法 设置。将研究三个关键的研究问题：（i）如何改善MHGAP/IPT-G-DEPSISTRYS DESTERTION的拟合 肯尼亚孕妇青少年的模型，（ii）如何有效整合任务转移/共享和协作策略 使用MCH的临床工作流程来实施MHGAP/IPT-G抑郁干预MCH中的孕妇青少年 设置，以及（iii）适应的MHGAP/IPT-G是否在解决围产期抑郁症方面可获得可接受的有效 在青少年。考虑到需求资源差距，因为MCH诊所通常为大量的青少年服务 围产期抑郁症，但资源有限，这项研究还将探索其他具有成本效益的策略，例如研究 应用长期和迷你版IPT-G和其他家庭/青少年同行共同领导干预方法的可行性 执行。这项研究将使用跨学科合作伙伴方法进行。这个特定的目的 研究是：1）探索改善MHGAP-IG/IPT-G拟合和实施青少年的障碍和策略 肯尼亚MCH诊所的围产期抑郁症； 2）开发IPT-G/和MHGAP-IG的改编版，并构建MCH 实施能力； 3）测试适用版本的可行性和实施效果结果 mhgap-ig/ ipt-g。