Scaling-Up Stepped Care for Women's Mental Health in Primary Care in an LMIC

这个新的R 01应用程序响应PAR-18-835，在测试 为低收入和中等收入国家建立的分级护理模式的有效性和实施情况。它使用护士， 心理健康同行治疗抑郁症和潜在的共同发生的焦虑症的妇女， 初级保健.为了改善实施情况，本研究探讨了诊所的影响， 执行小组为诊所和服务提供者做好准备。拟建项目 位于塔吉克斯坦，自2009年以来，研究人员在那里进行了NIH资助的研究。 它建立在韦内博士的R 01，K24和D43移民和健康研究的基础上，并扩展了该研究 特别是他最近的全球大脑R21研究， 调整并测试了阶梯式护理的可行性。目标1评估了 阶梯护理模式与420名妇女谁有抑郁症和潜在的共同发生的焦虑， 从塔吉克斯坦的12个初级保健诊所招募，与标准护理加相比， 提供健康生活方式材料，另外从6个初级保健机构招募了210名妇女 诊所，包括评估调解人和调解人（如执行控制效率，创伤 曝光）。目标2评估诊所实施团队是否能减缓妇女的减少 干预后抑郁症，以及临床水平（领导支持和程度 实施）和提供者级别（动机和忠诚度）的主持人。目标3建立了一个 国家心理健康研究网络，重点是提高心理健康水平， 通过建立心理健康实施研究能力，提供保健和获得服务的机会。 通过这项研究产生的知识将为心理健康的阶梯式护理模式提供信息， 塔吉克斯坦等中低收入国家和美国的低资源环境。

This new R01 application responds to PAR-18-835 by advancing task sharing in testing the effectiveness and implementation of a stepped care model for LMICs. It uses nurses and mental health peers to treat depression and potential co-occurring anxiety among women in primary care. To improve implementation, this study examines the impact of clinic implementation teams in readying the clinics and service providers. The proposed project is located in Tajikistan, where the investigators have conducted NIH funded research since 2009. It builds upon and extends Dr. Weine’s R01, K24, and D43 research on migration and health and mental health, and especially his recent Global Brain R21 research which successfully adapted and tested stepped care for feasibility. Aim 1 assesses the effectiveness of the stepped care model with 420 women who have depression and potential co-occurring anxiety, recruited from 12 primary care clinics in Tajikistan, compared with standard of care plus provision of healthy lifestyle materials, with another 210 women recruited from 6 primary care clinics, including assessing mediators and moderators (e.g. executive control efficiency, trauma exposure). Aim 2 assesses whether a clinic implementation team moderates women’s reduction in depression post-intervention, as well as clinic-level (leadership support and degree of implementation) and provider-level (motivation and fidelity) moderators. Aim 3 establishes a national mental health research network that focuses on improving the standard of mental health care and access to services by building mental health implementation research capacity. The knowledge produced through this study will inform stepped care models for mental health in LMICs such as Tajikistan and in low-resource settings in the United States.