This new R01 application responds to PAR-18-835 by advancing task sharing in testing the effectiveness and implementation of a stepped care model for LMICs. It uses nurses and mental health peers to treat depression and potential co-occurring anxiety among women in primary care. To improve implementation, this study examines the impact of clinic implementation teams in readying the clinics and service providers. The proposed project is located in Tajikistan, where the investigators have conducted NIH funded research since 2009. It builds upon and extends Dr. Weine?s R01, K24, and D43 research on migration and health and mental health, and especially his recent Global Brain R21 research which successfully adapted and tested stepped care for feasibility.
Aim 1 assesses the effectiveness of the stepped care model with 420 women who have depression and potential co-occurring anxiety, recruited from 12 primary care clinics in Tajikistan, compared with standard of care plus provision of healthy lifestyle materials, with another 210 women recruited from 6 primary care clinics, including assessing mediators and moderators (e.g. executive control efficiency, trauma exposure).
Aim 2 assesses whether a clinic implementation team moderates women?s reduction in depression post-intervention, as well as clinic-level (leadership support and degree of implementation) and provider-level (motivation and fidelity) moderators.
Aim 3 establishes a national mental health research network that focuses on improving the standard of mental health care and access to services by building mental health implementation research capacity. The knowledge produced through this study will inform stepped care models for mental health in LMICs such as Tajikistan and in low-resource settings in the United States.
In Tajikistan, as well as in other LMICs, women suffer disproportionally from common mental disorders and often experience trauma, separation from their migrant husbands, stigma, gender inequality, poverty, and access barriers to mental health services. This project will: test the effectiveness and implementation of a novel stepped care model for women with depression delivered by primary care nurses and mental health peers; examine the impact of clinic implementation teams in readying clinics and service providers and measure whether they improve implementation, and; explore how RDoC neuroscience contributes to implementation science through enhancing the evaluation and targeting of stepped care. Overall, it will develop a scalable evidence-based mental health program in primary care that could reduce the epidemic of common mental disorders among women, and augment an existing D43 and R21 research training program to further advance the implementation science capacities of mental health researchers in Tajikistan.