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Scaling-Up Stepped Care for Women's Mental Health in Primary Care in an LMIC

在中低收入国家的初级保健中扩大对妇女心理健康的分级护理

基本信息

批准号：
10001626
负责人：
Mahbat Bahromov
金额：
$ 64.11万
依托单位：
UNIVERSITY OF ILLINOIS AT CHICAGO
依托单位国家：
美国
项目类别：
财政年份：
2019
资助国家：
美国
起止时间：
2019-09-01 至 2024-07-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10001626
关键词：
Address Amitriptyline Anxiety Brain Caring Chicago Clinic Effectiveness Epidemic Evaluation Evidence Based Medicine Exposure to Fostering Funding Gender Health Health Services Accessibility Healthcare Husband Illinois Individual Inequality Intervention Knowledge Leadership Life Style Lifting Measures Mediator of activation protein Mental Depression Mental Health Mental Health Services Mental disorders Mentorship Migrant Modeling Motivation National Institute of Mental Health Neurosciences New York Nurses Outcome Participant Pharmaceutical Preparations Play Post-Traumatic Stress Disorders Poverty Primary Care Physician Primary Health Care Primary Nursing Care Provider Psyche structure Research Research Activity Research Domain Criteria Research Personnel Research Training Resources Risk Role Science Self Management Services Tajikistan Testing Training Training Programs Trauma United States United States National Institutes of Health Universities Ursidae Family Utah Woman base design effectiveness implementation study effectiveness testing evidence base executive function experience health care availability health goals healthy lifestyle implementation research implementation science implementation strategy improved interpersonal therapy low and middle-income countries meetings migration novel peer post intervention prevention service prisma programs recruit research and development scale up service providers social stigma standard care standard of care trauma exposure treatment effect treatment services young woman

项目摘要

This new R01 application responds to PAR-18-835 by advancing task sharing in testing the effectiveness and implementation of a stepped care model for LMICs. It uses nurses and mental health peers to treat depression and potential co-occurring anxiety among women in primary care. To improve implementation, this study examines the impact of clinic implementation teams in readying the clinics and service providers. The proposed project is located in Tajikistan, where the investigators have conducted NIH funded research since 2009. It builds upon and extends Dr. Weine’s R01, K24, and D43 research on migration and health and mental health, and especially his recent Global Brain R21 research which successfully adapted and tested stepped care for feasibility. Aim 1 assesses the effectiveness of the stepped care model with 420 women who have depression and potential co-occurring anxiety, recruited from 12 primary care clinics in Tajikistan, compared with standard of care plus provision of healthy lifestyle materials, with another 210 women recruited from 6 primary care clinics, including assessing mediators and moderators (e.g. executive control efficiency, trauma exposure). Aim 2 assesses whether a clinic implementation team moderates women’s reduction in depression post-intervention, as well as clinic-level (leadership support and degree of implementation) and provider-level (motivation and fidelity) moderators. Aim 3 establishes a national mental health research network that focuses on improving the standard of mental health care and access to services by building mental health implementation research capacity. The knowledge produced through this study will inform stepped care models for mental health in LMICs such as Tajikistan and in low-resource settings in the United States.

这个新的R 01应用程序响应PAR-18-835，在测试为低收入和中等收入国家建立的分级护理模式的有效性和实施情况。它使用护士，心理健康同行治疗抑郁症和潜在的共同发生的焦虑症的妇女，初级保健.为了改善实施情况，本研究探讨了诊所的影响，执行小组为诊所和服务提供者做好准备。拟建项目位于塔吉克斯坦，自2009年以来，研究人员在那里进行了NIH资助的研究。它建立在韦内博士的R 01，K24和D43移民和健康研究的基础上，并扩展了该研究特别是他最近的全球大脑R21研究，调整并测试了阶梯式护理的可行性。目标1评估了阶梯护理模式与420名妇女谁有抑郁症和潜在的共同发生的焦虑，从塔吉克斯坦的12个初级保健诊所招募，与标准护理加相比，提供健康生活方式材料，另外从6个初级保健机构招募了210名妇女诊所，包括评估调解人和调解人（如执行控制效率，创伤曝光）。目标2评估诊所实施团队是否会减缓妇女的减少干预后抑郁症，以及临床水平（领导支持和程度实施）和提供者级别（动机和忠诚度）的主持人。目标3建立了一个国家心理健康研究网络，重点是提高心理健康水平，通过建立心理健康实施研究能力，提供保健和获得服务的机会。通过这项研究产生的知识将为心理健康的阶梯式护理模式提供信息，塔吉克斯坦等中低收入国家和美国的低资源环境。