The goal of this proposed Emerging Global Leader (K43) Award is to provide intensive mentored research career support and protected time to a junior research scientist from a low- or middle income country (LMIC) to enable the awardee develop skills to become an independently funded researcher. The treatment gap for mental disorders in most LMICs is close to 90%. Bridging this treatment gap and improving coverage for mental health care will require building a critical mass of researchers who are able to develop and test interventions for mental health problems that are effective, culturally appropriate, and could be scaled up within this limited resource context; to generate evidence that could inform policy changes necessary for sustainable development. The candidate?s long term career goal is to become a leader in developing and evaluating effective models for the scaling up mental health care through its integration into routine health care in resource limited settings. The specific training objectives of this 4-year grant are to enable the candidate to develop expertise in (1) advanced research methodology especially the design and execution of clinical trials and implementation research, (2) advanced statistical methods and (3) qualitative research methods needed to adapt and contextualize mental health interventions. These objectives will be achieved with the mentorship of Drs Oye Gureje, an expert in psychiatric epidemiology and implementation research in LMICs, and Ian M. Bennett, a leader in the use of team based care, telemedicine, mHealth interventions for women in the perinatal period. I will utilize these skills and mentorship support to carry out a research project. The proposed project will adopt a mixed methods approach to pilot a telephone-based psychosocial intervention package for perinatal depression delivered by nurse/midwives in routine antenatal care. Women of child bearing age bear a disproportionate burden for common mental disorders such as depression. Perinatal depression is associated with poor obstetric outcomes and impairments in infant cognitive development and growth parameters. Even though evidence supports the efficacy of evidence based psychosocial interventions for perinatal depression delivered by non-specialist health and community workers to alleviate these negative outcomes, a major limitation is the low rate of attendance at follow up counseling sessions. The goal of this research is to adapt psychosocial interventions for perinatal depression for use over the mobile telephone and assess the acceptability, feasibility and the effectiveness of this approach. Qualitative methods, specifically key informant interviews will be used to explore the organizational structure of the maternal and child health facilities as well as barriers/facilitators for the successful implementation of mental health interventions. Following this, midwives in two maternal and child health (MCH) facilities will be trained to identify perinatal depression and deliver interventions based on treatment specifications of the WHO Mental Health Gap Action Program Intervention Guide (mhGAP-IG). Interventions will be delivered fortnightly over the phone in one MCH clinic and in-person at the other clinic. Depression outcome measures will be compared between the two groups to explore the effectiveness of the telephone-based interventions. The skills acquired through this K43 Award and data generated from this pilot will be used to pursue funding to conduct a larger randomized controlled trial of this strategy.
The proposed work has the potential to impact public health by providing evidence for the effectiveness of using telephone-based interventions as a tool for expanding the coverage of maternal mental health services in resource limited settings where specialists are few. The mentorship, training and research activities proposed will result in a better understanding of how mental health care could be effectively integrated into routine antenatal services in a sustainable way by implementing evidence-based psychosocial interventions delivered by non-mental health specialists. Having independent investigators with the ability to conduct this type of research and generate evidence capable of expanding access to mental health care and impacting on policy in low and middle income countries is essential.
