Mobile Mental Health in Community-Based Organizations: A Stepped Care Approach to Women's Mental Health

项目摘要 背景：未诊断和未治疗的抑郁症是低， 中等收入国家（LMIC），如印度。抑郁症的诊断率和治疗率 印度农村妇女的比例不成比例地低，尽管有一个以初级保健为基础的精神疾病任务分担模式， 健康治疗。阶梯式护理方法支持适当的症状治疗，同时减少 医疗保健系统和移动的技术的负担可以减少心理健康治疗的差距， 到达和容易访问。然而，我们在印度南部农村进行的任务分担护理模式的初步研究 显示，文盲和共享移动的电话作为家庭资源的做法， 采用基于移动的心理健康干预措施。到目前为止，基于社区的可行性 多用户mHealth应用程序，用于筛选抑郁症，跟踪症状严重程度，并支持 阶梯式护理治疗尚未在LMIC中进行测试。 具体目标1：在本探索性研究的第一阶段，我们将采用以用户为中心的参与式方法， 设计和开发一个多用户，语音响应，移动的应用程序（“MITHRA”），用于社区- 的组织进行筛查，跟踪和支持抑郁症的阶梯式护理治疗，包括 健康活动计划的选择模块，一种基于行为的简短心理干预 activation.该应用程序将包括音频，视频和增强的触摸屏功能，以克服 文盲和缺乏机会的障碍。 具体目标2：在第二阶段，使用随机对照设计，我们将研究 在社区组织部署“MITHRA”（n=3）与在社区加强常规护理（n=3）- （招收约60名妇女）。 具体目标3：在整个资助期内，我们将安排以下人员在指导下参加 来自印度的精神病学和社区医学居民参与了整个研究项目， 研究活动的范围，从访谈的发展和进行，以定性和定量数据 分析和手稿撰写及传播。这种指导性的参与将得到定期的 关于研究方法的视频会议教学和案例介绍会议。 这笔赠款将实现开发一个独特的可扩展的移动的应用程序的目标， 在印度的研究基地进行可行性研究和研究能力建设。

PROJECT SUMMARY Background: Undiagnosed and untreated depression is a significant cause of morbidity and mortality in low-, middle-income countries (LMIC) such as India. The rates of diagnosis and treatment of depression among women in rural India are disproportionately low despite a primary care based task-sharing model of mental- health treatment. Stepped care approaches support appropriate treatment of symptoms while reducing the burden on healthcare systems and mobile technology can reduce the mental health treatment gap given its reach and easy access. However, our preliminary study at a task-sharing care model in rural south India revealed that illiteracy and the practice of sharing mobile phones as a family resource present hurdles to the adoption of mobile mental health (mHealth) based interventions. To date, the feasibility of a community based multiple user mHealth application to screen depression, track symptom severity and support the delivery of stepped care treatment has not been tested in LMIC. Specific Aim 1: In phase I of this exploratory study, we will adopt a user centered participatory approach to design and develop a multiple-user, voice-response, mobile application (“MITHRA”), to be used in community- based organizations for screening, tracking and supporting stepped care treatment for depression, including select modules of the Healthy Activity Program, a brief psychological intervention based on behavioral activation. The application will include audio, video and enhanced touchscreen capabilities, to overcome the barrier of illiteracy and lack of access. Specific Aim 2: In phase II, using a randomized-control design, we will examine feasibility and utility of “MITHRA” deployed at community-based organizations (n=3) vs enhanced usual care (n=3) in community- based organizations (enrolling approximately 60 women). Specific aim 3: Throughout the duration of the funding period we will arrange for mentored participation of Psychiatry and Community Medicine residents from India in the research project with involvement in the entire spectrum of research activities from interview development and conduct to qualitative and quantitative data analysis and manuscript writing and dissemination. This mentored participation will be supported by regular videoconferenced didactic and case presentation sessions on research methodology. The grant will accomplish the goals of developing a unique mobile application that is scalable, examining its feasibility and building research capacity at the research site in India.