Posttraumatic Stress Disorder Intervention for People with Severe Mental Illness in Low- and Middle-Income Country Primary Care Settings

低收入和中等收入国家初级保健机构中严重精神疾病患者的创伤后应激障碍干预

• 批准号: 10127423
• 负责人: Lauren Christina Ng
• 金额: $ 18.76万
• 依托单位: UNIVERSITY OF CALIFORNIA LOS ANGELES
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-09-01 至 2021-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10127423
• 关键词: Posttraumatic; Stress; Disorder; Intervention; People

PROJECT SUMMARY Background: Low- and middle-income countries (LMICs) have very few mental health professionals. Given the chronic nature of mental disorders, primary care clinics may be best positioned to address mental health in LMICs. However, little is known about factors that influence real-world service delivery, access, quality, and sustainability of mental health interventions in LMIC primary care. Researching whether and how mental health services can be feasibly and effectively delivered in LMIC primary care is a NIMH priority and a grand challenge in global mental health. Severe mental illness (SMI) is the most common form of mental illness seen in primary care clinics in LMICs, and is a top contributor to the burden of disease. People with SMI are at high risk of developing posttraumatic stress disorder (PTSD), which is associated with more severe psychiatric symptoms, functional impairment, and worse treatment outcomes. Specific aims: The current study proposes to develop and assess the feasibility, effectiveness and implementation of a psychotherapy intervention to treat PTSD in patients with SMI in primary care clinics in rural Ethiopia. Aim 1: To conduct semi-structured qualitative interviews with patients, caregivers, providers and community members (n=60) and one community advisory board (n=17) to identify clinically and culturally relevant characteristics of the population and characterize barriers and facilitators to intervention adoption, implementation and sustainability. Results will be used to assess the fit and development of the intervention; Aim 2: To conduct a mixed methods open trial to refine the intervention and explore initial treatment effects (n=20 patients, 20 caregivers); Aim 3: To conduct a mixed methods multi-stakeholder process evaluation to assess intervention implementation as measured by the RE-AIM implementation framework (n=20 patients, 20 caregivers, 7 providers). Candidate: This Mentored Patient-Oriented Research Career Development Award (K23) builds upon the candidate's experience in trauma-focused global mental health research in low-income countries. The candidate's long-term career goal is to be an independent investigator of evidence-based interventions for PTSD and SMI in LMICs. Training objectives: The K23 provides training and mentorship in (1) the course, prevalence and treatment of comorbid PTSD and SMI; (2) health services research, including methods to evaluate how healthcare is delivered and accessed in Ethiopian primary care, and factors that might influence delivery of a psychosocial intervention for PTSD; and (3) implementation science methods to decrease “science-to-service” gaps in providing mental health care in LMIC primary care, including hybrid effectiveness-implementation trials. Training activities. Training will be achieved through mentorship by experts (Drs. David Henderson, Abebaw Fekadu, Charlotte Hanlon, Kim Mueser, and Graham Thornicroft), field-based experience in Ethiopia, formal coursework at Harvard and Boston Universities, and seminars, trainings, and conference and workshop attendance.

项目概要 背景：低收入和中等收入国家 (LMIC) 的心理健康专业人员很少。鉴于慢性 鉴于精神障碍的性质，初级保健诊所可能最适合解决中低收入国家的精神健康问题。然而， 对于影响现实世界心理健康服务的提供、获取、质量和可持续性的因素知之甚少 中低收入国家初级保健干预措施。研究心理健康服务是否以及如何可行和有效 中低收入国家初级保健服务是 NIMH 的优先事项，也是全球心理健康领域的一项重大挑战。严重精神疾病 (SMI) 是中低收入国家初级保健诊所中最常见的精神疾病形式，也是导致精神疾病的主要原因 疾病负担。患有 SMI 的人患创伤后应激障碍 (PTSD) 的风险很高，这是一种 与更严重的精神症状、功能障碍和更差的治疗结果相关。具体的 目标：当前的研究建议制定并评估一项计划的可行性、有效性和实施情况 在埃塞俄比亚农村地区的初级保健诊所，对 SMI 患者进行心理治疗干预以治疗 PTSD。目标1：进行 对患者、护理人员、提供者和社区成员 (n=60) 进行半结构化定性访谈，其中一项 社区咨询委员会（n=17）确定人群的临床和文化相关特征，并 描述干预措施采用、实施和可持续性的障碍和促进因素。结果将用于 评估干预措施的适合性和发展；目标 2：进行混合方法公开试验以完善 干预并探索初始治疗效果（n=20 名患者，20 名护理人员）；目标3：进行混合方法 多利益相关者流程评估，以评估通过 RE-AIM 实施衡量的干预措施实施情况 框架（n=20 名患者、20 名护理人员、7 名提供者）。候选人：这个以患者为导向的研究生涯 发展奖（K23）以候选人在以创伤为重点的全球心理健康研究中的经验为基础 低收入国家。候选人的长期职业目标是成为基于证据的独立调查员 针对中低收入国家 PTSD 和 SMI 的干预措施。培训目标：K23 提供以下方面的培训和指导：(1) 共病 PTSD 和 SMI 的病程、患病率和治疗； (2) 卫生服务研究，包括方法 评估埃塞俄比亚初级保健中如何提供和获得医疗保健，以及可能影响提供服务的因素 针对创伤后应激障碍 (PTSD) 的心理社会干预； (3) 实施科学方法来缩小“科学与服务”之间的差距 在中低收入国家初级保健中提供精神卫生保健，包括混合有效性实施试验。训练 活动。培训将通过专家（David Henderson 博士、Abebaw Fekadu、Charlotte Hanlon、Kim Mueser 和 Graham Thornicroft），在埃塞俄比亚的实地经验，哈佛大学的正式课程以及 波士顿大学，以及研讨会、培训以及会议和讲习班。