Posttraumatic Stress Disorder Intervention for People with Severe Mental Illness in Low- and Middle-Income Country Primary Care Settings

项目总结 背景：低收入和中等收入国家(LMIC)的精神卫生专业人员非常少。考虑到慢性病 由于精神障碍的性质，初级保健诊所可能是解决低收入群体精神健康问题的最佳选择。然而， 对影响实际服务提供、获取、质量和心理健康可持续性的因素知之甚少 LMIC初级保健的干预措施。研究是否以及如何可行和有效地提供精神卫生服务 在LMIC初级保健中提供服务是NIMH的优先事项，也是全球精神卫生领域的一项重大挑战。严重的精神疾病 (SMI)是LMIC初级保健诊所中最常见的精神疾病形式，是导致 疾病的负担。患有SMI的人患创伤后应激障碍(PTSD)的风险很高，这是 与更严重的精神症状、功能障碍和更差的治疗结果相关。特定的 目标：本研究建议制定和评估一项 心理治疗干预在埃塞俄比亚农村初级保健诊所治疗重度精神障碍患者的PTSD。目标1：进行 与患者、照顾者、提供者和社区成员的半结构化定性访谈(n=60)和1 社区咨询委员会(n=17)，以确定人口的临床和文化相关特征和 描述干预措施采用、实施和可持续性方面的障碍和促进者。结果将用于 评估干预的适合性和发展；目标2：进行混合方法开放试验，以完善 干预和探索初始治疗效果(n=20名患者，20名照顾者)；目标3：进行混合方法 多利益相关者过程评估，以评估RE-AIM实施所衡量的干预实施情况 框架(n=20名患者，20名照顾者，7名提供者)。应聘者：指导以患者为中心的研究生涯 发展奖(K23)基于候选人在以下领域以创伤为重点的全球精神卫生研究的经验 低收入国家。候选人的长期职业目标是成为一名基于证据的独立调查员 LMICs中创伤后应激障碍和SMI的干预培训目标：K23提供以下方面的培训和指导： 课程，共患创伤后应激障碍和精神障碍的患病率和治疗；(2)保健服务研究，包括 评估埃塞俄比亚初级保健如何提供和获得医疗保健，以及可能影响提供保健服务的因素 对创伤后应激障碍进行心理社会干预；以及(3)通过实施科学方法缩小“科学与服务”之间的差距 在LMIC初级保健中提供精神卫生保健，包括混合有效性实施试验。培训 活动。培训将通过专家(David Henderson博士、Abebaw Fekadu博士、夏洛特博士)的指导实现 Hanlon、Kim Mueser和Graham Thornmicroft)，在埃塞俄比亚的实地经验，哈佛大学和 波士顿大学，以及研讨会、培训以及出席会议和研讨会。

PROJECT SUMMARY Background: Low- and middle-income countries (LMICs) have very few mental health professionals. Given the chronic nature of mental disorders, primary care clinics may be best positioned to address mental health in LMICs. However, little is known about factors that influence real-world service delivery, access, quality, and sustainability of mental health interventions in LMIC primary care. Researching whether and how mental health services can be feasibly and effectively delivered in LMIC primary care is a NIMH priority and a grand challenge in global mental health. Severe mental illness (SMI) is the most common form of mental illness seen in primary care clinics in LMICs, and is a top contributor to the burden of disease. People with SMI are at high risk of developing posttraumatic stress disorder (PTSD), which is associated with more severe psychiatric symptoms, functional impairment, and worse treatment outcomes. Specific aims: The current study proposes to develop and assess the feasibility, effectiveness and implementation of a psychotherapy intervention to treat PTSD in patients with SMI in primary care clinics in rural Ethiopia. Aim 1: To conduct semi-structured qualitative interviews with patients, caregivers, providers and community members (n=60) and one community advisory board (n=17) to identify clinically and culturally relevant characteristics of the population and characterize barriers and facilitators to intervention adoption, implementation and sustainability. Results will be used to assess the fit and development of the intervention; Aim 2: To conduct a mixed methods open trial to refine the intervention and explore initial treatment effects (n=20 patients, 20 caregivers); Aim 3: To conduct a mixed methods multi-stakeholder process evaluation to assess intervention implementation as measured by the RE-AIM implementation framework (n=20 patients, 20 caregivers, 7 providers). Candidate: This Mentored Patient-Oriented Research Career Development Award (K23) builds upon the candidate's experience in trauma-focused global mental health research in low-income countries. The candidate's long-term career goal is to be an independent investigator of evidence-based interventions for PTSD and SMI in LMICs. Training objectives: The K23 provides training and mentorship in (1) the course, prevalence and treatment of comorbid PTSD and SMI; (2) health services research, including methods to evaluate how healthcare is delivered and accessed in Ethiopian primary care, and factors that might influence delivery of a psychosocial intervention for PTSD; and (3) implementation science methods to decrease “science-to-service” gaps in providing mental health care in LMIC primary care, including hybrid effectiveness-implementation trials. Training activities. Training will be achieved through mentorship by experts (Drs. David Henderson, Abebaw Fekadu, Charlotte Hanlon, Kim Mueser, and Graham Thornicroft), field-based experience in Ethiopia, formal coursework at Harvard and Boston Universities, and seminars, trainings, and conference and workshop attendance.