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

总结 在低收入和中等收入国家，少女怀孕的高发生率导致了巨大的 公共卫生负担。许多青少年怀孕是不想要的、计划外的和婚外的。当青春期 女孩成为母亲后，她们的经济和教育发展机会有限。数量迅速增加的 来自中低收入国家的未成年母亲也由于贫困或基于性别的传统而被边缘化，这进一步限制了她们的 获得保健资源、社会保障/支助和个人发展。结构性不平等和不利影响 这种情况导致青少年母亲抑郁症的发病率很高。尽管他的心理健康状况 在中低收入国家，青少年母亲的需求，儿童和青少年心理健康服务仍然处于起步阶段。有必要 推进文化和背景敏感的围产期抑郁症干预措施，可以与青少年的生活相一致， 同时解决提供心理健康方面的多种资源挑战 在LMIC环境中护理。本申请旨在应对这些青少年围产期抑郁症的干预， 通过i）利用世卫组织精神卫生治疗差距行动计划（mhGAP）和小组 人际心理治疗（IPT-G）抑郁症护理包已被证明对成人抑郁症有效， 进一步测试肯尼亚妇幼保健服务中患有围产期抑郁症的青少年的方法 设置.本研究将探讨三个关键的研究问题：（i）如何提高mhGAP/IPT-G-抑郁干预的拟合度 肯尼亚怀孕青少年的模式，（ii）如何有效地整合任务转移/共享和协作策略 结合妇幼保健临床工作流程，对妇幼保健院妊娠青少年实施mhGAP/IPT-G抑郁干预 以及（iii）适应的mhGAP/IPT-G在解决围产期抑郁症方面是否可行-可接受-有效 在青少年中。考虑到需求-资源差距，妇幼保健诊所通常为大量青少年提供服务， 但资源有限，本研究还将探讨其他具有成本效益的策略，如研究 应用长期和微型IPT-G和其他家庭/青少年同伴共同领导干预方法的可行性 实施.这项研究将采用跨学科伙伴关系的办法进行。具体目标是 本研究主要目的是：1）探讨提高mhGAP-IG/IPT-G在青少年中的适用性的障碍和策略 肯尼亚妇幼保健诊所围产期抑郁症; 2）开发IPT-G/和mhGAP-IG的适应版本，并建立妇幼保健诊所 3）测试《行动纲领》改编版的可行性和执行效果 mhGAP-IG/ IPT-G。

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.