This application for the renewal of an NIMH Mid-Career Investigator Award in Patient-Oriented Research (K24) seeks support for a family physician devoted to a career in patient-oriented research to carry out research of public health significance in the arena of community settings and mental health, and to mentor others. The application is based on careful consideration of my strengths as a clinician-investigator and the role I play as a mentor to clinician-investigators early in their career, and has the following goals: (1) to continue to attract, encourage, and mentor junior clinician-investigators to pursue high quality practice-based research related to mental disturbances in the primary health care setting;(2) to build infrastructure support that will encourage and facilitate the careers of junior clinician- investigators in disciplines such as Family Medicine and Psychiatry;(3) to contribute to the development of mixed methodology (quantitative and qualitative methods) for the design and evaluation of mental health interventions focused on primary health care settings;and, (4) to lead an interdisciplinary team that designs, implements, evaluates, and disseminates innovative interventions for depression and other psychiatric disturbances among primary care patients. The conceptual framework and activities of this K24 application rest on several principles for research and career development related to mental health interventions in primary health care and other community settings;namely: (1) the need to focus on community settings;(2) the need to involve stakeholders in development of interventions with a community-based participatory approach;(3) the use of mixed methods in research on community-based interventions;and (4) the need for an infrastructure that can sustain research in the community. The goals are consistent with NIMH Strategic Plan Strategy 3.3 which called for development of interventions "delivered by people outside of the traditional mental health systems, such as teachers and community leaders" and Strategy 4.3 "to strengthen partnerships to provide a clearer understanding of stakeholders'needs."
Relevance Mental health consistently arises in discussions with community representatives about the most serious problems facing the community. Blending clinical and community approaches holds promise for improving the reach of interventions. Improvement of depression through increased reach of interventions and novel services delivery are key elements of the research development program represented by the K24.
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