Project Summary
This project will explore primary healthcare providers (PHCPs) knowledge, attitudes, mental disorders
treatment practices (KAP), and implementation landscape for scaling-up mental health evidence-based
transdiagnostic treatment approaches in Ukraine. An estimated third of people in Ukraine have at least one-
lifetime experience of mental disorder. The most common are depression, anxiety, and substance use
disorder, which are frequently comorbid. Ukraine's suicide mortality rate is higher than in the U.S. and most
Eastern European countries. These contribute to one of the worst European region country health profiles, with
high morbidity, mortality, and disability rates. Due to the Soviet legacies and ineffective approaches during
independence, barriers to Ukraine's mental health services include historical and cultural negative
connotations of mental health services, lack of current evidence-based mental health training for healthcare
providers, and siloed care delivery systems. In the context of lagging mental health and successful primary
healthcare reform, PHCPs, given skills and resources, can offer mental health services using evidence-based
approaches simultaneously addressing several common disorders and substantially decrease the mental
health treatment gap. This five years mixed-methods sequential explanatory study within the Practical, Robust
Implementation and Sustainability Model (PRISM) include the following Specific Aims: 1)To examine
knowledge, attitudes, and treatment practices for common mental disorders among PHCPs in Ukraine; 2) To
assess acceptability, appropriateness, feasibility, adoption, and cost of Common Elements Treatment
Approach (CETA) when implemented by PHCPs; 3) To explore stakeholders' perceptions of implementation
and sustainability infrastructure for primary healthcare-based mental health services provision. First, I will
partner with the National Health Service in Ukraine (NHSU), a national purchasing entity for state medical
guarantees program, to create a sampling frame of PHCPs and distribute the KAP (target N=800) (Aim 1).
Second, in partnership with the Center for Mental Health and Psychosocial Support (CMHPS), I will assess
implementation outcomes among PHCPs trained in CETA (N=50) (Aim 2). Third, based on the findings from
Aim 1 & 2, I will conduct consensus panels with stakeholders (N=40-50) to understand different perspectives,
their interactions and develop implementation strategies for mental health services scale-up within primary
healthcare (Aim 3). This proposal leverages a partnership with the NHSU and builds on previous CETA
research in Ukraine conducted by CMHPS and Johns Hopkins Bloomberg School of Public Health (JHBSPH).
This study will yield critical evidence for increasing access to mental health services in Ukraine, a necessary
component of improving the country's health profile. It will generate evidence for implementation strategies for
scaling-up and sustaining mental health evidence-based approaches within primary healthcare worldwide.