Implementing mental health interventions for pregnant adolescents in primary care LMIC contexts

摘要 低收入和中等收入国家(LMIC)青少年怀孕的高流行率导致了巨大的 公共卫生负担。许多青少年怀孕都是意外的、计划外的和婚外的。青春期 女孩成为母亲，她们经济和教育增长的机会有限。数量迅速增加的 由于贫穷或基于性别的传统，来自小岛屿发展中国家的青少年母亲也被边缘化，这进一步限制了她们的能力。 获得卫生资源、社会保护/支持和个人发展。结构性不平等与不利因素 在这种情况下，青春期母亲患抑郁症的比例很高。尽管存在巨大的心理健康问题 青少年母亲在低收入家庭、儿童和青少年心理健康服务方面的需求仍处于起步阶段。有必要 促进对文化和背景敏感的围产期抑郁干预，使其与青少年的生活相一致 背景和发展需求，并同时应对提供心理健康方面的多重资源挑战 LMIC设置中的护理。这个应用程序寻求回应这些青少年围产期抑郁的干预和 实施研究差距：i)利用世卫组织精神卫生治疗差距行动计划(MhGAP)和小组 人际心理治疗(IPT-G)抑郁症护理包已被证明对成人抑郁症有效，以及 在肯尼亚妇幼保健服务中进一步测试患有围产期抑郁症的青少年的方法 设置。将研究三个关键问题：(I)如何提高mhGAP/IPT-G-抑郁干预的适合度 肯尼亚怀孕青少年的模式，(2)如何有效地将任务转移/分担和协作战略结合起来 结合妇幼保健院临床工作流程对妇幼保健院妊娠青少年实施mhGAP/IPT-G抑郁干预 以及(Iii)适应的mhGAP/IPT-G在解决围产期抑郁方面是否可行-可接受-有效 在青少年中。考虑到需求-资源缺口，由于妇幼保健诊所通常为大量有 但是围产期抑郁症的资源有限，这项研究还将探索其他具有成本效益的策略，如研究 应用长版和迷你版IPT-G和其他家庭/青少年同伴共同领导干预方法的可行性 实施。这项研究将采用跨学科伙伴关系的方法进行。这样做的具体目的是 研究的目的是：1)探索提高青少年MhGAP-IG/IPT-G适合度的障碍和策略 肯尼亚妇幼保健诊所的围产期抑郁症；2)开发IPT-G/和mhGAP-IG的改编版本，并建立妇幼保健 执行能力；以及3)经调整的版本的测试可行性和执行效果结果 MhGAP-IG/IPT-G

SUMMARY High prevalence of adolescent pregnancies in low-and-middle-income countries (LMICs) has resulted in a tremendous public health burden. Many adolescent pregnancies are unwanted, unplanned, and outside of marriage. When adolescent girls become mothers, their opportunities for economic and educational growth are limited. A burgeoning number of adolescent mothers from LMICs are also marginalized due to poverty or gender-based traditions, which further limit their access to health resources, social protection/ support and personal development. Structural inequalities and adverse circumstances have resulted in high prevalence of depression in adolescent mothers. Despite the enormous mental health needs for adolescent mothers in LMICs, child and adolescent mental health service remains in its’ infancy. There is a need to advance cultural and context-sensitive perinatal depression interventions that can align with adolescents’ living contexts and developmental needs and simultaneously address multiple resource challenges in provision of mental health care in LMIC settings. This application seeks to respond to these adolescent perinatal depression intervention and implementation research gaps by i) utilizing WHO Mental Health Treatment Gap Action Program (mhGAP) and Group Interpersonal psychotherapy (IPT-G) depression care packages that has shown to be efficacious for adult depression, and further test the approaches in adolescents with perinatal depression in Kenyan maternal and child health (MCH) service settings. Three key research questions will be studied: (i) how to improve fit of the mhGAP/IPT-G-depression intervention model for pregnant adolescents in Kenya, (ii) how to effectively integrate task-shifting/sharing and collaborative strategies with MCH clinical workflow to implement mhGAP/IPT-G depression intervention for pregnant adolescents in MCH settings, and (iii) whether the adapted mhGAP/IPT-G are feasible-acceptable-effective in addressing perinatal depression in adolescents. Considering the demand-resource gap, as MCH clinics usually serve high volume of adolescents with perinatal depression but have limited resources, this study will also explore other cost-effective strategies, such as study feasibility of applying long and mini version of IPT-G and other family/adolescent peer co-lead approach of intervention implementation. This study will be carried out using a cross-disciplinary partnership approach. The specific aims of this study are to: 1) explore barriers and strategies to improve mhGAP-IG/IPT-G fit and implementation for adolescent perinatal depression in MCH clinics in Kenya; 2) Develop adapted version of IPT-G/ and mhGAP-IG, and build MCH capacity for implementation; and 3) test feasibility and implementation-effectiveness outcomes for the adapted version of mhGAP-IG/ IPT-G.