Reducing stress, anxiety, and depressive symptoms via a family-centered preventative intervention for immigrants: A randomized controlled feasibility trial

摘要 生活在美国的移民比一般人更容易出现心理健康问题，而且 在最昂贵的医疗疾病中，精神健康疾病位居榜首。与尝试 融入一种社会孤立和沟通有限的新文化与心理健康结果有关 在移民中。现有的针对移民的心理健康干预主要是基于治疗模式 改善那些被诊断为精神健康问题的人的机会和护理质量，无论从文化上讲 旨在减轻移民压力的量身定制的预防性行为干预措施有限。为 预防，针对心理-社会-文化压力来源的针对文化的干预措施最有希望。 我们在此应用程序中的目标是：a)适应并在文化上修改Problem Management Plus(PMP) 由世界卫生组织开发的循证干预，以开发问题管理+ 对移民(PMP-I)作为以家庭为基础的预防性干预和b)测试可行性、可接受性、 和初步结果(压力，焦虑，抑郁症状)的PMP-I与训练有素的社区促进者。 我们计划将PMP调整为包括多个组成部分、心理教育、行为激活和心身 适当的干预措施，以减轻移民的长期压力。我们将适应和改变文化 PMP通过增加关于压力管理和沟通技能的教育课程来开发我们的PMP-I， 对应对机制、提供社会支持和瑜伽的行为激活。PMP-I是一个由同行主导的 在家庭中提供文化定制的心理教育、行为激活、呼吸和瑜伽干预 5周内的设置。该项目将与马萨诸塞州西部的不丹社区一起进行 大学生情绪困扰和社会孤立对心理健康问题的要求和需求 我们以社区为基础的试点参与性研究。我们强大的社区网络和跨学科研究 团队已经到位，赋予社区成员作为干预者、监督者和研究助理的权力 通过提供广泛的培训。训练有素的社区干预者将向感兴趣的人提供为期5周的PMP-I 58个家庭中18岁及以上的成年人，并将向另外58个家庭分发支助服务小册子， 将被随机分配。研究助理将收集有关结果和其他变量的信息 在基线、干预后和干预后三个月。我们会采集头发样本检测皮质醇 测量(基线，干预后3个月)，并在UMassAmherst实验室进行处理。这个 将使用多水平模型分析干预对结果的初步影响。我们将讨论 并采访干预者和参与者，以衡量PMP-I的可行性和可接受性。在 这个项目完成后，我们将开发和试行以家庭为基础的预防性心理健康 对移民的干预。实现这一目标将对改善心理健康产生显著的积极影响。 这将有助于移民及其家庭的健康，也将增强社区发挥领导作用的能力。

Summary Immigrants living in the U.S. are more vulnerable to mental health problems than the general population, and mental health disorders top the list of the most costly medical conditions. Stress associated with attempts to integrate into a new culture with social isolation and limited communication is linked to mental health outcomes among immigrants. Existing mental health interventions for immigrants are largely based on treatment models to improve the access and quality of care for those with diagnosed mental health problems, however culturally tailored preventative behavioral interventions aimed at reducing stress among immigrants are limited. For prevention, culturally-tailored interventions that address psycho-socio-cultural stressors hold the most promise. Our objectives in this application are: a) to adapt and culturally modify Problem Management Plus (PMP), an evidence-based intervention developed by World Health Organization, to develop Problem Management Plus for Immigrants (PMP-I) as a family-based preventative intervention and b) to test the feasibility, acceptability, and preliminary outcomes (stress, anxiety, depressive symptoms) of PMP-I with trained community facilitators. We plan to adapt PMP to include multi-component, psychoeducation, behavioral activation, and mind-body intervention that are appropriate to reduce chronic stress of immigrants. We will adapt and culturally modify PMP to develop our PMP-I by adding an educational session on stress management and communication skills, behavioral activation on coping mechanisms, provision of social support, and yoga. PMP-I is a peer-led, culturally-tailored psychoeducation, behavioral activation, breathing and yoga intervention delivered in family settings over a 5-week period. This project will take place with a Bhutanese community in Western, MA upon their request and identified need of mental health problem due to their emotional distress and social isolation in our pilot community based participatory research. Our strong community network and interdisciplinary research team is in place to empower community member as interventionists, supervisors, and research assistants through providing extensive training. Trained community interventionists will deliver 5-week PMP-I to interested adults aged 18 and older in 58 families and will distribute support services pamphlets to another 58 families, which will be allocated randomly. Research assistants will collect information on outcomes, and other variables at baseline, post-intervention, and three-month after intervention. We will collect hair samples for cortisol measurement (baseline, 3-mth post intervention) and process it at the UMass Amherst laboratory. The preliminary effect of the intervention on outcomes will be analyzed using multilevel modelling. We will discuss and interview interventionists and participants to measure the feasibility and acceptability of PMP-I. At the completion of this project, we will have developed and pilot tested family-based preventative mental health intervention for immigrants. Achieving this aim will have a significant positive impact on improving the mental health of immigrants and their families and will also empower the community to take a leading role.