Advancing Stepped Care for Women's Common Mental Disorders in an LMIC

在全球范围内，年轻女性承受着不成比例的常见精神障碍负担，特别是 抑郁和焦虑在低收入和中等收入国家解除这一负担需要分担任务， 这需要利用非专家和外行人提供心理健康服务。任务的几次尝试 在中低收入国家分享干预措施的情况略有改善。进一步进展的障碍包括缺乏 关于应该治疗什么样的疾病、用什么样的干预措施、由谁来治疗以及如何克服的证据 访问障碍。此R21应用程序通过开发和测试以下内容，提高了有关任务共享的知识 可行性阶梯护理模式LMIC使用初级保健（PC）护士和心理健康同行治疗 抑郁和焦虑它还通过研究如何低成本， 简要的研究领域标准（RDoC）工具可以帮助评估和定位阶梯式护理。RDoC是一个 NIMH倡议使用维度，疾病不可知论，基于大脑的工具，以更好地了解 精神疾病这项研究在塔吉克斯坦进行，塔吉克斯坦是一个低收入国家，韦内博士目前在那里 资助了R 01，K24和D43关于移民和心理健康和健康的研究。在塔吉克斯坦，妇女 面临与移民丈夫分离、家庭内外暴力、性传播感染 由配偶传播，以及高度的精神疾病耻辱，限制服务的获得， 有限的治疗资源。目标1更好地描述了心理健康的需求，支持，资源， 从一个初级保健中心招募的抑郁症（包括同时发生的焦虑症）妇女的护理障碍 通过定性访谈和焦点小组，在杜尚别的一家诊所进行了调查。目标2成立干预设计小组 它建立在通过目标1获得的知识和两个现有的干预措施（桥梁和人际关系）的基础上 心理治疗），以开发一种新的阶梯式护理模式，包括：1）PC护士和医生领导的筛选 2）同伴和PC护士共同领导的心理教育和支持小组; 3）同伴或PC护士领导的 人际心理治疗; 4）PC医生主导的药物治疗。目标3评估可行性 45名抑郁症患者（包括合并有抑郁症的患者）的分级护理模式的可接受性 焦虑）从杜尚别的初级保健诊所招募，以及评估RDoC的简要工具是否 急性威胁和认知控制的子结构，预测或适度的前后变化。它建立在博士。 韦内与塔吉克斯坦精神卫生和健康领导人和研究人员的强大合作伙伴关系， 杜尚别的棱镜研究中心以及塔吉克斯坦卫生部和共和国 精神病中心这项研究将导致一个适应和试点的阶梯式护理模式，我们希望在一个 R 01研究。它还将提高心理健康研究的能力， 韦内的K24和D43研究培训计划。该研究解决了全球心理的巨大挑战 健康目标C促进将心理健康纳入初级保健，NIMH战略目标3通过制定 新的和更好的干预措施，包括精神病患者的不同需求和情况， 病这将有助于建立一个循证计划，然后可以引入公共卫生服务 在塔吉克斯坦。

Globally, young women bear a disproportionate burden of common mental disorders especially including depression and anxiety. Lifting this burden in low- and middle-income countries (LMICs) requires task sharing, which entails using non-specialists and laypersons to deliver mental health services. Several trials of task sharing interventions in LMICs have shown modest improvement. Obstacles to further progress include lack of evidence regarding what conditions should be treated, with what interventions, by whom, and how to overcome access obstacles. This R21 application advances knowledge about task sharing by developing and testing for feasibility a stepped care model for LMICs using primary care (PC) nurses and mental health peers to treat depression and anxiety. It also integrates neuroscience-based prediction models by investigating how low-cost, brief Research Domain Criteria (RDoC) tools can assist in evaluating and targeting stepped care. RDoC is an NIMH initiative to use dimensional, disease agnostic, brain based tools to better understand the key features of mental illness. The research takes place in Tajikistan, a low-income country, where Dr. Weine has currently funded R01, K24, and D43 research on migration and mental health and health. In Tajikistan, women are exposed to separation from their migrant husbands, violence both within and outside of the home, STIs transmitted by their spouses, as well as high mental illness stigma, restricted service access, and severely limited treatment resources. Aim 1 better characterizes the mental health needs, supports, resources, and barriers to care of women with depression (including with co-occurring anxiety) recruited from one primary care clinic in Dushanbe, through qualitative interviews and focus groups. Aim 2 forms an intervention design team that builds on knowledge gained through Aim 1 and on two existing interventions (BRIDGES and Interpersonal Psychotherapy) to develop a novel stepped care model that includes: 1) PC nurse and physician led screening and triage; 2) peer and PC nurse co-led psycho-education and support groups; 3) peer or PC nurse led Interpersonal Psychotherapy, and; 4) PC physician led medication treatment. Aim 3 assesses the feasibility and acceptability of the stepped care model with 45 women who have depression (including with co-occurring anxiety) recruited from a primary care clinic in Dushanbe, and whether brief tools assessing RDoC subconstructs of acute threat and cognitive control, predict or moderate pre-post changes. It builds on Dr. Weine’s strong collaborative partnerships with Tajik mental health and health leaders and researchers at the Prisma Research Center in Dushanbe, as well as the Tajikistan Ministry of Health and the Republican Psychiatric Center. This study will result in an adapted and piloted stepped care model that we hope to test in a subsequent R01 study. It will also result in increased capacity for mental health research that will augment Weine’s K24 and D43 research training program. The study addresses Grand Challenges in Global Mental Health Goal C to foster integration of mental health into primary care, and NIMH Strategic Aim 3 by developing new and better interventions that incorporate the diverse needs and circumstances of people with mental illness. It will help to build an evidence-based program that can then be introduced into public health services in Tajikistan.