It is estimated that by the year 2030, depression will be the single largest contributor to the world's health care burden. Effective treatments exist, bu they do not reach many depressed individuals, especially in resource-poor communities--ethnic minorities, rural residents in the United States, and individuals in most of the developing world. Among the many barriers for treatment are lack of trained professionals, stigma attached to mental health issues, lack of knowledge about mental health resources, and the low perceived value of treatment, particularly when other survival needs seem more pressing. Women, in particular, are at risk for depression and poverty. Integrating programs that treat depression and address livelihood concerns may improve engagement in depression treatment and improve mental health and functioning for patients in low-resource settings. The proposed R-34 project would integrate depression care with existing "microfinance" programs, which provide poverty-alleviation services including small loans, savings programs, and vocational training to women. This project builds on a $2.5 million project funded by Atlantic Philanthropies in 2009 to develop a collaborative care model for the treatment of depression in the primary care systems of Danang and Khanh Hoa provinces in Vietnam by extending the collaborative care team to include the Women's Union lay health workers and delivering the program in the community. The Vietnam Women's Union has an impressive record of accomplishment for successful delivery of microfinance programs to Vietnamese women. This project will 1) conduct qualitative studies of barriers and facilitators of women's successful use of existing depression care and microfinance programs;2) adapt and integrate the depression care and microfinance services;3) train Women's Union facilitators to deliver the integrated depression care and microfinance program;and 4) conduct randomized pilot testing of the integrated program to assess acceptability, feasibility, and preliminary effectiveness. These findings will inform a future R01 proposal to conduct a full-scale randomized control study examining the effectiveness of the integrated model and the mechanism of change in the intervention. The proposed project has significant public health implications for providing depression treatment in resource-poor communities and it offers an innovative approach to addressing overlapping vulnerabilities of gender, depression, and poverty in a collaborative care model, which may be applicable to other resource- poor settings in the United States and abroad. The project is consistent with the designation of global health as one of NIH's top five research priorities.
This study seeks to develop and integrate microfinance program into behavior-activation based collaborative care program for depression for women in under-served and under-resourced communities in the U.S. and abroad. The project is consistent with NIH research priorities to address health disparities in the U.S. and promotion of global health.