A brief, task-shifted treatment to improve father depression and child outcomes in Kenya: A pilot effectiveness-implementation trial

PROJECT SUMMARY Globally, depression is the leading cause of disability world worldwide, yet over 75% of people in low and middle-income countries (LMIC) do not receive treatment. This gap is especially large for men. Treating men is essential to reducing the global burden of depression given its impact on families and children with men’s mental health (MH) predicting poor parenting and child MH. Although treating parent depression has been shown to improve parental MH, parenting, and child MH; men and fathers have been missing MH care and clinical trials. MH care relevant to fathers that address common barriers to MH, such as masculine norms and economic factors, are needed. The goal of the K23 is to expand the candidate’s skillset and prepare her to conduct independent research on scalable interventions for adult MH to improve child MH in low-resource settings. Through a combination of coursework and seminars, scientific conferences, collaborative publications, and mentorship from leading experts, the candidate will develop competency in 1) execution of randomized control trials using implementation science designs; 2) exploration of mechanism of change on MH using mixed methods; 3) understanding social determinant of health (SDH) on implementation. The candidate will apply knowledge and skills gained through training to conduct a pilot randomized control trial (RCT) using an effectiveness-implementation design in Kenya. The candidate will leverage existing partnerships with AMPATH and Moi Teaching and Referral Hospital (MTRH) in Kenya. She will also build on collaborative preliminary work with AMPATH/MTRH that showed promising proof-of-concept for ‘Learn, Act, Engage, Dedicate’ (LEAD), a 5-session task-shifted behavioral activation intervention with motivational interviewing and masculinity discussion strategies for fathers in Kenya. Proof-of-concept findings with nine fathers and families were promising with high participant satisfaction and improvements in father depression, parenting, and child MH. This supports pursuit of a pilot RCT, proposed here, using an effectiveness- implementation Hybrid Type I design to explore preliminary effectiveness and its implementation. Specifically, the candidate will conduct a pilot RCT with fathers randomized to either LEAD or a waitlist control group to (Aim1) explore change in fathers’ MH; (Aim 2) explore drivers of change in father MH, father parenting, and child MH (or non-response); and (Aim 3) explore the feasibility and acceptability of implementing a task-shifted MH treatment for fathers in a low-resource setting. Results will inform the development of an R01 proposal for a Hybrid trial to assess clinical outcomes of father and child MH and the impact of implementation strategies. Together, the training, research, and partnerships in the proposed award will support testing of a scalable MH treatment delivered by peer-father counselors with potential for engaging men and improving father and child MH in a low-resource setting, contributing to the NIMH’s goal of maximizing public health impact of research.