ASHA Bangladesh--An Integrated Intervention to Address Depression in Low Income Rural Women

抑郁症是导致全球残疾的主要原因之一，在中低位女性中普遍存在 收入国家(LMIC)。贫困通过多种途径在抑郁症中发挥重要作用，而 经济萧条加剧了贫困，损害了经济生产率。努力增加获取信息的机会 LMIC中抑郁症的治疗一直受到治疗摄取率/参与度低和治疗力度较弱的阻碍 治疗效果。最近，研究人员和政策制定者指出了贫困的重要性 缓解在全球范围内再次爆发的抑郁症大流行。我们建议实施一项综合的 孟加拉国农村低收入妇女的扶贫/抑郁治疗干预， 旨在打破贫困和抑郁的恶性循环。将建立一个能力建设组成部分 为年轻科学家提供定性实施研究的技能和支持职业发展 为达卡大学的研究生设立为期一年的研究奖学金。 我们的项目建立在阿尔伯特·爱因斯坦医学院和 达卡的ICDDRB。在我们成功的试点研究之后，我们将实施一项整群随机试验 综合干预，从80个村招募1200名低收入抑郁症妇女。 村庄将被随机分成四个治疗臂之一：1)循证抑郁症治疗； 2)农业资产转让扶贫；3)抑郁症/贫困综合治疗 缓解；4)不处理对照。参与者将被跟踪24个月。我们假设： 与抑郁症相比，联合治疗组在6个月和24个月时改善了抑郁结局 仅仅是治疗或扶贫。详细的、混合的方法流程评估，旨在 生成关于影响结果的计划和背景因素的新假设，将包括 对计划参与者和工作人员进行深入的定性访谈，由ASHA研究员进行。 拟议的项目将产生对政策制定者具有重大影响的调查结果。到目前为止， 抑郁症研究人员和经济发展组织的工作几乎没有包括 协作。寻求减少抑郁的计划并没有解决 同样，扶贫方案也没有解决心理健康在 经济生产力。这项研究的结果，如果有希望，将产生证据指导 发展机构、研究人员、政策制定者和治疗提供者之间的合作。 我们团队的传播努力将为政府机构、国际和国家健康 和经济发展非政府组织考虑新一代合作的潜力， 综合干预方法。

A leading cause of global disability, depression is widespread among women in low and middle income countries (LMIC). Poverty plays a major role in depression via multiple pathways, while depression worsens poverty, compromising economic productivity. Efforts to increase access to depression treatment in LMIC have been hampered by low treatment uptake/engagement and weak treatment effects. Recently, researchers & policy makers have pointed to the importance of poverty alleviation in the fight again the global depression pandemic. We propose to implement an integrated poverty alleviation/depression treatment intervention for low income women in rural Bangladesh, designed to break the toxic cycle of poverty and depression. A capacity building component will build skills and support career development in qualitative implementation research for young scientists and establish a year-long research fellowship for graduate students at the University of Dhaka. Our project builds on an established partnership between Albert Einstein College of Medicine and the ICDDRB in Dhaka. Following our successful pilot study, we will implement a cluster randomized trial of an integrated intervention, recruiting 1200 low income women with depression from 80 villages. Villages will be randomized into one of four treatment arms: 1) evidence based depression treatment; 2) poverty alleviation through an agricultural asset transfer; 3) combined depression treatment/poverty alleviation, and 4) no-treatment control. Participants will be followed for 24 months. We hypothesize: improved depression outcomes at 6 and 24 months in the combined arm, compared to depression treatment or poverty alleviation alone. A detailed, mixed methods process evaluation, designed to generate new hypotheses regarding program and contextual factors influencing outcomes, will include in-depth qualitative interviews with program participants and staff, conducted by ASHA fellows. The proposed project will generate findings with significant implications for policy makers. To date, the work of depression researchers and economic development groups has included little collaboration. Programs that seek to reduce depression do not address the devastating impact of poverty; while, similarly poverty alleviation programs do not address the role of mental health in economic productivity. Results of this study, if promising, will generate evidence to guide collaborations among development agencies, researchers, policy-makers, and treatment providers. Our team’s dissemination efforts will bring government agencies, international and national health and economic development NGOS to consider the potential for a new generation of collaborative, integrated intervention approaches.