Globally, mental disorders are the largest contributor to burden of disease in adolescents, yet the vast majority of youth worldwide do not have access to treatment. Mental health services integrated within primary care and delivered by non-specialists (i.e., task-shifting) offer an efficient and sustainable method to close the adolescent mental health treatment gap. However, research is needed to determine how to effectively implement task-shifted, integrated adolescent mental health care, particularly in low-resource settings. The goal of this K01 Award is to expand the candidate?s expertise and prepare her to conduct independent research on the implementation and dissemination of evidence-based practices (EBPs) for managing adolescent mental disorders in low-resource settings. Through a combination of coursework and seminars, clinical observation, scientific conferences, collaborative publications, and mentorship from experts in global adolescent mental health and global mental health implementation research, the candidate will develop competency in 1) the development, expression, and treatment of global adolescent mental disorders; 2) mixed- methods, community-based assessment of parameters relevant to contextual adaptation and implementation of adolescent mental health interventions; and 3) conducting hybrid effectiveness-implementation trials of EBP for sustainably managing adolescent mental disorders in low-resource settings. The candidate will apply knowledge and skills gained through training activities to conduct a multi- phase study in Mozambique, the fourth poorest country in the world. Leveraging an existing partnership with the Ministry of Health and research infrastructure developed through the PRIDES study to evaluate pathways for scaling-up adult mental health services (U19MH113203), the candidate aims to design and evaluate a strategy to implement screening and treatment for adolescent depression integrated within primary care clinics. Community-based, mixed-methods research will identify cultural and contextual barriers and facilitators to implementing integrated adolescent depression services (Aim 1). This data will inform contextual adaptation of group interpersonal therapy for adolescents (IPT-A), an EBP for adolescent depression. It will also be used to develop a strategy to implement depression screening and IPT-A in which non-specialist providers are guided by mobile health (mHealth) tools that promote treatment fidelity (Aim 2). Patient and implementation outcomes of the depression management strategy will be evaluated in a pilot, cluster-randomized trial (Aim 3) and used to develop an R01 proposal for a hybrid effectiveness-implementation trial to assess scale-up of integrated adolescent depression care throughout Mozambique. Together, the training, research, and research-policy partnership in the proposed award will support the development of an innovative model for engaging with local stakeholders to adapt and implement mHealth, task-shifted EBPs for managing adolescent mental disorders in low-resource settings, contributing to the NIMH?s goal of maximizing public health impact of research.
Mental disorders are the leading cause of disability among adolescents worldwide, but only a very small minority, mostly in high-resource settings, have access to mental health care. The proposed K01 supports the candidate?s transition to a research career generating novel models for effectively implementing adolescent mental health services in low-resource settings. The resulting knowledge can inform both public health policy and intervention strategies to reduce the global burden of adolescent mental disorders.
