Generation Malawi: A study of family, maternal and childhood mental health

低收入和中等收入国家(LMIC)缺乏研究培训、资源、基础设施和数据，极大地限制了它们对常见心理健康状况进行研究的能力。在非洲，尤其是马拉维，这一点尤为明显。在马拉维，仅有稀少的精神卫生保健不仅限制了临床研究能力，而且还限制了吸引外来投资的能力。在英国和马拉维机构之间的伙伴关系中，我们建议通过协调任命新的研究人员和研究助理、教育和传播方案以及开发人口心理健康数据集来直接应对这一挑战，方法是协调任命新的研究人员和研究助理，并开发人口心理健康数据集，重点放在一个巨大的未得到满足的需求领域--母亲及其子女的心理健康。经过一段时间的研究评估试点并获得必要的批准后，我们将从利隆圭和卡隆加地区的产前诊所招募5000名分娩前的母亲，这两个地区分别代表城市和农村人口。我们将评估母亲在出生前和出生后的心理健康状况，以及其配偶和其他家庭成员的心理健康状况，以确定心理健康障碍的主要危险因素，并缓解促进韧性的变量。然后，我们将研究母亲和父亲的心理健康对其后代神经发育的影响。除了创建新的高度有价值的数据外，我们还将创建未来遗传学和基于组学的研究所需的生物资源。我们认为，这对于防止目前偏向以欧洲血统为主的富裕国家的基因研究的不平衡导致全球卫生不平等更加根深蒂固。作为拟议工作的一部分，我们将在马拉维发展具有国际竞争力的研究能力和数据集，提高护理治疗标准，发展研究培训，并提供负担得起的有效干预措施，如“友谊长凳”干预措施。我们的研究将是多学科的，包括来自英国和马拉维的精神病学、临床心理学、护理、生殖和儿童健康以及社会科学的专家。在整个项目中，我们将仔细监测我们的进展和对参与者及其社区的影响。该项目如果得到资助，将导致马拉维精神卫生研究能力的阶段性变化，为新的对内投资和制定基于证据的干预措施和政策铺平道路。

A lack of research training, resources, infrastructure and data in Low- and Middle-Income Countries (LMIC) greatly limits their ability to conduct studies of common mental health conditions. Nowhere is this more true than in Africa generally and in Malawi specifically, where sparse mental health care alone limits not only clinical research capacity, but also the ability to attract inward investment. In a partnership between UK and Malawian institutions, we propose to directly address this challenge by building clinical research capacity through the coordinated appointment of new researchers and research assistants, a programme of education and dissemination, and the development of a population mental health dataset focussed on an area of great unmet need - the mental heath of mothers and their children. After a period of piloting our research assessments and obtaining the necessary approvals, we will recruit 5000 mothers prior to delivery of their child from antenatal clinics in Lilongwe and Karonga districts, selected to represent urban and rural populations respectively. We will assess the mental health of mothers before and after birth, and the mental health of their spouses and other family members with a view to identifying the major risk factors for mental health disorders and mitigating variables that promote resilience. We will then examine the impact of maternal and, where possible, paternal mental health on the neurodevelopment of their offspring. In addition to creating new and highly valuable data, we will also create the bioresources needed for future genetics and 'omics based research. We believe this is essential to prevent the current imbalance in genetic research favouring rich countries of predominantly European ancestries leading to greater entrenchment of global health inequalities.As part of the proposed work, we will develop internationally competitive research capacity and datasets in Malawi, augment standard of care treatment, develop research training and the availability of affordable and effective interventions for depression and other common mental disorders, such as the "Friendship Bench" intervention. Our research will be multidisciplinary, involving experts from psychiatry, clinical psychology, nursing, reproductive and child health, and social sciences in both UK and Malawi. Throughout the project, we will carefully monitor our progress and impact on the participants and their communities. The project, if funded, will lead to a step change in mental health research capacity in Malawi, paving the way for new inward investment and the development of evidence based interventions and policies.