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      Novel implementation research designs for scaling up global mental health care: overcoming translational challenges to address the world’s leading cause of disability

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          Abstract

          Despite established knowledge that Low and Middle Income Countries (LMICs) bear the majority of the world’s burden of mental disorders, and more than a decade of efficacy research showing that the most common disorders, such as depression and anxiety, can be treated using readily available local personnel in LMICs to apply evidence-based treatments, there remains a massive mental health treatment gap, such that 75 % of those in LMICs never receive care. Here, we discuss the use of a new type of implementation science study design, the effectiveness-implementation hybrids, to speed the translation and scale up of mental health care in LMICs. We use our current study of Interpersonal Psychotherapy (IPT) delivered by local personnel for depression and trauma-related disorders among HIV+ women in Kenya as an example of effectiveness-implementation hybrid design for mental health services research in LMICs.

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          Lifetime prevalence of gender-based violence in women and the relationship with mental disorders and psychosocial function.

          Zachary Steel, Tim Slade, Richard Bryant … (2011)
          Intimate partner physical violence, rape, sexual assault, and stalking are pervasive and co-occurring forms of gender-based violence (GBV). An association between these forms of abuse and lifetime mental disorder and psychosocial disability among women needs to be examined. To assess the association of GBV and mental disorder, its severity and comorbidity, and psychosocial functioning among women. A cross-sectional study based on the Australian National Mental Health and Well-being Survey in 2007, of 4451 women (65% response rate) aged 16 to 85 years. The Composite International Diagnostic Interview version 3.0 of the World Health Organization's World Mental Health Survey Initiative was used to assess lifetime prevalence of any mental disorder, anxiety, mood disorder, substance use disorder, and posttraumatic stress disorder (PTSD). Also included were indices of lifetime trauma exposure, including GBV, sociodemographic characteristics, economic status, family history of mental disorder, social supports, general mental and physical functioning, quality of life, and overall disability. A total of 1218 women (27.4%) reported experiencing at least 1 type of GBV. For women exposed to 3 or 4 types of GBV (n = 139), the rates of mental disorders were 77.3% (odds ratio [OR], 10.06; 95% confidence interval [CI], 5.85-17.30) for anxiety disorders, 52.5% (OR, 3.59; 95% CI, 2.31-5.60) for mood disorder, 47.1% (OR, 5.61; 95% CI, 3.46-9.10) for substance use disorder, 56.2% (OR, 15.90; 95% CI, 8.32-30.20) for PTSD, 89.4% (OR, 11.00; 95% CI, 5.46-22.17) for any mental disorder, and 34.7% (OR, 14.80; 95% CI, 6.89-31.60) for suicide attempts. Gender-based violence was associated with more severe current mental disorder (OR, 4.60; 95% CI, 2.93-7.22), higher rates of 3 or more lifetime disorders (OR, 7.79; 95% CI, 6.10-9.95), physical disability (OR, 4.00; 95% CI, 1.82-8.82), mental disability (OR, 7.14; 95% CI, 2.87-17.75), impaired quality of life (OR, 2.96; 95% CI, 1.60-5.47), an increase in disability days (OR, 3.14; 95% CI, 2.43-4.05), and overall disability (OR, 2.73; 95% CI, 1.99-3.75). Among a nationally representative sample of Australian women, GBV was significantly associated with mental health disorder, dysfunction, and disability.
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            Depression, somatization and the "new cross-cultural psychiatry".

            Peter Kleinman (1976)
            Article 0 comments Cited 38 times – based on 0 reviews     Review now
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              HIV, violence and women: unmet mental health care needs.

              Brian Zunner, Shari Dworkin, Thomas C Neylan … (2015)
              HIV-infected (HIV+) women have high rates of Gender Based Violence (GBV). Studies of GBV find that approximately 50-90% of survivors develop mood and anxiety disorders. Given that women in sub-Saharan African constitute the largest population of HIV+ individuals in the world and the region׳s high GBV prevalence, mental health research with HIV+ women affected by GBV (HIV+GBV+) in this region is urgently needed.
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                Author and article information

                Contributors
                Susan M. Meffert:
                ORCID: http://orcid.org/0000-0002-5882-7102
                Susan.Meffert@ucsf.edu
                Thomas C. Neylan: Thomas.Neylan@ucsf.edu
                David A. Chambers: dchamber@mail.nih.gov
                Helen Verdeli: verdeli@tc.columbia.edu
                Journal
                Journal ID (nlm-ta): Int J Ment Health Syst
                Journal ID (iso-abbrev): Int J Ment Health Syst
                Title: International Journal of Mental Health Systems
                Publisher: BioMed Central (London )
                ISSN (Electronic): 1752-4458
                Publication date (Electronic): 8 March 2016
                Publication date PMC-release: 8 March 2016
                Publication date Collection: 2016
                Volume: 10
                Electronic Location Identifier: 19
                Affiliations
                [ ]Department of Psychiatry, University of California, San Francisco, 401 Parnassus Avenue, San Francisco, CA 94127 USA
                [ ]Department of Psychiatry, University of California, San Francisco, 4150 Clement Street, San Francisco, CA 94121 USA
                [ ]National Cancer Institute, National Institutes of Health, BG 9609 MSC 9760, 9609 Medical Center Drive, Bethesda, MD 20892-9760 USA
                [ ]Teachers College, Columbia University, 325 HMann 525 West 120th Street, New York, NY 10027 USA
                Author information
                http://orcid.org/0000-0002-5882-7102
                Article
                Publisher ID: 49
                DOI: 10.1186/s13033-016-0049-7
                PMC ID: 4782517
                PubMed ID: 26958075
                SO-VID: d8b4008a-9b10-4144-93c7-92c69bfffb35
                Copyright © © Meffert et al. 2016
                License:

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                Date received : 9 February 2016
                Date accepted : 11 February 2016
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/100000025, National Institute of Mental Health;
                Award ID: K23MH098767
                Award Recipient :
                Funded by: National Institute of Mental Health (US)
                Award ID: K23MH098767-01A1S1
                Award Recipient :
                Categories
                Subject: Commentary
                Custom metadata
                issue-copyright-statement © The Author(s) 2016

                ScienceOpen disciplines: Neurology
                Keywords: mental health,low and middle income countries (lmics),implementation science,effectiveness-implementation hybrid,interpersonal psychotherapy,hiv,trauma,depression,treatment gap
                Data availability:
                ScienceOpen disciplines: Neurology
                Keywords: mental health, low and middle income countries (lmics), implementation science, effectiveness-implementation hybrid, interpersonal psychotherapy, hiv, trauma, depression, treatment gap

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