Sweetland Annika C, Mann Claudio Gruber, Fernandes Maria Jose, Matsuzaka Camila, de Silva Fatima Virginia, Lee Jae, McCarty Christopher, Kritski Afrânio, Fortes Sandra, Cavalcanti Maria, Mello Marcelo Feijó, Oquendo Maria A, Valente Thomas, Pincus Harold, Wainberg Milton L
Department of Psychiatry, Columbia Vagelos College of Physicians & Surgeons/New York State Psychiatric Institute, New York, NY, USA.
Psychiatric Institute at Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
Curr Psychiatry Res Rev. 2024;20(4):350-365. doi: 10.2174/0126660822243332230921052022. Epub 2023 Oct 17.
Tuberculosis (TB) and depression are highly comorbid and linked to higher rates of death and disability. Several evidence-based treatments for depression have been successfully implemented in low- and middle-income countries, but more knowledge is needed on how to bring these innovations to scale within complex 'real world' public health systems.
To explore whether the principles of social network analysis could be used to enhance receptivity to integrating depression treatment into primary care for individuals with and without TB in Brazil.
We used existing scales to identify settings and providers with high receptivity and connectivity within the primary care network. We trained and supervised existing staff in three primary care sites to deliver a brief evidence-based intervention over one year, coupled with active dissemination activities. Afterwards, we reassessed receptivity among individuals involved, and not involved, in the pilot.
Highly significant changes were observed in mental health literacy, attitudes towards evidence-based practices, work self-efficacy, and implementation leadership supporting our hypothesis. Limited social connections between primary care clinics precluded the examination of the hypothesis that targeting settings with high connectivity could capitalize on the information flow between and transcend the decentralized structure of the network, but leveraging the centralized nature of the TB program to integrate mental health services emerged as a promising alternative.
The findings of this study strongly suggest that social networks may be leveraged to change individual providers' attitudes, thereby contributing to the enhanced dissemination of evidence-based interventions.
结核病（TB）与抑郁症高度共病，且与更高的死亡率和残疾率相关。一些基于证据的抑郁症治疗方法已在低收入和中等收入国家成功实施，但对于如何在复杂的“现实世界”公共卫生系统中扩大这些创新方法的应用规模，还需要更多了解。
探讨社会网络分析的原理是否可用于提高巴西将抑郁症治疗纳入针对有或无结核病个体的初级保健的接受度。
我们使用现有量表来确定初级保健网络中接受度高且联系紧密的机构和提供者。我们对三个初级保健点的现有工作人员进行培训和监督，使其在一年时间内提供简短的基于证据的干预措施，并开展积极的传播活动。之后，我们重新评估了参与和未参与试点的个体的接受度。
在心理健康素养、对基于证据的实践的态度、工作自我效能以及支持我们假设的实施领导力方面观察到了非常显著的变化。初级保健诊所之间有限的社会联系妨碍了对以下假设的检验：针对联系紧密的机构可以利用网络之间的信息流并超越网络的分散结构，但利用结核病项目的集中性质来整合心理健康服务成为一种有前景的替代方案。
本研究结果强烈表明，可以利用社会网络来改变个体提供者的态度，从而有助于加强基于证据的干预措施的传播。
