ASHA 2: An Ethnographic Study Embedded in a Depression Treatment Trial

抑郁症是全球残疾的主要原因，在低收入和中等收入的妇女中普遍存在。 （LMIC）。贫穷是抑郁症的主要原因，而抑郁症则是贫穷的结果， 经济生产力。由NIMH的全球脑倡议资助，阿莎项目是一个开创性的 一项旨在解决孟加拉国农村妇女贫困-抑郁综合症问题的研究， 心理治疗与经济治疗相结合的综合干预模式。该项目是一个双臂集群 在孟加拉国北方Rangpur地区的村庄进行的一项随机临床试验， 农村贫困率高的地区。由12至15名妇女组成的治疗小组，由村卫生工作者领导， 分组随机分配到综合干预组（现金/资产转移+问题管理（PM）+--a 以小组为基础的手动心理治疗）或单独PM+。 本申请建议在阿莎RCT中嵌入人种学研究。前面的是一头 由美国心理学家、人类学家和孕产妇健康专家组成的跨学科团队， 孟加拉国，该研究将调查阿莎干预过程和 结果，以及个人、家庭、邻里和村庄层面的社会背景。虽然 民族志调查--对当地社会文化背景的全面研究--非常适合新一代的人。 然而，由于缺乏相关知识，人种学研究很少被纳入精神健康治疗试验。研究团队将 使用快速人种志（RE）方法进行定性访谈，焦点小组， 观察，包括突出的当地属性，如学校，诊所和道路的存在，以及 观察日常生活和治理是如何组织的。比较分析将研究 研究组间的差异（综合治疗vs单独心理治疗），参与者参与度（保留/vs自然减员） 和临床结果（治疗反应vs无）。这将允许生成关于关键的假设。 影响结果的调节变量和中介变量。 一个能力建设项目将培训三名来自当地一所大学的人类学年轻毕业生， Rangpur，在达卡提供教学培训，并在数据收集方面进行实际监督， 领域研究员将接受数据收集、临床试验设计、研究伦理和数据分析方面的培训。 研究员将获得指导和支持，以获得研究职位。

A leading cause of global disability, depression is widespread among women in low- and middle-income countries (LMIC). Poverty is a major cause of depression, while depression worsens poverty, compromising economic productivity. Funded by NIMH’s Global Brain Initiative, the ASHA Project is a groundbreaking research study that seeks to address the poverty-depression syndemic among rural Bangladeshi women using an integrated intervention model with both psychological and economic treatment. The project is a two-arm cluster randomized clinical trial carried out in villages in the Rangpur district of northern Bangladesh—a flood prone region with high rates of rural poverty. Treatment groups of 12-15 women, led by village health workers, will be cluster-randomized into the integrated intervention arm (cash/asset transfer plus Problem Management (PM)+--a group-based, manualized psychotherapy) or to PM+ alone. This application proposes to embed an ethnographic study inside the ASHA RCT. Led by an interdisciplinary team of psychologists, anthropologists, and maternal health specialists in the US and Bangladesh, the study will investigate the complex relationships between ASHA intervention processes and outcomes, and social contexts at the individual, household, neighborhood, and village levels. Although ethnographic inquiry—the holistic study of local sociocultural contexts—is well suited to the generation of new knowledge, ethnographic studies are rarely integrated into mental health treatment trials. The research team will use a rapid ethnography (RE) approach to conduct qualitative interviews, focus groups, and structured observations, including salient local attributes such as presence of schools, clinics, and roads, alongside observations about how everyday life and governance is organized. A comparative analysis will examine differences across study arms (integrated vs psychotherapy alone), participant engagement (retention/vs attrition) and clinical outcomes (treatment response vs none). This will allow for the generation of hypotheses about key moderating and mediating variables affecting outcomes. A capacity building program will train three young graduates in anthropology from a local university in Rangpur, providing both didactic training in Dhaka as well as hands on supervision in data collection in the field. Fellows will receive training in data collection, clinical trial design, research ethnics and data analysis. Fellows will receive mentoring and support in obtaining research positions.