Reducing Barriers to Mental Health Task Sharing

描述（由申请人提供）：从1990年到2010年，抑郁症导致的全球疾病负担上升了37%。低收入和中等收入国家（LMIC）的未来预测增幅最大。然而，在低收入和中等收入国家，提供精神卫生服务需要120万卫生工作者。分担任务，让非专业卫生工作者参与提供精神卫生服务，是缩小这一差距的一个重要方面。包括心理治疗在内的任务分担干预的随机对照试验（rct）已经证明，许多低收入人群的抑郁症状有所减轻。扩大随机对照试验的障碍包括非专业卫生工作者对精神疾病患者的消极态度和歧视行为。K01指导研究职业发展奖的目标是扩大候选人在任务分担倡议的复杂干预试验方面的专业知识，重点是减少承担精神卫生保健提供新责任的卫生工作者的消极态度和歧视行为。通过研究、课程作业和结构化的指导活动，候选人将在复杂干预研究中发展新的能力，包括(1)复杂干预的概念知识和变革理论；(2)在卫生系统中设计、实施和分析聚类随机对照试验的方法学技术；(3)低收入和中等收入国家卫生系统干预研究的伦理行为及与心理保健消费者的合作；(4)专业发展，成为独立的nimh资助的研究者。Drs。Kathleen Sikkema, Vikram Patel， Crick Lund和Bernice Pescosolido将在这四个目标上指导候选人。这项研究将通过NIMH南亚精神卫生宣传、研究和教育中心（SHARE）的基础设施和改善精神卫生保健任务分担倡议（PRIME）在尼泊尔进行。候选人将评估补充培训模块的可行性和可接受性，以改善对精神疾病患者的态度和社会参与，目标是超越传统的耻辱感和减少耻辱感干预的概念。该模块将被添加到精神卫生差距行动方案（mhGAP）培训中，以提高提供者在循证实践（EBP）方面的能力，并减轻患者抑郁症的严重程度。将对初级保健工作者进行社会参与培训的分组随机对照试验，以评估培训内容、程序、不良事件监测和分析方法的可行性和可接受性。本试验的目的包括适应和预试点社会参与培训模块，试点集群rct，并进行定量描述性分析，为适当动力的R01做准备，该R01将评估减少初级保健工作者的消极态度和歧视行为对EBP质量和患者结果的影响。在尼泊尔，这项研究将有助于建立可扩展的培训模式，以促进高质量的临床服务，并最大限度地减少因提供者长期存在的偏见和歧视而导致的实施障碍。该研究解决了全球精神卫生方面的重大挑战：目标C促进将精神卫生纳入初级保健；目标D推进减少耻辱感的方法；目标E开发可持续的培训模式以提供EBP。这些目标推进了NIMH战略目标4，通过扩大知识库，在不同的提供者群体中促进EBP，并通过与精神疾病患者合作，改善EBP的传播和实施，为NIMH前进之路的使命做出贡献。

DESCRIPTION (provided by applicant): The global burden of disease attributable to depression rose 37% from 1990 to 2010. The future projected rise is greatest in low- and middle-income countries (LMIC). However, there is a gap of 1.2 million health workers needed to provide mental health services in LMIC. Task-sharing, the involvement of non-specialist health workers to deliver mental health services, is an essential aspect of reducing this gap. Randomized controlled trials (RCTs) of task-sharing interventions including psychotherapy have demonstrated depression symptom reduction in numerous LMIC. Barriers to scaling up RCTs include negative attitudes and discriminatory behaviors among non-specialist health workers against persons with mental illness. The goal of this K01 Mentored Research Career Development Award is to broaden the candidates expertise in complex intervention trials of task-sharing initiatives with a focus on reducing negative attitudes and discriminatory behaviors among health workers assuming new responsibilities in mental health care delivery. Through research, coursework, and structured mentorship activities, the candidate will develop new competencies in complex intervention research including (1) conceptual knowledge of complex interventions and theory of change; (2) methodological techniques for design, implementation and analysis of cluster-RCTs in health systems; (3) ethical conduct of health systems intervention research in LMIC and collaboration with mental healthcare consumers; and (4) professional development to become an independent NIMH-funded investigator. Drs. Kathleen Sikkema, Vikram Patel, Crick Lund, and Bernice Pescosolido will mentor the candidate in these four objectives. The research will be conducted in Nepal through infrastructure of the NIMH U19 South Asia Hub for Advocacy, Research, and Education for Mental Health (SHARE) and the task-sharing initiative Programme for Improving Mental Health Care (PRIME). The candidate will evaluate the feasibility and acceptability of a supplemental training module to improve attitudes toward and social engagement with persons with mental illness, with the goal of moving past traditional concepts of stigma and stigma-reduction interventions. This module will be added to a mental health Gap Action Programme (mhGAP) training to of improve provider competence in evidence based practices (EBP), and reduce patient depression severity. A pilot cluster-RCT of social engagement training for primary care workers will be conducted to assess feasibility and acceptability of content, procedures, adverse event monitoring, and analytic approaches. The aims of this pilot cluster-RCT include adaptation and pre-piloting a social engagement training module, piloting a cluster-RCT, and performing quantitative descriptive analysis to prepare for an appropriately powered R01, which would evaluate the impact of reducing negative attitudes and discriminatory behaviors among primary care workers on EBP quality and patient outcomes. In Nepal, this research will contribute to scalable training models that promote quality clinical services and minimize barriers to implementation stemming from biases and discrimination perpetuated by providers. The study addresses Grand Challenges in Global Mental Health Goal C to foster integration of mental health into primary care, Goal D to advance methods to reduce stigma, and Goal E to develop sustainable training models to deliver EBP. These goals advance NIMH Strategic Aim 4 by expanding the knowledge base to promote EBP among diverse provider groups and contribute to the mission of the NIMH Road Ahead through collaboration with persons living with mental illness to improve dissemination and implementation of EBP.