This proposal aims to establish a regional hub for mental health research and training addressing the comorbidity between mental and chronic diseases, aiming to decrease the treatment gap for mental disorders among people with physical disorders in LA &C.
These aims will be achieved through: 1. Development of a research agenda focused on developing an intervention for the identification and treatment of depression among people attending programs for chronic diseases. This intervention will involve two key elements: a) improved recognition and b) improved psycho-social management of depression in diverse health care settings in LA &C. It will be mostly delivered through the use of mobile phones, with minimal assistance from primary care auxiliary nurses, with substantial task-shifting. The main emphasis is on patients helping themselves through using resources that are currently delivered on a one-to-one basis by specialized human resources. The intervention will be tested in primary care clinics in Sao Paulo, Brazil, and in secondary care clinics in Lima, Peru. Pilot studies will take place in Guatemala, Colombia and Ecuador. 2. To build increased mental health research capacity in the region through a research training program delivered by a network involving the University of Sao Paulo in Brazil, the Latin American network for the Global Alliance for Chronic Disease, and Universities of Washington and Bristol. The strategy will include: 1) greater prominence to South-South collaboration;2) focus on a multiplying strategy starting with the strengthening of a solid research hub and gradual expansion to other sub-centers in a large mutually supportive research network;and 3) more efficient methods of delivering training with improved accessibility. The capacity building component prioritizes training in research methodologies that can generate sound evidence on the best strategies to reduce this gap, allowing 'hands-on'training for researchers. In both components due importance is given to issues related to scaling up and policy making, including the creation of a highly qualified advisory board and consultation with a range of stakeholders throughout the life of the project.

Public Health Relevance

Depression is highly prevalent in LA &C and is now considered the second most important contributor to the global health burden in the region. Only small proportions of those depressed are recognized and receive treatment in LA &C. There is substantial co-morbidity between depression and chronic physical conditions, and outcome of both conditions is impaired when there is co-morbidity. Evidence on efficient, low-cost interventions is urgently needed to guide reduce the mental health treatment gap.

National Institute of Health (NIH)
National Institute of Mental Health (NIMH)
Research Program--Cooperative Agreements (U19)
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Special Emphasis Panel (ZMH1-ERB-B (04))
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Pringle, Beverly
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Fundacao Faculdade de Medicina
Sao Paulo
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