ASHA 2: An Ethnographic Study Embedded in a Depression Treatment Trial

Univ Of Massachusetts Med Sch Worcester, Worcester MA

Investigators

Abstract

A leading cause of global disability, depression is widespread among women in low- and middle-income countries (LMIC). Poverty is a major cause of depression, while depression worsens poverty, compromising economic productivity. Funded by NIMH’s Global Brain Initiative, the ASHA Project is a groundbreaking research study that seeks to address the poverty-depression syndemic among rural Bangladeshi women using an integrated intervention model with both psychological and economic treatment. The project is a two-arm cluster randomized clinical trial carried out in villages in the Rangpur district of northern Bangladesh—a flood prone region with high rates of rural poverty. Treatment groups of 12-15 women, led by village health workers, will be cluster-randomized into the integrated intervention arm (cash/asset transfer plus Problem Management (PM)+--a group-based, manualized psychotherapy) or to PM+ alone. This application proposes to embed an ethnographic study inside the ASHA RCT. Led by an interdisciplinary team of psychologists, anthropologists, and maternal health specialists in the US and Bangladesh, the study will investigate the complex relationships between ASHA intervention processes and outcomes, and social contexts at the individual, household, neighborhood, and village levels. Although ethnographic inquiry—the holistic study of local sociocultural contexts—is well suited to the generation of new knowledge, ethnographic studies are rarely integrated into mental health treatment trials. The research team will use a rapid ethnography (RE) approach to conduct qualitative interviews, focus groups, and structured observations, including salient local attributes such as presence of schools, clinics, and roads, alongside observations about how everyday life and governance is organized. A comparative analysis will examine differences across study arms (integrated vs psychotherapy alone), participant engagement (retention/vs attrition) and clinical outcomes (treatment response vs none). This will allow for the generation of hypotheses about key moderating and mediating variables affecting outcomes. A capacity building program will train three young graduates in anthropology from a local university in Rangpur, providing both didactic training in Dhaka as well as hands on supervision in data collection in the field. Fellows will receive training in data collection, clinical trial design, research ethnics and data analysis. Fellows will receive mentoring and support in obtaining research positions.