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

抑郁症是全球残疾的主要原因之一，在中低收入女性中普遍存在 国家(LMIC)。贫困是抑郁症的一个主要原因，而抑郁症会加剧贫困，损害 经济生产力。由NIMH的全球大脑倡议资助的Asha项目是一个开创性的项目 一项旨在解决孟加拉农村妇女中贫困-抑郁综合征的研究 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 在孟加拉北部易发洪水的朗普尔地区的村庄进行了随机临床试验 这是一个农村贫困率高的地区。由村卫生工作者领导的12-15名妇女的治疗小组将 集群-随机进入综合干预分支(现金/资产转移加上问题管理(PM)+--a 以团体为基础的人工心理治疗)或单独使用PM+。 该应用程序建议在Asha RCT中嵌入一项人种学研究。由An领导 由美国心理学家、人类学家和产妇健康专家组成的跨学科团队 在孟加拉国，这项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 在知识方面，人种学研究很少被纳入心理健康治疗试验。研究小组将 使用快速人种志(RE)方法进行定性访谈、焦点小组和结构化 观察，包括突出的地方属性，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。一项比较分析将检验 不同研究分支之间的差异(综合治疗与单独心理治疗)、参与者参与度(保留/消耗) 和临床结果(治疗反应与无反应)。这将允许生成关于键的假设 调节和调节影响结果的变量。 一项能力建设计划将培训三名来自当地大学的人类学年轻毕业生。 Rangpur，在达卡提供教学培训，并在#年实际监督数据收集 菲尔德。研究员将接受数据收集、临床试验设计、研究伦理学和数据分析方面的培训。 研究员将在获得研究职位方面得到指导和支持。

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.