Designing and evaluating a Single-session Transdiagnostic intervention for Emotion Regulation with follow-up mHealth support for domestic violence survivors in India.

Project Summary/Abstract Domestic violence (DV) is a widespread global public health concern, with higher prevalence rates in low -and- middle-income countries (LMIC), such as India, where a staggering 41% of Indian women report lifetime DV. Although DV causes posttraumatic stress disorder (PTSD) and depression, the unmet needs for mental health

care for women are massive. Drivers of this care gap include 1) a lack of treatments relevant for DV (i.e., continuous traumatic stress conditions), 2) a shortage of skilled providers, 3) high drop-out following initial treatment sessions. The objective of this 5-year mixed-methods proposal is to develop and test a novel low-

intensity psychosocial intervention delivered to DV survivors in primary health clinics in Goa, India, by non- specialists through task-sharing—a critical strategy that successfully addresses treatment gaps for mental health in many LMIC. Dr. Patel (PI) will develop and test a brief intervention that is evidence-informed, culturally

acceptable, and brief using a single-session intervention (SSI) format, which are clinically effective for many disorders among youth yet remain less-studied among adults. The SSI will target emotion regulation to build resilience rather than actively processing trauma memories, as DV may be ongoing for many women who remain

married. Dr. Patel will then capitalize on the penetration of smartphones in India (61%) to sustain the clinical effects of the SSI with ecological momentary intervention (EMI) follow-up via interactive chatbot to encourage skills practice in daily life. In Aim 1, Dr Patel will design the intervention (Aim 1a: SSI development;

Aim 1b: EMI development). In Aim 2, she will conduct a case series (n=24) to optimize the content and delivery processes of the intervention. In Aim 3, Dr Patel will pilot a randomized clinical trial (N=90) with three arms (SSI alone; SSI+EMI; and enhanced usual care alone) to evaluate the acceptability and feasibility of the two

interventions and assess their preliminary effectiveness. She will base her research at Sangath, a world- renowned community-based mental health research organization in India where she conducted her Fogarty fellowship. The project research aims are integrated into Dr. Patel’s training aims to fill critical gaps in (1)

designing scalable psychosocial interventions for trauma-exposed people, (2) mastering the design and deployment of mobile health (mHealth) support tools, such as EMI, to supplement in-person care, and (3) leading RCTs with high ecological validity in ‘real-world’ public health settings. The exceptional training environment at

the Harvard Chan School of Public Health, world-class mentoring team with complementary expertise for all training goals, and Dr. Patel’s long-standing partnership with the field site foster the success of this study. This K23 award will support Dr. Patel in gaining the methods expertise and preliminary data to pursue an independent

research career. Her long-term goal is to develop, evaluate, and scale a suite of psychosocial services for trauma survivors in low-resource settings.