RISE Study ("Resist, Intervene, Support, Empower"): Feasibility/Acceptability of MHealth Intervention targeting Transgender Women facing gender-based violence and mental health disorders in Brazil

与非变性妇女相比，变性妇女不成比例地遭受身体/性暴力。 一般人口和其他性和性别少数群体（SGM）。最近的一项系统评价确定了一个 过渡时期妇女中终身身体暴力（68%）或性暴力（49%）的发生率很高。频繁的经历 暴力导致高水平的创伤后应激障碍（PTSD），广泛性焦虑症 (GAD)自杀倾向、物质使用障碍（SUD），并可能影响 TGW中的重度抑郁障碍（MDD）。自2008年以来，巴西占全球人口的40%以上。 跨性别杀人案在世界各地都有报道。在2016/17年度，我们对来自12个国家的2，846 TGW进行了调查 巴西城市，确定60%的终生暴力（身体和/或性暴力）发生率，60%的参与者 抑郁症筛查阳性，广泛性焦虑症38%，自杀未遂35%。大多数暴力事件是 没有向警方报案（91%），大多数受害者没有接受任何咨询或心理健康（MH） 治疗（82%）。在这次重新提交，我们将利用社区参与式研究（CBPR），以适应 “UNI-FORM”应用程序和在线平台（https：uni-form.eu）。研究的具体目标是： (1)完善和调整“UNI-FORM”移动健康干预措施，使之适用于巴西（RISE），包括MH筛查和链接 （2）预防暴力、改善精神卫生筛查和治疗的RISE试点试验;（3）评估 的可行性和可接受性。这个R21探索性项目建议从里约热内卢招募200 TGW 巴西里约热内卢研究RISE的实施。与NIMH提高研究能力的目标相一致， 该提案由一名早期研究人员领导，包括与来自以下国家的研究人员密切合作： 杜克谁将提供不断的监督，从研究人员与高级专业知识在SGM的健康（博士。 Legrand）、SGM MH国际研究（Whetten博士）、MH和实施科学（Belden博士）。这 该提案在几个方面具有创新性：它将适应巴西现有的移动健康干预措施， 与性暴力侵害妇女行为有关的暴力行为（UNI-FORM），增加对性暴力侵害妇女行为的筛查和与性暴力侵害妇女行为的联系 在乎拟议的应用程序RISE有可能改善危机应对并促进及时的MH护理 在高风险人群中：TGW。它具有重要意义和影响：干预将预防和应对 在一个世界上变性人谋杀率最高的国家，对TGW的暴力行为。它还将 制定一项创新战略，以确定需要MH护理的TGW， PTSD、GAD、MDD、SUD和自杀倾向的患病率。这些精神障碍没有得到充分的筛查， 在TGW中诊断不足和治疗不足。如果成功，干预措施可以扩大规模， 适应其他国家和地区。这项研究将产生关键的第一步，在发展一个较低的 我们计划在随后的R 01中通过RCT进行评估。上升 解决了SGM健康研究特别关注通知中确定的所有三个NIMH优先事项 人口（NOT-MD-19-001），全球心理健康的重大挑战和NIMH战略目标3。

Transgender women (TGW) disproportionately experience physical/sexual violence when compared with the general population and with other sexual and gender minorities (SGMs). A recent systematic review identified a high prevalence of lifetime physical (68%) or sexual violence (49%) among TGW. Frequent experiences of violence contributes to high levels of posttraumatic stress disorder (PTSD), generalized anxiety disorder (GAD), suicidality, substance use disorder (SUD) and might influence the onset, progression, and prognosis of major depressive disorder (MDD) among TGW. Since 2008 Brazil is responsible for more than 40% of all transgender homicides reported worldwide. In 2016/17 we conducted a survey with 2,846 TGW from twelve Brazilian cities, identifying 60% prevalence of lifetime violence (physical and/or sexual), 60% of participants screened positive for MDD, 38% for GAD, and 35% attempted suicide. The majority of violent incidents were not reported to the police (91%) and most victims did not receive any counseling or mental health (MH) treatment (82%). On this resubmission, we will utilize community-based participatory research (CBPR) to adapt the “UNI-FORM” app and online platform (https://uni-form.eu) to TGW from Brazil. The study specific aims are: (1) Refine and adapt the “UNI-FORM” mHealth intervention to Brazil (RISE), including MH screening and link to MH care; (2) Pilot test RISE to prevent violence, improve MH screening and treatment; and (3) Evaluate the feasibility and acceptability of RISE. This R21 exploratory project proposes to recruit 200 TGW from Rio de Janeiro, Brazil to study the implementation of RISE. Consistent with NIMH goal to enhance research capacity, the proposal is led by an early stage investigator and includes a close collaboration with researchers from Duke who will provide constant supervision from researchers with senior expertise in SGM mHealth (Dr. Legrand), SGM MH international research (Dr. Whetten), MH and implementation science (Dr. Belden). This proposal is innovative in several ways: it will adapt to Brazil an existing mHealth intervention addressing SGM-related violence (UNI-FORM), to include additional features to increase MH screening and linkage to MH care. The proposed app, RISE, has the potential to improve crises response and promote timely MH care among a high-risk population: TGW. It has significance and impact: The intervention will prevent and respond to violence against TGW, in a country with the highest rate of transgender murders in the world. It will also develop an innovative strategy to identify and link to care TGW who need MH care, a population with high prevalence of PTSD, GAD, MDD, SUD and suicidality. Those mental disorders are underscreened, underdiagnosed, and undertreated among TGW. If successful, the intervention could be scaled up and adapted to other populations and countries. This research will yield the crucial first steps in developing a lower cost and efficacious mHealth intervention that we plan to evaluate with an RCT in a subsequent R01. RISE addresses all three NIMH priorities identified in the Notice of Special Interest in Research on Health of SGM Populations (NOT-MD-19-001), Grand Challenges in Global Mental Health and NIMH Strategic Aim 3.