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

ASHA 2：抑郁症治疗试验中的人种学研究

• 批准号: 10746492
• 负责人: ALISON KARASZ
• 金额: $ 34.81万
• 依托单位: UNIV OF MASSACHUSETTS MED SCH WORCESTER
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-01 至 2025-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10746492
• 关键词: Address; Affect; Anthropology; Attention; Attitude; BRAIN initiative; Bangladesh; Bangladeshi; Clinic; Clinical; Clinical Trials; Clinical Trials Design; Complex; Data; Data Analyses; Data Collection; Decision Making; Depressed mood; Disease remission; Dose; Economics; Employment; Employment Opportunities; Epidemic; Ethnic Origin; Ethnography; Failure; Floods; Focus Groups; Funding; Future; Gender; Gender Role; Generations; Goals; Government; Health; Household; Individual; Intervention; Intervention Studies; Interview; Knowledge; Life; Link; Local Government; Low income; Manuals; Manuscripts; Marketing; Maternal Health; Mediating; Mediator; Mental Depression; Mental Health; Mentors; Methods; Modeling; National Institute of Mental Health; Neighborhoods; Outcome; Participant; Perception; Phase; Play; Politics; Positioning Attribute; Poverty; Preparation; Process; Productivity; Psychologist; Psychotherapy; Randomized; Recovery; Research; Research Design; Research Personnel; Resources; Risk; Role; Rural; Schools; Security; Social Environment; Source; Specialist; Structure; Students; Supervision; Surveys; Symptoms; Testing; Time; Training; Transportation; Universities; Village Health Workers; Woman; arm; career; comparative; comparison group; contextual factors; cultural values; depressive symptoms; disability; experience; indexing; insight; life history; low and middle-income countries; member; participant observation; patient engagement; poverty alleviation; programs; psychologic; randomized, clinical trials; recruit; reduce symptoms; research study; responders and non-responders; rural poverty; social capital; social culture; sociocultural determinant; syndemic; tool; treatment arm; treatment group; treatment responders; treatment response; treatment trial

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.

全球残疾的主要原因，低收入和中等收入的女性抑郁症普遍存在 国家（LMIC）。贫困是抑郁症的主要原因，而抑郁症会恶化贫困，妥协 经济生产力。 ASHA项目由NIMH的全球大脑计划资助，是一个开创性的 旨在解决孟加拉国妇女中贫困抑郁症联合性的研究研究 具有心理和经济治疗的综合干预模型。该项目是两臂群 在孟加拉国北部朗布尔区的村庄进行的随机临床试验 - 容易发生的洪水 农村贫困率高的地区。由乡村卫生工作者领导的12-15名妇女的治疗组将是 集群随机成综合干预部门（现金/资产转移加问题管理（PM）+ - 基于组的，手动心理治疗）或单独使用PM+。 该申请提出的建议将民族志研究嵌入ASHA RCT中。由an 美国心理学家，人类学家和孕产妇健康专家的跨学科团队以及 孟加拉国，该研究将调查ASHA干预过程之间的复杂关系 个人，家庭，邻里和乡村级别的成果和社会环境。虽然 人种学探究（对当地社会文化背景的整体研究）非常适合新一代 知识，民族志研究很少被整合到心理健康治疗试验中。研究小组将 使用快速民族志（RE）方法进行定性访谈，焦点小组和结构化 观察结果，包括显着的当地属性，例如学校，诊所和道路的存在，以及 关于如何组织生活和治理的观察。比较分析将检查 研究臂之间的差异（仅综合与心理治疗），参与参与度（保留/损耗） 和临床结果（治疗反应与无）。这将允许产生有关关键的假设 调节和中介变量影响结果。 能力建设计划将培训三名来自当地大学的人类学的年轻毕业生 朗布尔（Rangpur），在达卡（Dhaka 场地。研究员将接受数据收集，临床试验设计，研究民族和数据分析的培训。 研究员将在获得研究职位方面获得心理和支持。