Global Mental Health Research Fellowship: Interventions That Make a Difference

描述（由申请人提供）：在全球15岁及以上人群中，精神障碍占致残年的前10名贡献者中的3名。这一贡献在低收入和中等收入国家更为明显。低收入和中等收入国家中75%以上的精神障碍患者尽管有严重残疾，但没有得到治疗，即使提供治疗，也很少基于循证做法，侵犯人权的行为仍然经常发生。2007年，《柳叶刀》全球精神卫生系列杂志得出结论，“应当资助研究开发和评估非精神卫生专业人员（任务转移）可提供的干预措施，并评估卫生系统如何在所有常规护理环境中扩大此类干预措施。”在美国，全球健康研究已经成为NIH的五个优先事项之一，全球精神健康研究现在是NIMH明确的优先事项。尽管最近呼吁采取行动并将其视为高度优先事项，但关注中低收入国家精神障碍的国际研究合作有限。此外，在GMH临床研究中没有正式的NIH研究生培训计划。这个拟议的项目将与巴西、尼日利亚和中亚国家合作，为下一代转基因基因科学家提供培训，并将有双重重点。第一个是以部署为重点的干预研究，这样，研究员将学习开发针对资源贫乏地区部署的干预措施。通过社区合作，研究人员将接受适应和实地试验方面的培训，以直接处理识别、评估、预防和治疗的行之有效的干预措施。第二个重点是干预措施的传播、实施和服务研究，研究人员学习审查如何将心理健康预防、评估和治疗干预措施转化为在特定的低收入和中等收入国家环境中加以利用。全球心理健康（GMH）研究培训方案将包括八个组成部分：(1)指导；(2)临床研究设计、统计学、专题、基金写作等教学课程；(3) GMH专业培训；(4)参与研究，包括研究的设计、执行和分析，以及提交科学论文、评审和提案；(5)通过设计和实施自己的试点项目，在任务转移和其他增强访问策略方面具有实践研究经验；（六）指导负责任的研究工作；(7)在科学会议上作报告；(8)与哥伦比亚大学的教师、我们的全球合作伙伴和该领域的杰出研究人员进行交流。该项目将利用哥伦比亚大学现有的项目和设施以及国际网站提供丰富的学习环境，使研究员沉浸在一个专注于促进当地和全球心理健康的科学努力的环境中。因为在美国，服务不足的人群非常多，这个培训项目也将教会年轻的研究人员必要的技能来实施研究方案，从而缩小这个国家精神卫生保健服务的差距。

DESCRIPTION (provided by applicant): Mental disorders comprise three of the top 10 contributors to years lived with disability globally among those aged 15 years and over. The contribution is more pronounced in low- and middle-income countries (LMICs). Over 75% of those with mental disorders in LMICs receive no care despite substantial disability, and where treatment is provided, it is rarely based on evidence-based practices and human rights violations still occur frequently. In 2007, the Lancet Global Mental Health Series concluded that "funding should be given to research that develops and assesses interventions that can be delivered by people who are not mental health professionals (task-shifting), and that assesses how health systems can scale up such interventions across all routine-care settings." In the US, global health research has become one of five NIH priorities and global mental health research is now an explicit NIMH priority. Despite recent calls for action and recognition as a high priority, international research collaborations focused on mental disorders in LMICs is limited. Further, formal NIH postgraduate training programs in GMH clinical research are not available. In partnership with Brazil, Nigeria and countries in Central Asia, this proposed program will provide training to the next generation of GMH scientists and will have a two-fold focus. The first is deployment-focused interventions research, such that fellows will learn to develop interventions geared towards deployment in resource poor areas. With community collaboration, fellows will be trained on adaptation and field-testing of tried and true interventions that directly address recognition, assessment, prevention and treatment. The second focus is intervention dissemination, implementation and services research, with fellows learning to examine how mental health prevention, assessment and treatment interventions can be translated for utilization in specific LMIC settings. The Global Mental Health (GMH) Research Training program will include eight components: (1) mentorship; (2) didactic courses in clinical research design, statistics, special topics, grant writing; (3) specialized training in GMH; (4) participation in research, including design, execution and analysis of studies and submission of scientific papers, reviews and proposals; (5) hands-on research experience in task-shifting and other access- enhancing strategies through design and implementation of their own pilot projects; (6) instruction in the responsible conduct of research; (7) presentation at scientific meetings; and (8) interchange with Columbia faculty, our Global partners, and distinguished researchers in the field. This program will leverage existing programs and facilities at Columbia University and international sites to provide a rich learning environment so that fellows are steeped in a milieu focused on the scientific endeavor of promoting mental health locally and worldwide. Because underserved populations are sadly abundant in the US, this training program will also teach young investigators the necessary skills to implement research protocols that can lead to the closing of the mental health care delivery gap in this country as well. PUBLIC HEALTH RELEVANCE: People in Low and Middle Income Countries do not receive proper mental health care. This Global Mental Health Research Fellowship will train scientists to enhance access and implementation of effective and feasible mental health interventions that are adapted to each country's culture and context, making more efficient use of less specialized human resources available in various systems of care., U.S. repercussions too are of import, given the lack of services available in low resource areas in our country.