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McGorry PD, Mei C, Dalal N, Alvarez-Jimenez M, Blakemore SJ, Browne V, Dooley B, Hickie IB, Jones PB, McDaid D, Mihalopoulos C, Wood SJ, El Azzouzi FA, Fazio J, Gow E, Hanjabam S, Hayes A, Morris A, Pang E, Paramasivam K, Quagliato Nogueira I, Tan J, Adelsheim S, Broome MR, Cannon M, Chanen AM, Chen EYH, Danese A, Davis M, Ford T, Gonsalves PP, Hamilton MP, Henderson J, John A, Kay-Lambkin F, Le LKD, Kieling C, Mac Dhonnagáin N, Malla A, Nieman DH, Rickwood D, Robinson J, Shah JL, Singh S, Soosay I, Tee K, Twenge J, Valmaggia L, van Amelsvoort T, Verma S, Wilson J, Yung A, Iyer SN, Killackey E. The Lancet Psychiatry Commission on youth mental health. Lancet Psychiatry 2024; 11:731-774. [PMID: 39147461 DOI: 10.1016/s2215-0366(24)00163-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 05/01/2024] [Accepted: 05/08/2024] [Indexed: 08/17/2024]
Affiliation(s)
- Patrick D McGorry
- Orygen, Melbourne, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia.
| | - Cristina Mei
- Orygen, Melbourne, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | | | - Mario Alvarez-Jimenez
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | | | - Vivienne Browne
- Orygen, Melbourne, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Barbara Dooley
- School of Psychology, University College Dublin, Dublin, Ireland
| | - Ian B Hickie
- Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
| | - Peter B Jones
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - David McDaid
- Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, London, UK
| | - Cathrine Mihalopoulos
- Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Monash University Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Stephen J Wood
- Orygen, Melbourne, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia; School of Psychology, University of Birmingham, Birmingham, UK
| | | | | | - Ella Gow
- Orygen, Melbourne, VIC, Australia; Melbourne, VIC, Australia
| | | | | | | | - Elina Pang
- Hong Kong Special Administrative Region, China
| | | | | | | | - Steven Adelsheim
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Matthew R Broome
- Institute for Mental Health, University of Birmingham, Birmingham, UK; Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Mary Cannon
- Department of Psychiatry, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Andrew M Chanen
- Orygen, Melbourne, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Eric Y H Chen
- Institute of Mental Health, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; LKS School of Medicine, University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Andrea Danese
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; National and Specialist Child and Adolescent Mental Health Service Clinic for Trauma, Anxiety, and Depression, South London and Maudsley NHS Foundation Trust, London, UK
| | - Maryann Davis
- Department of Psychiatry, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Tamsin Ford
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Pattie P Gonsalves
- Youth Mental Health Group, Sangath, New Delhi, India; School of Psychology, University of Sussex, Brighton, UK
| | - Matthew P Hamilton
- Orygen, Melbourne, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia; Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Jo Henderson
- Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Ann John
- Swansea University Medical School, Swansea University, Swansea, UK
| | | | - Long K-D Le
- Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Monash University Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Christian Kieling
- Department of Psychiatry, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | | | - Ashok Malla
- Department of Psychiatry, Faculty of Medicine and Health Sciences, McGill University, Montréal, QC, Canada; ACCESS Open Minds and Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, Verdun, QC, Canada
| | - Dorien H Nieman
- Amsterdam University Medical Centers, location AMC, Amsterdam, The Netherlands
| | - Debra Rickwood
- Faculty of Health, University of Canberra, Canberra, ACT, Australia; headspace National Youth Mental Health Foundation, Melbourne, VIC, Australia
| | - Jo Robinson
- Orygen, Melbourne, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Jai L Shah
- Department of Psychiatry, Faculty of Medicine and Health Sciences, McGill University, Montréal, QC, Canada; ACCESS Open Minds and Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, Verdun, QC, Canada
| | - Swaran Singh
- Mental Health and Wellbeing, Warwick Medical School, University of Warwick and Coventry and Warwickshire Partnership Trust, Coventry, UK
| | - Ian Soosay
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Karen Tee
- Foundry, Providence Health Care, Vancouver, BC, Canada
| | - Jean Twenge
- Department of Psychology, San Diego State University, San Diego, California, USA
| | - Lucia Valmaggia
- Orygen, Melbourne, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia; Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Therese van Amelsvoort
- Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, The Netherlands
| | | | - Jon Wilson
- Norfolk and Suffolk NHS Foundation Trust, Norwich, UK
| | - Alison Yung
- Orygen, Melbourne, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia; Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, VIC, Australia; School of Health Sciences, The University of Manchester, Manchester, UK
| | - Srividya N Iyer
- Department of Psychiatry, Faculty of Medicine and Health Sciences, McGill University, Montréal, QC, Canada; ACCESS Open Minds and Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, Verdun, QC, Canada
| | - Eóin Killackey
- Orygen, Melbourne, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
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Desai N, Holliday S, Braun-Courville D. Addressing Post-Pandemic Adolescent Health in Schools. Pediatr Clin North Am 2024; 71:671-682. [PMID: 39003009 DOI: 10.1016/j.pcl.2024.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/15/2024]
Abstract
The coronavirus disease 2019 pandemic disrupted in-person learning for adolescents and young adults across the world. Inequities in learning outcomes were primarily caused by digital inequalities. Social needs of adolescent and young adult (AYA) emerged during the pandemic and school is a key part of supporting AYA social health. School-based health clinics can serve as a method to improve mental and physical health outcomes for AYA.
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Affiliation(s)
- Neerav Desai
- Division of Adolescent and Young Adult Health, Department of Pediatrics, Vanderbilt University Medical Center, 719 Thompson Lane Suite 36300, Nashville, TN 37204, USA.
| | - Sarah Holliday
- Division of Adolescent and Young Adult Health, Department of Pediatrics, Vanderbilt University Medical Center, 719 Thompson Lane Suite 36300, Nashville, TN 37204, USA
| | - Debra Braun-Courville
- Division of Adolescent and Young Adult Health, Department of Pediatrics, Vanderbilt University Medical Center, 719 Thompson Lane Suite 36300, Nashville, TN 37204, USA
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3
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Hamdani SU, Huma ZE, Malik A, Tamizuddin-Nizami A, Javed H, Minhas FA, Jordans MJD, Sijbrandij M, Suleman N, Baneen UU, Bryant RA, van Ommeren M, Rahman A, Wang D. Effectiveness of a group psychological intervention to reduce psychosocial distress in adolescents in Pakistan: a single-blind, cluster randomised controlled trial. THE LANCET. CHILD & ADOLESCENT HEALTH 2024; 8:559-570. [PMID: 39025557 PMCID: PMC11254783 DOI: 10.1016/s2352-4642(24)00101-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 04/02/2024] [Accepted: 04/05/2024] [Indexed: 07/20/2024]
Abstract
BACKGROUND Emotional problems in adolescents living in low-income and middle-income countries (LMICs) remain largely unaddressed; key reasons include a scarcity of trained mental health professionals and unavailability of evidence-based, scalable psychological interventions. We aimed to evaluate the effectiveness of a non-specialist-delivered, group psychological intervention to reduce psychosocial distress in school-going adolescents in Pakistan. METHODS In a two-arm, single-blind, cluster randomised controlled trial, eligible public school clusters from a rural subdistrict of Gujar Khan, Rawalpindi, Pakistan, were randomised (1:1, stratified by sex) using permuted block randomisation into intervention (n=20) and wait-list control (n=20) groups. Adolescents aged 13-15 years who provided informed assent and caregivers' consent were screened for psychosocial distress using the youth-reported Pediatric Symptoms Checklist (PSC; total psychosocial distress scores from 0 to 70), and those scoring 28 or more and their caregivers were enrolled into the trial. Adolescents in the intervention group received seven weekly group sessions and their caregivers received three biweekly group sessions in school settings from trained non-specialists. The primary outcome was change from baseline in the total PSC scores at 3 months post-intervention. The trial was registered prospectively with the International Standard Randomised Controlled Trial Number registry, ISRCTN17755448. FINDINGS From the 40 school clusters that were included, 282 adolescents in the intervention group and 284 adolescents in the wait-list control group were enrolled between Nov 2 and Nov 30, 2021. At 3 months, adolescents in the intervention group had significantly lower mean total score on the PSC compared with adolescents in the control group (mean difference in change from baseline 3·48 [95% CI 1·66-5·29], p=0·0002, effect size 0·38 [95% CI 0·18-0·57]; adjusted mean difference 3·26 (95% CI 1·46-5·06], p=0·0004, effect size 0·35 (0·16-0·55). No adverse events were reported in either group. INTERPRETATION The group psychological intervention most likely represents a feasible and effective option for adolescents with psychosocial distress in school settings. FUNDING UK Medical Research Council, Foreign Commonwealth and Development Office, Department of Health and Social Care. TRANSLATION For the Urdu translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Syed Usman Hamdani
- Global Institute of Human Development, Shifa Tameer-e-Millat University, Islamabad, Pakistan.
| | - Zill-E Huma
- Global Institute of Human Development, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | - Aiysha Malik
- Department of Mental Health and Substance Use, WHO, Geneva, Switzerland
| | - Asad Tamizuddin-Nizami
- Institute of Psychiatry, Benazir Bhutto Hospital, Rawalpindi Medical University, Rawalpindi, Pakistan
| | - Hashim Javed
- Global Institute of Human Development, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | - Fareed Aslam Minhas
- Global Institute of Human Development, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | - Mark J D Jordans
- Amsterdam Institute of Social Science Research, University of Amsterdam, Amsterdam, Netherlands
| | - Marit Sijbrandij
- Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Nadia Suleman
- Global Institute of Human Development, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | - Um-Ul Baneen
- Global Institute of Human Development, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | | | - Mark van Ommeren
- Department of Mental Health and Substance Use, WHO, Geneva, Switzerland
| | - Atif Rahman
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
| | - Duolao Wang
- Global Health Trials Unit, Liverpool School of Tropical Medicine, Liverpool, UK
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4
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Jack HE, Giusto A, Rose AL, Mwamuka R, Brown I, Bere T, Verhey R, Wainberg M, Myers B, Kohrt B, Wingood G, DiClemente R, Magidson JF. Mutual capacity building model for adaptation (MCB-MA): a seven-step procedure bidirectional learning and support during intervention adaptation. Glob Health Res Policy 2024; 9:25. [PMID: 38956652 PMCID: PMC11218126 DOI: 10.1186/s41256-024-00369-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Accepted: 06/19/2024] [Indexed: 07/04/2024] Open
Abstract
Global health reciprocal innovation emphasizes the movement of technologies or interventions between high- and low-income countries to address a shared public health problem, in contrast to unidirectional models of "development aid" or "reverse innovation". Evidence-based interventions are frequently adapted from the setting in which they were developed and applied in a new setting, presenting an opportunity for learning and partnership across high- and low-income contexts. However, few clear procedures exist to guide researchers and implementers on how to incorporate equitable and learning-oriented approaches into intervention adaptation across settings. We integrated theories from pedagogy, implementation science, and public health with examples from experience adapting behavioral health interventions across diverse settings to develop a procedure for a bidirectional, equitable process of intervention adaptation across high- and low-income contexts. The Mutual capacity building model for adaptation (MCB-MA) is made up of seven steps: 1) Exploring: A dialogue about the scope of the proposed adaptation and situational appraisal in the new setting; 2) Developing a shared vision: Agreeing on common goals for the adaptation; 3) Formalizing: Developing agreements around resource and data sharing; 4) Sharing complementary expertise: Group originating the intervention supporting the adapting group to learn about the intervention and develop adaptations, while gleaning new strategies for intervention implementation from the adapting group; 5) Reciprocal training: Originating and adapting groups collaborate to train the individuals who will be implementing the adapted intervention; 6) Mutual feedback: Originating and adapting groups share data and feedback on the outcomes of the adapted intervention and lessons learned; and 7) Consideration of next steps: Discuss future collaborations. This evidence-informed procedure may provide researchers with specific actions to approach the often ambiguous and challenging task of equitable partnership building. These steps can be used alongside existing intervention adaptation models, which guide the adaptation of the intervention itself.
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Affiliation(s)
- Helen E Jack
- Division of General Internal Medicine, Department of Medicine, University of Washington, Harborview Medical Center, Box 359780, Seattle, Washington, 325 9th Ave98104, USA.
| | - Ali Giusto
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, 1051 Riverside Dr, New York, NY, 10032, USA
| | - Alexandra L Rose
- Department of Psychology, University of Maryland, 4094 Campus Dr, College Park, MD, 20742, USA
| | - Rukudzo Mwamuka
- Graduate School for Health Sciences, University of Bern, Uni Mittelstrasse, Mittelstrasse 43, Bern, 3012, Switzerland
| | - Imani Brown
- Department of Psychology, University of Maryland, 4094 Campus Dr, College Park, MD, 20742, USA
| | - Tarisai Bere
- Mental Health Department, Faculty of Medicine, University of Zimbabwe, Mazowe Street, Avondale, Harare, Zimbabwe
| | - Ruth Verhey
- Friendship Bench Zimbabwe, 4 Weale Rd, Harare, Zimbabwe
| | - Milton Wainberg
- Department of Psychology, University of Maryland, 4094 Campus Dr, College Park, MD, 20742, USA
| | - Bronwyn Myers
- Mental Health, Alcohol, Substance Use, and Tobacco Research Unit, South African Medical Research Council, Parow, South Africa
- Department of Psychiatry and Mental Health, University of Cape Town, Neuroscience Institute, Groote Schuur Hospital, Observatory, Anzio Road, 1st Floor, Cape Town, South Africa
- Curtin enAble Institute, Faculty of Health Sciences, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia
| | - Brandon Kohrt
- Center for Global Mental Health Equity, The George Washington University School of Medicine and Health Sciences, 2120 L Street NW, 6th Floor, Washington, DC, 20037, USA
| | - Gina Wingood
- Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, NY, 10032, USA
| | - Ralph DiClemente
- School of Global Public Health, New York University, 708 Broadway, New York, NY, 10003, USA
| | - Jessica F Magidson
- Department of Psychology, University of Maryland, 4094 Campus Dr, College Park, MD, 20742, USA
- Center for Substance Use, Addiction & Health Research (CESAR), University of Maryland College Park, 1114 Chincoteague Hall, 7401 Preinkert Drive, College Park, MD, 20742, USA
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5
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Gellatly R, Boustani M, Nair P, Mahajan R, Jambhale A, Sahu R, Chodankar B, Krishna M, Malik K, Mathur S, Becker K, Michelson D, Patel V, Chorpita B. Adolescent engagement in a stepped care, transdiagnostic mental health intervention delivered in Indian schools. DISCOVER PSYCHOLOGY 2024; 4:43. [PMID: 38686018 PMCID: PMC11057193 DOI: 10.1007/s44202-024-00154-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 04/12/2024] [Indexed: 05/02/2024]
Abstract
Given the relationship between poor engagement and worse treatment outcomes, improving engagement has been the focus of attention in recent years. Engagement is a particular challenge among minoritized and otherwise challenged youth, such as those from socioeconomically disadvantaged groups, including youth in low- and middle-income countries (LMICs), where they face lower levels of access to resources, including mental health treatment. The present study describes engagement challenges that arose in an uncontrolled pre-post evaluation of a school-based, modular, multi-problem, stepped-care intervention delivered in urban Indian communities. Specifically, the study aimed to (1) characterize barriers and facilitators of youth treatment engagement; and (2) evaluate treatment acceptability and fit of treatment from the youth perspective. Youth participants completed semi-structured interviews, which were transcribed and coded using thematic analysis. Participants described numerous facilitators to engagement (e.g., positive therapeutic relationship) and reported high overall satisfaction with the intervention, while also identifying barriers to engagement (e.g., concerns about confidentiality) and offering suggestions to increase fit and acceptability (e.g., more visually appealing treatment materials). Findings highlight ways in which engagement can be enhanced and implementation supports improved to maximize treatment effectiveness among minoritized and disadvantaged youth in LMICs. Supplementary Information The online version contains supplementary material available at 10.1007/s44202-024-00154-1.
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Affiliation(s)
- Resham Gellatly
- Boston University Chobanian & Avedisian School of Medicine, Boston, MA USA
| | | | | | | | | | | | | | | | - Kanika Malik
- PRIDE Project, Sangath, New Delhi India
- Jindal School of Psychology and Counselling, O.P. Jindal Global University, Sonipat, Haryana India
| | | | - Kimberly Becker
- Department of Psychology, University of South Carolina, Columbia, SC USA
| | - Daniel Michelson
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Vikram Patel
- PRIDE Project, Sangath, New Delhi India
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA USA
| | - Bruce Chorpita
- Department of Psychology, University of California, Los Angeles, CA USA
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6
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Li G, Sit HF, Chen W, Wu K, Sou EKL, Wong M, Chen Z, Burchert S, Hong IW, Sit HY, Lam AIF, Hall BJ. A WHO digital intervention to address depression among young Chinese adults: a type 1 effectiveness-implementation randomized controlled trial. Transl Psychiatry 2024; 14:102. [PMID: 38378687 PMCID: PMC10879210 DOI: 10.1038/s41398-024-02812-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 01/22/2024] [Accepted: 01/29/2024] [Indexed: 02/22/2024] Open
Abstract
Common mental disorders among young people are rising globally. Current university-based interventions are inadequate to address the need for evidence-based interventions. We investigated the effectiveness and implementation of Step-by-Step (SbS), a WHO digital intervention to address depression, among Chinese university students with depressive symptoms. In this paper, we report a type 1 hybrid effectiveness-implementation randomized controlled trial conducted between September 2021 and September 2022. The control condition was enhanced treatment as usual (ETAU, psychoeducation). The primary outcome was improvement in depression symptoms. Secondary outcomes were improvements in psychological well-being, anxiety symptoms, and self-identified psychosocial problems. Effectiveness of the intervention was evaluated using generalized linear mixed models. Implementation outcomes were evaluated by thematic analysis of participant interviews. A total of 371 participants were enrolled to two treatment conditions in a 1:1 ratio. SbS resulted in a greater reduction in depressive symptoms at posttreatment (p = 0.004, Hedges' g = 0.35), but no significant difference between SbS and ETAU was observed at three-month follow-up (p = 0.179, Hedges' g = 0.16). The treatment effect was larger among those who adhered to the treatment (Hedges' gs = 0.59 and 0.30). Subjective well-being also improved for SbS at both time points (Hedges' gs = 0.31 and 0.30). In addition, SbS resulted in more improvement in anxiety symptoms at posttreatment (p = 0.029, Hedges' g = 0.26), but not at three-month follow-up (p = 0.265, Hedges' g = 0.13). The qualitative results demonstrated that the intervention was well-implemented as a self-help mental health service, with minimal support from peer supporters. In conclusion, Step-by-Step, a digital intervention developed by WHO, was effective in reducing depressive symptoms in the short term and improving psychological well-being in a longer term. The sustained effect on depression needs further investigation. Improving uptake and engagement in the program is needed for its scale-up implementation as a university-based mental health service for Chinese young adults. Trial registration: ChiCTR2100050214.
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Affiliation(s)
- Gen Li
- Center for Global Health Equity, New York University Shanghai, Shanghai, China
| | - Hao Fong Sit
- Department of Psychology, The University of Hong Kong, Hong Kong SAR, China
| | - Wen Chen
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
- Sun Yat-sen Centre for Migrant Health Policy, Sun Yat-sen University, Guangzhou, China
| | - Kunpeng Wu
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
- Sun Yat-sen Centre for Migrant Health Policy, Sun Yat-sen University, Guangzhou, China
| | | | - Mek Wong
- Student Affairs Office, University of Macau, Macau SAR, China
| | - Ze Chen
- Centre for Macau Studies, University of Macau, Macau SAR, China
| | - Sebastian Burchert
- Department of Education and Psychology, Division of Clinical Psychological Intervention, Freie Universität Berlin, Berlin, Germany
| | - Ieng Wai Hong
- Moon Chun Memorial College, University of Macau, Macau SAR, China
| | - Ho Yi Sit
- Shiu Pong College, University of Macau, Macau SAR, China
| | | | - Brian J Hall
- Center for Global Health Equity, New York University Shanghai, Shanghai, China.
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7
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Chi Z, Devine RT, Wolstencroft J, Skuse D, Hughes C, Baker K. Rare neurodevelopmental conditions and parents' mental health - how and when does genetic diagnosis matter? Orphanet J Rare Dis 2024; 19:70. [PMID: 38360654 PMCID: PMC10870533 DOI: 10.1186/s13023-024-03076-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 02/03/2024] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND Parents of individuals with rare neurodevelopmental conditions and intellectual disabilities (ID) are vulnerable to mental health difficulties, which vary between parents and within parents over time. The underlying cause of a child's condition can influence parents' mental health, via uncertain pathways and within unknown time-windows. RESULTS We analysed baseline data from the IMAGINE-ID cohort, comprising 2655 parents of children and young people with ID of known genetic origin. First, we conducted a factor analysis of the SDQ Impact scale to isolate specific pathways from genetic aetiology to parents' mental health. This suggested a two-factor structure for the SDQ Impact scale, with a "home & distress" dimension and a "participation" dimension. Second, we tested via structural equation modelling (SEM) whether genetic diagnosis affects Impact and mental health directly, or indirectly via children's characteristics. This analysis identified an indirect pathway linking genetic aetiology to parents' mental health, serially through child characteristics (physical disabilities, emotional and behavioural difficulties) and Impact: home & distress. Third, we conducted moderation analysis to explore the influence of time elapsed since genetic diagnosis. This showed that the serial mediation model was moderated by time since diagnosis, with strongest mediating effects among recently diagnosed cases. CONCLUSIONS There are multiple steps on the pathway from ID-associated genetic diagnoses to parents' mental health. Pathway links are strongest within 5 years of receiving a genetic diagnosis, highlighting opportunities for better post-diagnostic support. Recognition and enhanced support for children's physical and behavioural needs might reduce impact on family life, ameliorating parents' vulnerabilities to mental health difficulties.
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Affiliation(s)
- Zhaotian Chi
- MRC Cognition and Brain Sciences Unit, University of Cambridge, 15 Chaucer Road, CB2 7EF, Cambridge, UK
| | - Rory T Devine
- School of Psychology, University of Birmingham, Birmingham, UK
| | | | - David Skuse
- UCL Great Ormond Street Institute of Child Health, London, UK
| | - Claire Hughes
- Centre for Family Research, Department of Psychology, University of Cambridge, Cambridge, UK
| | - Kate Baker
- MRC Cognition and Brain Sciences Unit, University of Cambridge, 15 Chaucer Road, CB2 7EF, Cambridge, UK.
- Department of Medical Genetics, University of Cambridge, Cambridge, UK.
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8
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Closing the global gap in adolescent mental health. Nat Med 2024; 30:309-310. [PMID: 38378824 DOI: 10.1038/s41591-024-02846-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
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9
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Alozkan-Sever C, Uppendahl JR, Cuijpers P, de Vries R, Rahman A, Mittendorfer-Rutz E, Akhtar A, Zheng Z, Sijbrandij M. Research Review: Psychological and psychosocial interventions for children and adolescents with depression, anxiety, and post-traumatic stress disorder in low- and middle-income countries - a systematic review and meta-analysis. J Child Psychol Psychiatry 2023; 64:1776-1788. [PMID: 37781856 DOI: 10.1111/jcpp.13891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/13/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND The incidence of depression, anxiety, and post-traumatic stress disorder (PTSD) among children and adolescents residing in low- and middle-income countries (LMICs) poses a significant public health concern. However, there is variation in the evidence of effective psychological interventions. This meta-analysis aims to provide a complete overview of the current body of evidence in this rapidly evolving field. METHODS We conducted searches on PubMed, Embase.com, and EBSCO/APA PsycInfo databases up to June 23, 2022, identify randomized controlled trials (RCTs) investigating the effectiveness of psychological interventions in LMICs that targeted children and adolescents with elevated symptoms above a cut-off score for depression, anxiety, and PTSD, comparing a psychological or psychosocial intervention with other control conditions. We conducted random effects meta-analyses for depression, anxiety, and PTSD symptoms. Sensitivity analysis for outliers and high-risk studies, and analyses for the publication bias were carried out. Subgroup analyses investigated how the intervention type, intervention format, the facilitator, study design, and age group of the participant predicted effect sizes. RESULTS Thirty-one RCTs (6,123 participants) were included. We found a moderate effect of interventions on depression outcomes compared to the control conditions (g = 0.53; 95% CI: 0.06-0.99; NNT = 6.09) with a broad prediction interval (PI) (-1.8 to 2.86). We found a moderate to large effect for interventions on anxiety outcomes (g = 0.88; 95% CI: -0.03 to 1.79; NNT = 3.32) with a broad PI (-3.14 to 4.9). Additionally, a moderate effect was observed on PTSD outcomes (g = 0.54; 95% CI: 0.19-0.9; NNT = 5.86) with a broad PI (-0.64 to 1.72). CONCLUSIONS Psychological and psychosocial interventions aimed at addressing depression, anxiety, and PTSD among children and adolescents in LMICs have demonstrated promising results. However, future studies should consider the variation in evidence and incorporate long-term outcomes to better understand the effectiveness of these interventions.
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Affiliation(s)
- Cansu Alozkan-Sever
- Department of Clinical, Neuro- and Developmental Psychology, WHO Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Jana R Uppendahl
- Chair of Social Pediatrics, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Pim Cuijpers
- Department of Clinical, Neuro- and Developmental Psychology, WHO Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Ralph de Vries
- Medical Library, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Atif Rahman
- Department of Primary Care and Mental Health, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Ellenor Mittendorfer-Rutz
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Aemal Akhtar
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Zhuoli Zheng
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
| | - Marit Sijbrandij
- Department of Clinical, Neuro- and Developmental Psychology, WHO Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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10
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Mathur S, Weiss HA, Neuman M, Leurent B, Field AP, Shetty T, J. JE, Nair P, Mathews R, Malik K, Michelson D, Patel V. Developing knowledge-based psychotherapeutic competencies in non-specialist providers: A pre-post study with a nested randomised controlled trial of a coach-supported versus self-guided digital training course for a problem-solving psychological intervention in India. Glob Ment Health (Camb) 2023; 10:e87. [PMID: 38161749 PMCID: PMC10755375 DOI: 10.1017/gmh.2023.81] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 11/14/2023] [Accepted: 11/17/2023] [Indexed: 01/03/2024] Open
Abstract
We evaluated a digital learning programme for non-specialists to develop knowledge-based competencies in a problem-solving intervention for adolescents to examine the overall impact of training on knowledge-based competencies among learners; and to compare the effects of two training conditions (self-guided digital training with or without coaching) in a nested parallel, two-arm, individually randomised controlled trial. Eligible participants were 18 or older; fluent in Hindi or English; able to access digital training; and had no prior experience of delivering structured psychotherapies. 277 participants were enrolled from 31 March 2022 to 19 June 2022 of which 230 (83%) completed the study. There was a significant increase in competency score from pre-training (Mean = 7.01, SD = 3.29) to post-training (Mean = 8.88, SD = 3.80), 6 weeks after the pre-training assessment. Knowledge competency scores showed larger increase among participants randomised to the coaching arm (AMD = 1.09, 95% CI 0.26-1.92, p = 0.01) with an effect size (d) of 0.33 (95% CI 0.08-0.58). More participants completed training in the coaching arm (n = 96, 69.6%) compared to the self-guided training arm (n = 56, 40.3%). In conclusion, a coach-supported remote digital training intervention is associated with enhanced participation by learners and increased psychotherapeutic knowledge competencies.
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Affiliation(s)
| | - Helen A. Weiss
- Medical Research Council International Statistics and Epidemiology Group, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Melissa Neuman
- Medical Research Council International Statistics and Epidemiology Group, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Baptiste Leurent
- Department of Statistical Science, University College London, London, UK
| | - Andy P. Field
- School of Psychology, University of Sussex, Brighton, UK
| | | | | | | | | | - Kanika Malik
- Jindal School of Psychology and Counselling, O.P. Jindal Global University, Sonipat, India
| | - Daniel Michelson
- School of Psychology, University of Sussex, Brighton, UK
- Department of Child & Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Vikram Patel
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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11
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Purgato M, Prina E, Ceccarelli C, Cadorin C, Abdulmalik JO, Amaddeo F, Arcari L, Churchill R, Jordans MJ, Lund C, Papola D, Uphoff E, van Ginneken N, Tol WA, Barbui C. Primary-level and community worker interventions for the prevention of mental disorders and the promotion of well-being in low- and middle-income countries. Cochrane Database Syst Rev 2023; 10:CD014722. [PMID: 37873968 PMCID: PMC10594594 DOI: 10.1002/14651858.cd014722.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
BACKGROUND There is a significant research gap in the field of universal, selective, and indicated prevention interventions for mental health promotion and the prevention of mental disorders. Barriers to closing the research gap include scarcity of skilled human resources, large inequities in resource distribution and utilization, and stigma. OBJECTIVES To assess the effectiveness of delivery by primary workers of interventions for the promotion of mental health and universal prevention, and for the selective and indicated prevention of mental disorders or symptoms of mental illness in low- and middle-income countries (LMICs). To examine the impact of intervention delivery by primary workers on resource use and costs. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, CINAHL, Global Index Medicus, PsycInfo, WHO ICTRP, and ClinicalTrials.gov from inception to 29 November 2021. SELECTION CRITERIA Randomized controlled trials (RCTs) of primary-level and/or community health worker interventions for promoting mental health and/or preventing mental disorders versus any control conditions in adults and children in LMICs. DATA COLLECTION AND ANALYSIS Standardized mean differences (SMD) or mean differences (MD) were used for continuous outcomes, and risk ratios (RR) for dichotomous data, using a random-effects model. We analyzed data at 0 to 1, 1 to 6, and 7 to 24 months post-intervention. For SMDs, 0.20 to 0.49 represented small, 0.50 to 0.79 moderate, and ≥ 0.80 large clinical effects. We evaluated the risk of bias (RoB) using Cochrane RoB2. MAIN RESULTS Description of studies We identified 113 studies with 32,992 participants (97 RCTs, 19,570 participants in meta-analyses) for inclusion. Nineteen RCTs were conducted in low-income countries, 27 in low-middle-income countries, 2 in middle-income countries, 58 in upper-middle-income countries and 7 in mixed settings. Eighty-three RCTs included adults and 30 RCTs included children. Cadres of primary-level workers employed primary care health workers (38 studies), community workers (71 studies), both (2 studies), and not reported (2 studies). Interventions were universal prevention/promotion in 22 studies, selective in 36, and indicated prevention in 55 RCTs. Risk of bias The most common concerns over risk of bias were performance bias, attrition bias, and reporting bias. Intervention effects 'Probably', 'may', or 'uncertain' indicates 'moderate-', 'low-', or 'very low-'certainty evidence. *Certainty of the evidence (using GRADE) was assessed at 0 to 1 month post-intervention as specified in the review protocol. In the abstract, we did not report results for outcomes for which evidence was missing or very uncertain. Adults Promotion/universal prevention, compared to usual care: - probably slightly reduced anxiety symptoms (MD -0.14, 95% confidence interval (CI) -0.27 to -0.01; 1 trial, 158 participants) - may slightly reduce distress/PTSD symptoms (SMD -0.24, 95% CI -0.41 to -0.08; 4 trials, 722 participants) Selective prevention, compared to usual care: - probably slightly reduced depressive symptoms (SMD -0.69, 95% CI -1.08 to -0.30; 4 trials, 223 participants) Indicated prevention, compared to usual care: - may reduce adverse events (1 trial, 547 participants) - probably slightly reduced functional impairment (SMD -0.12, 95% CI -0.39 to -0.15; 4 trials, 663 participants) Children Promotion/universal prevention, compared to usual care: - may improve the quality of life (SMD -0.25, 95% CI -0.39 to -0.11; 2 trials, 803 participants) - may reduce adverse events (1 trial, 694 participants) - may slightly reduce depressive symptoms (MD -3.04, 95% CI -6 to -0.08; 1 trial, 160 participants) - may slightly reduce anxiety symptoms (MD -2.27, 95% CI -3.13 to -1.41; 1 trial, 183 participants) Selective prevention, compared to usual care: - probably slightly reduced depressive symptoms (SMD 0, 95% CI -0.16 to -0.15; 2 trials, 638 participants) - may slightly reduce anxiety symptoms (MD 4.50, 95% CI -12.05 to 21.05; 1 trial, 28 participants) - probably slightly reduced distress/PTSD symptoms (MD -2.14, 95% CI -3.77 to -0.51; 1 trial, 159 participants) Indicated prevention, compared to usual care: - decreased slightly functional impairment (SMD -0.29, 95% CI -0.47 to -0.10; 2 trials, 448 participants) - decreased slightly depressive symptoms (SMD -0.18, 95% CI -0.32 to -0.04; 4 trials, 771 participants) - may slightly reduce distress/PTSD symptoms (SMD 0.24, 95% CI -1.28 to 1.76; 2 trials, 448 participants). AUTHORS' CONCLUSIONS The evidence indicated that prevention interventions delivered through primary workers - a form of task-shifting - may improve mental health outcomes. Certainty in the evidence was influenced by the risk of bias and by substantial levels of heterogeneity. A supportive network of infrastructure and research would enhance and reinforce this delivery modality across LMICs.
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Affiliation(s)
- Marianna Purgato
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
- Cochrane Global Mental Health, University of Verona, Verona, Italy
| | - Eleonora Prina
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Caterina Ceccarelli
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Camilla Cadorin
- Department of Neurosciences, Biomedicine and Movement Sciences, Verona, Italy
| | | | - Francesco Amaddeo
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | | | - Rachel Churchill
- Cochrane Common Mental Disorders, Centre for Reviews and Dissemination, University of York, York, UK
| | - Mark Jd Jordans
- Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Crick Lund
- King's Global Health Institute, Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Davide Papola
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
- Cochrane Global Mental Health, University of Verona, Verona, Italy
| | - Eleonora Uphoff
- Cochrane Common Mental Disorders, Centre for Reviews and Dissemination, University of York, York, UK
| | - Nadja van Ginneken
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
| | - Wietse Anton Tol
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Corrado Barbui
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
- Cochrane Global Mental Health, University of Verona, Verona, Italy
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12
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Tran TD, Nguyen H, Shochet I, Nguyen N, La N, Wurfl A, Orr J, Nguyen H, Stocker R, Fisher J. School-based universal mental health promotion intervention for adolescents in Vietnam: Two-arm, parallel, controlled trial. Glob Ment Health (Camb) 2023; 10:e69. [PMID: 38024797 PMCID: PMC10643236 DOI: 10.1017/gmh.2023.66] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 08/25/2023] [Accepted: 10/12/2023] [Indexed: 12/01/2023] Open
Abstract
The aim of this study was to evaluate the effects of Happy House, a universal school-based programme, in reducing adolescents' depressive symptoms and improving their mental well-being, coping self-efficacy and school connectedness. This was a school-based, two-arm parallel controlled trial. Depressive symptoms were measured using the Centre for Epidemiologic Studies Depression Scale. Data were collected at recruitment, and at 2 weeks and 6 months post-intervention. Mixed-effect models were conducted to estimate the effects of the intervention on the outcomes. A total of 1,084 students were recruited. At 2 weeks post-intervention, the effect size on depressive symptoms was 0.11 (p = 0.011) and the odds of having clinically significant depressive symptoms were lower in the intervention compared to the control (0.56, p = 0.027). Both of these were no longer significant at 6 months post-intervention. Psychological well-being mean scores in the intervention were significantly higher than in the control at 2 weeks post-intervention (effect size 0.13). Coping self-efficacy mean scores were significantly higher in the intervention group at both 2-week and 6-month post-intervention (effect sizes from 0.17 to 0.26). Data support the potential of Happy House to reduce the prevalence of adolescent mental health problems and to promote positive mental health in the school context in Vietnam.
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Affiliation(s)
- Thach Duc Tran
- Global and Women’s Health, Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Huong Nguyen
- Department of Health Promotion, Hanoi University of Public Health, Hanoi, Vietnam
| | - Ian Shochet
- School of Psychology and Counselling, Queensland University of Technology, Brisbane, QLD, Australia
| | - Nga Nguyen
- Department of Health Promotion, Hanoi University of Public Health, Hanoi, Vietnam
| | - Nga La
- Department of Health Promotion, Hanoi University of Public Health, Hanoi, Vietnam
| | - Astrid Wurfl
- School of Psychology and Counselling, Queensland University of Technology, Brisbane, QLD, Australia
| | - Jayne Orr
- School of Psychology and Counselling, Queensland University of Technology, Brisbane, QLD, Australia
| | - Hau Nguyen
- Global and Women’s Health, Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Ruby Stocker
- Global and Women’s Health, Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Jane Fisher
- Global and Women’s Health, Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
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13
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Giusto A, Vander Missen MR, Kosgei G, Njiriri F, Puffer E, Kamaru Kwobah E, Barasa J, Turissini M, Rasmussen J, Ott M, Binayo J, Rono W, Jaguga F. Peer-delivered Problem-solving Therapy for Adolescent Mental Health in Kenya: Adaptation for Context and Training of Peer-counselors. Res Child Adolesc Psychopathol 2023; 51:1243-1256. [PMID: 37219680 PMCID: PMC10203666 DOI: 10.1007/s10802-023-01075-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2023] [Indexed: 05/24/2023]
Abstract
Peer-delivered interventions for adolescent mental health can help address poor access to mental health interventions. Questions remain about how interventions can be adapted for peer delivery and whether peers can be trained. In this study, we adapted problem solving therapy (PST) for peer-delivery with adolescents in Kenya and explored whether peer counselors can be trained in PST. We adapted treatment prior to and during training using the Cultural Adaptation and Contextualization for Implementation framework. Nine peer counselors (Ages 20-24) were selected and trained over 10 days. Peer competencies and knowledge were measured pre-post using a written exam, a written case study, and role plays rated using a standardized competency measure. We chose a version of PST used in India with secondary school adolescents originally delivered by teachers. All materials were translated into Kiswahili. Language and format were adapted to Kenyan adolescents as well as for delivery by peers with a focus on understandability and relevance (e.g., noting shared experience). Metaphors, examples, and visual materials were adapted for the context to reflect the culture and vernacular of Kenyan youth. Peer counselors were able to be trained in PST. Pre-post competencies and understanding of content showed improvements with peers minimally meeting patient needs (pre) on average to moderate/fully meeting patient needs (post). Post-training written exam score showed an average 90% correct. There is an adapted version of PST for Kenyan adolescents and peer delivery. Peer counselors can be trained to deliver a 5-session PST in a community context.
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Affiliation(s)
- Ali Giusto
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University Medical Center, New York, NY, 10032, USA.
| | | | - Gilliane Kosgei
- Department of Mental Health, Moi Teaching & Referral Hospital, Eldoret, Kenya
| | - Faith Njiriri
- Department of Mental Health, Moi Teaching & Referral Hospital, Eldoret, Kenya
| | - Eve Puffer
- Duke Global Health Institute, Durham, NC, 27710, USA
- Department of Neuroscience and Psychology, Duke University, Durham, NC, 27708, USA
| | - Edith Kamaru Kwobah
- Department of Mental Health, Moi Teaching & Referral Hospital, Eldoret, Kenya
| | - Julius Barasa
- Department of Mental Health, Moi Teaching & Referral Hospital, Eldoret, Kenya
| | - Matthew Turissini
- Department of Medicine, Indiana University, Bloomington, IN, 47405, USA
| | - Justin Rasmussen
- Duke Global Health Institute, Durham, NC, 27710, USA
- Department of Neuroscience and Psychology, Duke University, Durham, NC, 27708, USA
| | - Mary Ott
- Department of Medicine, Indiana University, Bloomington, IN, 47405, USA
| | | | - Wilter Rono
- Department of Mental Health, Moi Teaching & Referral Hospital, Eldoret, Kenya
| | - Florence Jaguga
- Department of Mental Health, Moi Teaching & Referral Hospital, Eldoret, Kenya
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14
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Metz K, Lewis J, Mitchell J, Chakraborty S, McLeod BD, Bjørndal L, Mildon R, Shlonsky A. Problem-solving interventions and depression among adolescents and young adults: A systematic review of the effectiveness of problem-solving interventions in preventing or treating depression. PLoS One 2023; 18:e0285949. [PMID: 37643196 PMCID: PMC10464969 DOI: 10.1371/journal.pone.0285949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 05/04/2023] [Indexed: 08/31/2023] Open
Abstract
Problem-solving (PS) has been identified as a therapeutic technique found in multiple evidence-based treatments for depression. To further understand for whom and how this intervention works, we undertook a systematic review of the evidence for PS's effectiveness in preventing and treating depression among adolescents and young adults. We searched electronic databases (PsycINFO, Medline, and Cochrane Library) for studies published between 2000 and 2022. Studies meeting the following criteria were included: (a) the intervention was described by authors as a PS intervention or including PS; (b) the intervention was used to treat or prevent depression; (c) mean or median age between 13-25 years; (d) at least one depression outcome was reported. Risk of bias of included studies was assessed using the Cochrane Risk of Bias 2.0 tool. A narrative synthesis was undertaken given the high level of heterogeneity in study variables. Twenty-five out of 874 studies met inclusion criteria. The interventions studied were heterogeneous in population, intervention, modality, comparison condition, study design, and outcome. Twelve studies focused purely on PS; 13 used PS as part of a more comprehensive intervention. Eleven studies found positive effects in reducing depressive symptoms and two in reducing suicidality. There was little evidence that the intervention impacted PS skills or that PS skills acted as a mediator or moderator of effects on depression. There is mixed evidence about the effectiveness of PS as a prevention and treatment of depression among AYA. Our findings indicate that pure PS interventions to treat clinical depression have the strongest evidence, while pure PS interventions used to prevent or treat sub-clinical depression and PS as part of a more comprehensive intervention show mixed results. Possible explanations for limited effectiveness are discussed, including missing outcome bias, variability in quality, dosage, and fidelity monitoring; small sample sizes and short follow-up periods.
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Affiliation(s)
- Kristina Metz
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States of America
| | - Jane Lewis
- Centre for Evidence and Implementation, London, United Kingdom
| | - Jade Mitchell
- Centre for Evidence and Implementation, London, United Kingdom
| | | | - Bryce D. McLeod
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, United States of America
| | - Ludvig Bjørndal
- Centre for Evidence and Implementation, London, United Kingdom
| | - Robyn Mildon
- Centre for Evidence and Implementation, Melbourne, Victoria, Australia
| | - Aron Shlonsky
- Department of Social Work, Monash University, Melbourne, Victoria, Australia
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15
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Bellón JA, Rodríguez-Morejón A, Conejo-Cerón S, Campos-Paíno H, Rodríguez-Bayón A, Ballesta-Rodríguez MI, Rodríguez-Sánchez E, Mendive JM, López del Hoyo Y, Luna JD, Tamayo-Morales O, Moreno-Peral P. A personalized intervention to prevent depression in primary care based on risk predictive algorithms and decision support systems: protocol of the e-predictD study. Front Psychiatry 2023; 14:1163800. [PMID: 37333911 PMCID: PMC10275079 DOI: 10.3389/fpsyt.2023.1163800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 05/02/2023] [Indexed: 06/20/2023] Open
Abstract
The predictD is an intervention implemented by general practitioners (GPs) to prevent depression, which reduced the incidence of depression-anxiety and was cost-effective. The e-predictD study aims to design, develop, and evaluate an evolved predictD intervention to prevent the onset of major depression in primary care based on Information and Communication Technologies, predictive risk algorithms, decision support systems (DSSs), and personalized prevention plans (PPPs). A multicenter cluster randomized trial with GPs randomly assigned to the e-predictD intervention + care-as-usual (CAU) group or the active-control + CAU group and 1-year follow-up is being conducted. The required sample size is 720 non-depressed patients (aged 18-55 years), with moderate-to-high depression risk, under the care of 72 GPs in six Spanish cities. The GPs assigned to the e-predictD-intervention group receive brief training, and those assigned to the control group do not. Recruited patients of the GPs allocated to the e-predictD group download the e-predictD app, which incorporates validated risk algorithms to predict depression, monitoring systems, and DSSs. Integrating all inputs, the DSS automatically proposes to the patients a PPP for depression based on eight intervention modules: physical exercise, social relationships, improving sleep, problem-solving, communication skills, decision-making, assertiveness, and working with thoughts. This PPP is discussed in a 15-min semi-structured GP-patient interview. Patients then choose one or more of the intervention modules proposed by the DSS to be self-implemented over the next 3 months. This process will be reformulated at 3, 6, and 9 months but without the GP-patient interview. Recruited patients of the GPs allocated to the control-group+CAU download another version of the e-predictD app, but the only intervention that they receive via the app is weekly brief psychoeducational messages (active-control group). The primary outcome is the cumulative incidence of major depression measured by the Composite International Diagnostic Interview at 6 and 12 months. Other outcomes include depressive symptoms (PHQ-9) and anxiety symptoms (GAD-7), depression risk (predictD risk algorithm), mental and physical quality of life (SF-12), and acceptability and satisfaction ('e-Health Impact' questionnaire) with the intervention. Patients are evaluated at baseline and 3, 6, 9, and 12 months. An economic evaluation will also be performed (cost-effectiveness and cost-utility analysis) from two perspectives, societal and health systems. Trial registration ClinicalTrials.gov, identifier: NCT03990792.
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Affiliation(s)
- Juan A. Bellón
- Biomedical Research Institute of Malaga (IBIMA Plataforma Bionand), Málaga, Spain
- Prevention and Health Promotion Research Network (redIAPP), ISCIII, Madrid, Spain
- Network for Research on Chronicity, Primary Care, and Prevention and Health Promotion (RICAPPS), ISCIII, Madrid, Spain
- ‘El Palo' Health Centre, Servicio Andaluz de Salud (SAS), Málaga, Spain
- Department of Public Health and Psychiatry, University of Málaga (UMA), Málaga, Spain
| | - Alberto Rodríguez-Morejón
- Biomedical Research Institute of Malaga (IBIMA Plataforma Bionand), Málaga, Spain
- Prevention and Health Promotion Research Network (redIAPP), ISCIII, Madrid, Spain
- Network for Research on Chronicity, Primary Care, and Prevention and Health Promotion (RICAPPS), ISCIII, Madrid, Spain
- Department of Personality, Evaluation and Psychological Treatment, University of Málaga (UMA), Málaga, Spain
| | - Sonia Conejo-Cerón
- Biomedical Research Institute of Malaga (IBIMA Plataforma Bionand), Málaga, Spain
- Prevention and Health Promotion Research Network (redIAPP), ISCIII, Madrid, Spain
- Network for Research on Chronicity, Primary Care, and Prevention and Health Promotion (RICAPPS), ISCIII, Madrid, Spain
| | - Henar Campos-Paíno
- Biomedical Research Institute of Malaga (IBIMA Plataforma Bionand), Málaga, Spain
- Prevention and Health Promotion Research Network (redIAPP), ISCIII, Madrid, Spain
- Network for Research on Chronicity, Primary Care, and Prevention and Health Promotion (RICAPPS), ISCIII, Madrid, Spain
| | - Antonina Rodríguez-Bayón
- Prevention and Health Promotion Research Network (redIAPP), ISCIII, Madrid, Spain
- Network for Research on Chronicity, Primary Care, and Prevention and Health Promotion (RICAPPS), ISCIII, Madrid, Spain
- Centro de Salud San José, Distrito Sanitario Jaén Norte, Servicio Andaluz de Salud (SAS), Linares, Jaén, Spain
| | - María I. Ballesta-Rodríguez
- Prevention and Health Promotion Research Network (redIAPP), ISCIII, Madrid, Spain
- Network for Research on Chronicity, Primary Care, and Prevention and Health Promotion (RICAPPS), ISCIII, Madrid, Spain
- Centro de Salud Federico del Castillo, Distrito Sanitario Jaén, Servicio Andaluz de Salud (SAS), Jaén, Spain
| | - Emiliano Rodríguez-Sánchez
- Prevention and Health Promotion Research Network (redIAPP), ISCIII, Madrid, Spain
- Network for Research on Chronicity, Primary Care, and Prevention and Health Promotion (RICAPPS), ISCIII, Madrid, Spain
- Unidad de Investigación de Atención Primaria de Salamanca (APISAL), Gerencia de Atención Primaria de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
- Department of Medicine, University of Salamanca (USAL), Salamanca, Spain
| | - Juan M. Mendive
- Prevention and Health Promotion Research Network (redIAPP), ISCIII, Madrid, Spain
- Network for Research on Chronicity, Primary Care, and Prevention and Health Promotion (RICAPPS), ISCIII, Madrid, Spain
- ‘La Mina' Health Centre, Institut Català de la Salut (ICS), Barcelona, Spain
| | - Yolanda López del Hoyo
- Prevention and Health Promotion Research Network (redIAPP), ISCIII, Madrid, Spain
- Network for Research on Chronicity, Primary Care, and Prevention and Health Promotion (RICAPPS), ISCIII, Madrid, Spain
- Instituto de Investigación Sanitaria de Aragón (IISA), Universidad de Zaragoza (UNIZAR), Zaragoza, Spain
| | - Juan D. Luna
- Prevention and Health Promotion Research Network (redIAPP), ISCIII, Madrid, Spain
- Network for Research on Chronicity, Primary Care, and Prevention and Health Promotion (RICAPPS), ISCIII, Madrid, Spain
- Department of Statistics and Operational Research, University of Granada (UGR), Granada, Spain
| | - Olaya Tamayo-Morales
- Prevention and Health Promotion Research Network (redIAPP), ISCIII, Madrid, Spain
- Network for Research on Chronicity, Primary Care, and Prevention and Health Promotion (RICAPPS), ISCIII, Madrid, Spain
- Unidad de Investigación de Atención Primaria de Salamanca (APISAL), Gerencia de Atención Primaria de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
| | - Patricia Moreno-Peral
- Biomedical Research Institute of Malaga (IBIMA Plataforma Bionand), Málaga, Spain
- Prevention and Health Promotion Research Network (redIAPP), ISCIII, Madrid, Spain
- Network for Research on Chronicity, Primary Care, and Prevention and Health Promotion (RICAPPS), ISCIII, Madrid, Spain
- Department of Personality, Evaluation and Psychological Treatment, University of Málaga (UMA), Málaga, Spain
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16
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Reininghaus U, Rauschenberg C, Schick A, Hartmann JA. [Public mental health from an international perspective: from "shifting the curve" to inclusion of vulnerable populations]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2023; 66:371-378. [PMID: 36847854 PMCID: PMC9969372 DOI: 10.1007/s00103-023-03673-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 02/03/2023] [Indexed: 03/01/2023]
Abstract
In recent years, efforts in the field of public mental health have increased that seek to promote mental health and mental health literacy at population level and yield advances in the prevention, treatment and care of mental health conditions. This paper provides an overview of contemporary conceptualisations of indicators and determinants of public mental health as well as population-based intervention strategies from an international perspective. Current conceptual and methodological challenges of so-called high-risk, whole-population and vulnerable population strategies are critically discussed. Future efforts in research, policy and practice need to address fundamental causes of social and health inequalities, drawing on all societal fields, to contribute to improving population mental health.
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Affiliation(s)
- Ulrich Reininghaus
- Abteilung Public Mental Health, Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Deutschland. .,Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, Großbritannien. .,ESRC Centre for Society and Mental Health, King's College London, London, Großbritannien.
| | - Christian Rauschenberg
- Abteilung Public Mental Health, Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Deutschland
| | - Anita Schick
- Abteilung Public Mental Health, Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Deutschland
| | - Jessica A. Hartmann
- Abteilung Public Mental Health, Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Deutschland ,Orygen, the National Centre of Excellence in Youth Mental Health, Parkville, Australien
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17
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Sheel H, Suárez L, Marsh NV. Parents' Evaluation of Developmental Status and Strength and Difficulties Questionnaire as Screening Measures for Children in India: A Scoping Review. Pediatr Rep 2023; 15:175-196. [PMID: 36976721 PMCID: PMC10055800 DOI: 10.3390/pediatric15010014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 02/11/2023] [Accepted: 02/13/2023] [Indexed: 03/29/2023] Open
Abstract
Due to the limited availability of suitable measures, screening children for developmental delays and social-emotional learning has long been a challenge in India. This scoping review examined the use of the Parents' Evaluation of Developmental Status (PEDS), PEDS: Developmental Milestones (PEDS:DM), and the Strength and Difficulties Questionnaire (SDQ) with children (<13 years old) in India. The scoping review was conducted following the Joanna Briggs Institute Protocol to identify primary research studies that examined the use of the PEDS, PEDS:DM, and SDQ in India between 1990 and 2020. A total of seven studies for the PEDS and eight studies for the SDQ were identified for inclusion in the review. There were no studies using the PEDS:DM. Two empirical studies used the PEDS, while seven empirical studies used the SDQ. This review represents the first step in understanding the use of screening tools with children in India.
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Affiliation(s)
- Hina Sheel
- School of Social and Health Sciences, James Cook University, 149 Sims Drive, Singapore 387380, Singapore
| | - Lidia Suárez
- School of Social and Health Sciences, James Cook University, 149 Sims Drive, Singapore 387380, Singapore
| | - Nigel V Marsh
- School of Social and Health Sciences, James Cook University, 149 Sims Drive, Singapore 387380, Singapore
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18
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Malik K, Shetty T, Mathur S, Jose JE, Mathews R, Sahay M, Chauhan P, Nair P, Patel V, Michelson D. Feasibility and Acceptability of a Remote Stepped Care Mental Health Programme for Adolescents during the COVID-19 Pandemic in India. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1722. [PMID: 36767090 PMCID: PMC9914840 DOI: 10.3390/ijerph20031722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 01/12/2023] [Accepted: 01/13/2023] [Indexed: 06/18/2023]
Abstract
Remote mental health services were rapidly deployed during the COVID-19 pandemic, yet there is relatively little contemporaneous evidence on their feasibility and acceptability. This study assessed the feasibility and acceptability of a stepped care mental health programme delivered remotely by lay counsellors to adolescents in New Delhi, India, during a period of 'lockdown'. The programme consisted of a brief problem-solving intervention ("Step 1") followed by a tailored behavioural module ("Step 2") for non-responders. We enrolled 34 participants (M age = 16.4 years) with a self-identified need for psychological support. Feasibility and acceptability were assessed through quantitative process indicators and qualitative interviews (n = 17 adolescents; n = 5 counsellors). Thirty-one (91%) adolescents started Step 1 and 16 (52%) completed the planned Step 1 protocol. Twelve (75%) of the Step 1 completers were non-responsive. Eight (67%) non-responsive cases started Step 2, all of whom met response criteria when reassessed at 12 weeks post-enrolment. Adolescents favoured voice-only sessions over video-calls due to privacy concerns and difficulties accessing suitable devices. Counsellors noted challenges of completing remote sessions within the allotted time while recognising the importance of supervision for developing competence in new ways of working. Both adolescents and counsellors discussed the importance of working collaboratively and flexibly to fit around individual preferences and circumstances. Disentangling pandemic-specific barriers from more routine challenges to remote delivery should be a focus of future research.
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Affiliation(s)
- Kanika Malik
- Jindal School of Psychology and Counselling, O.P. Jindal Global University, Sonipat 13100, India
- PRIDE Project, Sangath, New Delhi 110030, India
| | | | | | | | | | | | | | - Pooja Nair
- PRIDE Project, Sangath, New Delhi 110030, India
| | - Vikram Patel
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA 02115, USA
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA 02115, USA
| | - Daniel Michelson
- School of Psychology, University of Sussex, Brighton BN1 9RH, UK
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE5 8AF, UK
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19
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Chingono R, Kasese C, Miles S, Busza J. 'I was in need of somewhere to release my hurt:' Addressing the mental health of vulnerable adolescent mothers in Harare, Zimbabwe, through self-help groups. Glob Health Action 2022; 15:2040151. [PMID: 35322767 PMCID: PMC8956306 DOI: 10.1080/16549716.2022.2040151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Adolescents experiencing multiple vulnerabilities, including poverty, curtailed education, transactional sex and early childbearing, are at risk of poor mental health. In Zimbabwe, girls who are pregnant or new mothers and involved in selling sex struggle to cope with the combined pressures of parenthood, financial insecurity, and social stigma. A pilot intervention brought such girls together into self-help groups to increase peer support, resources and skills. Objective This study aimed to explore whether and how participation in a self-help group intervention affected vulnerable young mothers’ experiences and perceptions of mental health stressors. Methods Self-help groups received 12 participatory sessions over 6 months. Eighteen semi-structured interviews and three focus group discussions were held with participants and drop-outs. Before and after the intervention, participants completed the locally validated 14-item Shona Symptom Questionnaire tool to indicate the probable prevalence of common mental health disorders. Results Adolescent girls described mutually reinforcing stressors in their lives and reported low self-esteem and anxiety. Key themes emerging from qualitative data centred around girls’ struggles with adverse life events, the burden of new motherhood, social isolation related to sex work and self-help groups as a source of hope. Participants joined groups to obtain support and felt their mental well-being improved due to new social networks, feelings of solidarity with peers, and increased confidence for positive action, that is, seeking health services for themselves and their babies. Prior to enrolment 16% showed signs of possible common mental disorders falling to 2% at follow-up. Conclusions Participants believed involvement in interactive self-help groups improved their mental health by strengthening peer support and engendering hope for the future. Although reduced mental distress cannot be attributed to the programme, the pilot intervention offers a low-cost approach that could be rigorously tested and adapted to a wide range of community settings.
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Affiliation(s)
- Rudo Chingono
- Centre for Sexual Health and HIV/AIDS Research, Harare, Zimbabwe.,Biomedical Research and Training Institute, Harare, Zimbabwe.,Institute of Global Health, University College London, UK
| | - Constance Kasese
- Centre for Sexual Health and HIV/AIDS Research, Harare, Zimbabwe
| | - Sam Miles
- Department of Public Health, Environment & Society, London School of Hygiene and Tropical Medicine, London, UK
| | - Joanna Busza
- Department of Public Health, Environment & Society, London School of Hygiene and Tropical Medicine, London, UK
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20
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Gonsalves PP, Bhat B, Sharma R, Jambhale A, Chodankar B, Verma M, Hodgson E, Weiss HA, Leurent B, Cavanagh K, Fairburn CG, Cuijpers P, Michelson D, Patel V. Pilot randomised controlled trial of a remotely delivered online intervention for adolescent mental health problems in India: lessons learned about low acceptability and feasibility during the COVID-19 pandemic. BJPsych Open 2022; 9:e7. [PMID: 36573376 PMCID: PMC9798210 DOI: 10.1192/bjo.2022.624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND 'POD Adventures' is a gamified problem-solving intervention delivered via smartphone app, and supported by non-specialist counsellors for a target population of secondary school students in India during the COVID-19 pandemic. AIMS To evaluate the feasibility and acceptability of undertaking a randomised controlled trial of POD Adventures when delivered online with telephone support from counsellors. METHOD We conducted a parallel, two-arm, individually randomised pilot-controlled trial with 11 secondary schools in Goa, India. Participants received either the POD Adventures intervention delivered over 4 weeks or usual care comprising information about local mental health services and national helplines. Outcomes were assessed at two timepoints: baseline and 6 weeks post-randomisation. RESULTS Seventy-nine classroom sensitisation sessions reaching a total of 1575 students were conducted. Ninety-two self-initiated study referrals (5.8%) were received, but only 11 participants enrolled in the study. No intervention arm participants completed the intervention. Outcomes at 6 weeks were not available for intervention arm participants (n = 5), and only four control arm participants completed outcomes. No qualitative interviews or participant satisfaction measures were completed because participants could not be reached by the study team. CONCLUSIONS Despite modifications to address barriers arising from COVID-19 restrictions, online delivery was not feasible in the study context. Low recruitment and missing feasibility and acceptability data make it difficult to draw conclusions about intervention engagement and indicative clinical outcomes. Prior findings showing high uptake, adherence and engagement with POD Adventures when delivered in a school-based context suggest that an online study and delivery posed the biggest barriers to study participation and engagement.
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Affiliation(s)
- Pattie P Gonsalves
- PRIDE, Sangath, India; and School of Psychology, University of Sussex, UK
| | | | | | | | | | | | | | - Helen A Weiss
- Medical Research Council Tropical Epidemiology Group, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, UK
| | - Baptiste Leurent
- Medical Research Council Tropical Epidemiology Group, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, UK
| | | | | | - Pim Cuijpers
- Department of Clinical Psychology, Vrije Universiteit, The Netherlands
| | - Daniel Michelson
- School of Psychology, University of Sussex, UK; and Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Vikram Patel
- Department of Clinical Psychology, Vrije Universiteit, The Netherlands; and Department of Global Health and Social Medicine, Harvard Medical School, Massachusetts, USA
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21
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Venturo-Conerly KE, Eisenman D, Wasil AR, Singla DR, Weisz JR. Meta-analysis: The Effectiveness of Youth Psychotherapy Interventions in Low- and Middle-Income Countries. J Am Acad Child Adolesc Psychiatry 2022:S0890-8567(22)01980-3. [PMID: 36563875 DOI: 10.1016/j.jaac.2022.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 07/20/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Because most youth psychotherapies are developed and tested in high-income countries, relatively little is known about their effectiveness or moderators in low- and middle-income countries (LMICs). To address this gap, we conducted a meta-analysis of randomized controlled trials (RCTs) testing psychotherapies for youth with multiple psychiatric conditions in LMICs, and we tested candidate moderators. METHOD We searched 9 international databases for RCTs of youth psychotherapies in LMICs published through January 2021. The RCTs targeted elevated symptoms of youth anxiety (including post-traumatic stress disorder [PTSD] and obsessive-compulsive disorder), depression, conduct problems, and attention problems. Using robust variance estimation, we estimated the pooled effect sizes (Hedges g) at post treatment and follow-up for intervention vs control conditions. RESULTS Of 5,145 articles identified, 34 articles (with 43 treatment-control comparisons and 4,176 participants) met methodological standards and were included. The overall pooled g with winsorized outliers was 1.01 (95% CI = 0.72-1.29, p < .001) at post treatment and 0.68 (95% CI = 0.29-1.07, p = .003) at follow-up. Interventions delivered by professional clinicians significantly outperformed those delivered by lay providers (g = 1.59 vs 0.53), but all interventions for conduct problems were delivered by professionals, and the difference for interventions targeting internalizing problems (g = 1.33 vs .53) was not significant. Interventions developed non-locally were more effective if they were not adapted to local contexts than if they were adapted locally (g = 2.31 vs 0.66), highlighting a need for further research on effective adaptations. Significant risk of bias was identified. CONCLUSION Overall, pooled effects of youth psychotherapies in LMICs were markedly larger than those in recent comparable non-LMIC meta-analyses, which have shown small-to-medium effects for youth psychotherapies. Findings highlight the potential benefits of youth psychotherapies in LMICs, as well as a need for more RCTs and improved study quality.
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Affiliation(s)
| | | | | | - Daisy R Singla
- Center of Addiction and Mental Health, Toronto, Ontario, Canada; University of Toronto, Ontario, Canada; Sinai Health, Toronto, Ontario, Canada
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22
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Will increasing access to mental health treatment close India's mental health gap? SSM - MENTAL HEALTH 2022. [DOI: 10.1016/j.ssmmh.2022.100184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
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23
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Hassan E, BK P, Magar J, Luitel N, Kohrt BA, Jordans M, Rose-Clarke K. Community perspectives on the implementation of a group psychological intervention for adolescents with depression: A qualitative study in rural Nepal. Front Psychiatry 2022; 13:949251. [PMID: 36339866 PMCID: PMC9634215 DOI: 10.3389/fpsyt.2022.949251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 08/05/2022] [Indexed: 11/25/2022] Open
Abstract
Group-based psychological interventions could help to close the treatment gap for depression in low-resource settings, but implementation barriers exist. In Nepal we sought community members' perspectives on how to implement group interpersonal therapy for adolescents. We conducted qualitative interviews with 25 adolescents with depression (aged 13-18) and seven health and non-governmental organization workers, and four focus groups with non-depressed adolescents, four with parents/guardians, and two with teachers (126 participants total). Data were analyzed using the Framework Method. Participants recommended same-sex groups. School was the preferred location because it is accessible for adolescents and acceptable to parents. Adolescents wanted facilitators from their own community with good communication skills. They did not want parents or teachers to participate in groups but emphasized the need to inform parents and obtain their permission. Community members supported group psychological intervention. School-based psychological interventions facilitated by local people could be an acceptable option in rural Nepal.
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Affiliation(s)
- Eliz Hassan
- Department of Global Health and Social Medicine, King's College London, London, United Kingdom
| | - Prakash BK
- Transcultural Psychosocial Organization Nepal, Kathmandu, Nepal
| | - Jananee Magar
- Transcultural Psychosocial Organization Nepal, Kathmandu, Nepal
| | - Nagendra Luitel
- Transcultural Psychosocial Organization Nepal, Kathmandu, Nepal
| | - Brandon A. Kohrt
- Duke Global Health Institute, Duke University, Durham, NC, United States
| | - Mark Jordans
- Department of Global Health and Social Medicine, King's College London, London, United Kingdom
| | - Kelly Rose-Clarke
- Department of Global Health and Social Medicine, King's College London, London, United Kingdom
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24
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Michelson D, Hodgson E, Bernstein A, Chorpita BF, Patel V. Problem Solving as an Active Ingredient in Indicated Prevention and Treatment of Youth Depression and Anxiety: An Integrative Review. J Adolesc Health 2022; 71:390-405. [PMID: 35803863 DOI: 10.1016/j.jadohealth.2022.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 03/09/2022] [Accepted: 05/05/2022] [Indexed: 10/17/2022]
Abstract
Problem solving is a common focus of psychological interventions for young people. However, existing evidence syntheses are relatively limited in their scope and conclusions. Taking a transdiagnostic approach and incorporating diverse sources of evidence, we examined the role of problem solving as an active ingredient for the indicated prevention and treatment of depression and anxiety in 14-24-year-olds. Three information sources were integrated using framework synthesis: (1) a systematic review of randomized controlled trials of problem solving; (2) a metasynthesis of qualitative evidence on the therapeutic experience of problem solving; and (3) consultations with a Youth Advisory Group. Intervention protocols that included problem solving and no more than one other specific component appeared to be effective for depression but not anxiety. Larger multicomponent interventions with a problem-solving element achieved moderate effect sizes for both conditions. There was no clear evidence that effectiveness varied by population characteristics, intervention formats, or contextual factors. Qualitative evidence and youth consultations highlighted positive views about the practicality, simplicity, and flexibility of problem solving. Converging sources also suggested changes in problem orientation as a key transdiagnostic process contributing to positive outcomes. Problem solving is a widely applicable therapeutic approach that can help young people with emotional problems to resolve specific stressors and lead to a more hopeful mindset about managing future challenges. Implications for practice are discussed.
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Affiliation(s)
- Daniel Michelson
- School of Psychology, University of Sussex, Brighton, United Kingdom.
| | - Eleanor Hodgson
- School of Psychology, University of Sussex, Brighton, United Kingdom
| | | | - Bruce F Chorpita
- Department of Psychology, University of California, Los Angeles, California
| | - Vikram Patel
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
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25
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Thapar A, Eyre O, Patel V, Brent D. Depression in young people. Lancet 2022; 400:617-631. [PMID: 35940184 DOI: 10.1016/s0140-6736(22)01012-1] [Citation(s) in RCA: 158] [Impact Index Per Article: 79.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 05/16/2022] [Accepted: 05/19/2022] [Indexed: 02/06/2023]
Abstract
Depression rates in young people have risen sharply in the past decade, especially in females, which is of concern because adolescence is a period of rapid social, emotional, and cognitive development and key life transitions. Adverse outcomes associated with depression in young people include depression recurrence; the onset of other psychiatric disorders; and wider, protracted impairments in interpersonal, social, educational, and occupational functioning. Thus, prevention and early intervention for depression in young people are priorities. Preventive and early intervention strategies typically target predisposing factors, antecedents, and symptoms of depression. Young people who have a family history of depression, exposure to social stressors (eg, bullying, discordant relationships, or stressful life events), and belong to certain subgroups (eg, having a chronic physical health problem or being a sexual minority) are at especially high risk of depression. Clinical antecedents include depressive symptoms, anxiety, and irritability. Evidence favours indicated prevention and targeted prevention to universal prevention. Emerging school-based and community-based social interventions show some promise. Depression is highly heterogeneous; therefore, a stepwise treatment approach is recommended, starting with brief psychosocial interventions, then a specific psychological therapy, and then an antidepressant medication.
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Affiliation(s)
- Anita Thapar
- Wolfson Centre for Young People's Mental Health and Child and Adolescent Psychiatry Section, Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK.
| | - Olga Eyre
- Wolfson Centre for Young People's Mental Health and Child and Adolescent Psychiatry Section, Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
| | - Vikram Patel
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - David Brent
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
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26
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Cluver LD, Sherr L, Toska E, Zhou S, Mellins CA, Omigbodun O, Li X, Bojo S, Thurman T, Ameyan W, Desmond C, Willis N, Laurenzi C, Nombewu A, Tomlinson M, Myeketsi N. From surviving to thriving: integrating mental health care into HIV, community, and family services for adolescents living with HIV. THE LANCET. CHILD & ADOLESCENT HEALTH 2022; 6:582-592. [PMID: 35750063 DOI: 10.1016/s2352-4642(22)00101-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 03/18/2022] [Accepted: 03/23/2022] [Indexed: 01/10/2023]
Abstract
Adolescents are a crucial generation, with the potential to bring future social and economic success for themselves and their countries. More than 90% of adolescents living with HIV reside in sub-Saharan Africa, where their mental health is set against a background of poverty, familial stress, service gaps, and an HIV epidemic that is now intertwined with the COVID-19 pandemic. In this Series paper, we review systematic reviews, randomised trials, and cohort studies of adolescents living with and affected by HIV. We provide a detailed overview of mental health provision and collate evidence for future approaches. We find that the mental health burden for adolescents living with HIV is high, contributing to low quality of life and challenges with adherence to antiretroviral therapy. Mental health provision is scarce, infrastructure and skilled providers are missing, and leadership is needed. Evidence of effective interventions is emerging, including specific provisions for mental health (eg, cognitive behavioural therapy, problem-solving, mindfulness, and parenting programmes) and broader provisions to prevent drivers of poor mental health (eg, social protection and violence prevention). We provide evidence of longitudinal associations between unconditional government grants and improved mental health. Combinations of economic and social interventions (known as cash plus care) could increase mental health benefits. Scalable delivery models include task sharing, primary care integration, strengthening families, and a pyramid of provision that differentiates between levels of need, from prevention to the care of severe disorders. A turning point has now been reached, from which complacency cannot persist. We conclude that there is substantial need, available frameworks, and a growing evidence base for action while infrastructure and skill acquisition is built.
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Affiliation(s)
- Lucie D Cluver
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK; Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.
| | - Lorraine Sherr
- Institute of Global Health, University College London, London, UK
| | - Elona Toska
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK; Centre for Social Science Research, University of Cape Town, Cape Town, South Africa
| | - Siyanai Zhou
- Centre for Social Science Research, University of Cape Town, Cape Town, South Africa; School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Claude-Ann Mellins
- HIV Center for Clinical and Behavioral Studies, Department of Psychiatry, New York State Psychiatric Institute, New York, NY, USA; Columbia University Irving Medical Center, New York, NY, USA
| | - Olayinka Omigbodun
- Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Xiaoming Li
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Samuel Bojo
- Agency for Research and Development Initiative, Juba, South Sudan
| | - Tonya Thurman
- Highly Vulnerable Children Research Center, Cape Town, South Africa; Tulane University School of Public Health, New Orleans, LA, USA
| | - Wole Ameyan
- Global HIV, Hepatitis and Sexually Transmitted Infections Programmes, World Health Organization, Geneva, Switzerland
| | - Chris Desmond
- Centre for Rural Health, University of KwaZulu-Natal, Durban, South Africa
| | | | - Christina Laurenzi
- Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Amahle Nombewu
- Teen Advisory Group, University of Cape Town, Cape Town, South Africa
| | - Mark Tomlinson
- Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa; School of Nursing and Midwifery, Queens University, Belfast, UK
| | - Noxolo Myeketsi
- Department of Information Systems, University of the Western Cape, Cape Town, South Africa
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Sahu B, Tamysetty S, Babu GR, Shapeti S, Queeny S, Dubasi HB, R D, Dolcy Saldanha N, Bhatia R, Khetrapal S. Suicide during pandemic requires deeper engagement. Asian J Psychiatr 2022; 73:103161. [PMID: 35644080 DOI: 10.1016/j.ajp.2022.103161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 05/06/2022] [Accepted: 05/08/2022] [Indexed: 11/21/2022]
Affiliation(s)
- Biswamitra Sahu
- Department of Public Health, Indian Institute of Public Health (IIPH), Bengaluru 560023.
| | | | - Giridhara R Babu
- Department of Public Health, Indian Institute of Public Health (IIPH), Bengaluru 560023
| | - Suresh Shapeti
- Department of Public Health, Indian Institute of Public Health (IIPH), Bengaluru 560023
| | | | - Hima Bindu Dubasi
- Department of Public Health, Indian Institute of Public Health (IIPH), Bengaluru 560023
| | - Deepa R
- Department of Public Health, Indian Institute of Public Health (IIPH), Bengaluru 560023
| | - Nolita Dolcy Saldanha
- Department of Public Health, Indian Institute of Public Health (IIPH), Bengaluru 560023
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Patel V, Naslund JA, Wood S, Patel A, Chauvin JJ, Agrawal R, Bhan A, Joshi U, Amara M, Kohrt BA, Singla DR, G. Fairburn C. EMPOWER: Toward the Global Dissemination of Psychosocial Interventions. FOCUS 2022; 20:301-306. [PMID: 37021040 PMCID: PMC10071408 DOI: 10.1176/appi.focus.20220042] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Even before the COVID-19 pandemic, the needs for care of persons with mental illness remained largely unmet worldwide, testifying to the inadequacy of current approaches to mental health care and their unsuitability for the rising demand. One hurdle to improved access to quality care is the reliance on expensive specialist providers, particularly for the delivery of psychosocial interventions. This article describes EMPOWER, a not-for-profit program that builds on the clinical science demonstrating the effectiveness of brief psychosocial interventions for a range of psychiatric conditions; implementation science demonstrating the effectiveness of delivery of these interventions by non-specialist providers (NSPs); and pedagogical science demonstrating the effectiveness of digital approaches for training and quality assurance. The EMPOWER program leverages digital tools for training and supervising NSPs, designing competency-based curricula, assessing treatment-specific competencies, implementing measurement-based peer supervision for support and quality assurance, and evaluating impacts to enhance the effectiveness of the delivery system.
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Affiliation(s)
- Vikram Patel
- Department of Global Health and Social Medicine, Harvard Medical School (V. Patel, Naslund, Wood, Chauvin, Amara) and Harvard T. H. Chan School of Public Health (V. Patel, A. Patel), Harvard University, Boston; Sangath, Bhopal, Madhya Pradesh, India (Bhan, Agrawal, Joshi); Division of Global Mental Health, George Washington University, Washington, DC (Kohrt); Centre for Complex Interventions, Centre for Addiction and Mental Health, and Department of Psychiatry, University of Toronto, Toronto (Singla)
| | - John A. Naslund
- Department of Global Health and Social Medicine, Harvard Medical School (V. Patel, Naslund, Wood, Chauvin, Amara) and Harvard T. H. Chan School of Public Health (V. Patel, A. Patel), Harvard University, Boston; Sangath, Bhopal, Madhya Pradesh, India (Bhan, Agrawal, Joshi); Division of Global Mental Health, George Washington University, Washington, DC (Kohrt); Centre for Complex Interventions, Centre for Addiction and Mental Health, and Department of Psychiatry, University of Toronto, Toronto (Singla)
| | - Sheena Wood
- Department of Global Health and Social Medicine, Harvard Medical School (V. Patel, Naslund, Wood, Chauvin, Amara) and Harvard T. H. Chan School of Public Health (V. Patel, A. Patel), Harvard University, Boston; Sangath, Bhopal, Madhya Pradesh, India (Bhan, Agrawal, Joshi); Division of Global Mental Health, George Washington University, Washington, DC (Kohrt); Centre for Complex Interventions, Centre for Addiction and Mental Health, and Department of Psychiatry, University of Toronto, Toronto (Singla)
| | - Anushka Patel
- Department of Global Health and Social Medicine, Harvard Medical School (V. Patel, Naslund, Wood, Chauvin, Amara) and Harvard T. H. Chan School of Public Health (V. Patel, A. Patel), Harvard University, Boston; Sangath, Bhopal, Madhya Pradesh, India (Bhan, Agrawal, Joshi); Division of Global Mental Health, George Washington University, Washington, DC (Kohrt); Centre for Complex Interventions, Centre for Addiction and Mental Health, and Department of Psychiatry, University of Toronto, Toronto (Singla)
| | - Joshua J. Chauvin
- Department of Global Health and Social Medicine, Harvard Medical School (V. Patel, Naslund, Wood, Chauvin, Amara) and Harvard T. H. Chan School of Public Health (V. Patel, A. Patel), Harvard University, Boston; Sangath, Bhopal, Madhya Pradesh, India (Bhan, Agrawal, Joshi); Division of Global Mental Health, George Washington University, Washington, DC (Kohrt); Centre for Complex Interventions, Centre for Addiction and Mental Health, and Department of Psychiatry, University of Toronto, Toronto (Singla)
| | - Ravindra Agrawal
- Department of Global Health and Social Medicine, Harvard Medical School (V. Patel, Naslund, Wood, Chauvin, Amara) and Harvard T. H. Chan School of Public Health (V. Patel, A. Patel), Harvard University, Boston; Sangath, Bhopal, Madhya Pradesh, India (Bhan, Agrawal, Joshi); Division of Global Mental Health, George Washington University, Washington, DC (Kohrt); Centre for Complex Interventions, Centre for Addiction and Mental Health, and Department of Psychiatry, University of Toronto, Toronto (Singla)
| | - Anant Bhan
- Department of Global Health and Social Medicine, Harvard Medical School (V. Patel, Naslund, Wood, Chauvin, Amara) and Harvard T. H. Chan School of Public Health (V. Patel, A. Patel), Harvard University, Boston; Sangath, Bhopal, Madhya Pradesh, India (Bhan, Agrawal, Joshi); Division of Global Mental Health, George Washington University, Washington, DC (Kohrt); Centre for Complex Interventions, Centre for Addiction and Mental Health, and Department of Psychiatry, University of Toronto, Toronto (Singla)
| | - Udita Joshi
- Department of Global Health and Social Medicine, Harvard Medical School (V. Patel, Naslund, Wood, Chauvin, Amara) and Harvard T. H. Chan School of Public Health (V. Patel, A. Patel), Harvard University, Boston; Sangath, Bhopal, Madhya Pradesh, India (Bhan, Agrawal, Joshi); Division of Global Mental Health, George Washington University, Washington, DC (Kohrt); Centre for Complex Interventions, Centre for Addiction and Mental Health, and Department of Psychiatry, University of Toronto, Toronto (Singla)
| | - Margaux Amara
- Department of Global Health and Social Medicine, Harvard Medical School (V. Patel, Naslund, Wood, Chauvin, Amara) and Harvard T. H. Chan School of Public Health (V. Patel, A. Patel), Harvard University, Boston; Sangath, Bhopal, Madhya Pradesh, India (Bhan, Agrawal, Joshi); Division of Global Mental Health, George Washington University, Washington, DC (Kohrt); Centre for Complex Interventions, Centre for Addiction and Mental Health, and Department of Psychiatry, University of Toronto, Toronto (Singla)
| | - Brandon A. Kohrt
- Department of Global Health and Social Medicine, Harvard Medical School (V. Patel, Naslund, Wood, Chauvin, Amara) and Harvard T. H. Chan School of Public Health (V. Patel, A. Patel), Harvard University, Boston; Sangath, Bhopal, Madhya Pradesh, India (Bhan, Agrawal, Joshi); Division of Global Mental Health, George Washington University, Washington, DC (Kohrt); Centre for Complex Interventions, Centre for Addiction and Mental Health, and Department of Psychiatry, University of Toronto, Toronto (Singla)
| | - Daisy R. Singla
- Department of Global Health and Social Medicine, Harvard Medical School (V. Patel, Naslund, Wood, Chauvin, Amara) and Harvard T. H. Chan School of Public Health (V. Patel, A. Patel), Harvard University, Boston; Sangath, Bhopal, Madhya Pradesh, India (Bhan, Agrawal, Joshi); Division of Global Mental Health, George Washington University, Washington, DC (Kohrt); Centre for Complex Interventions, Centre for Addiction and Mental Health, and Department of Psychiatry, University of Toronto, Toronto (Singla)
| | - Christopher G. Fairburn
- Department of Global Health and Social Medicine, Harvard Medical School (V. Patel, Naslund, Wood, Chauvin, Amara) and Harvard T. H. Chan School of Public Health (V. Patel, A. Patel), Harvard University, Boston; Sangath, Bhopal, Madhya Pradesh, India (Bhan, Agrawal, Joshi); Division of Global Mental Health, George Washington University, Washington, DC (Kohrt); Centre for Complex Interventions, Centre for Addiction and Mental Health, and Department of Psychiatry, University of Toronto, Toronto (Singla)
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Feasibility and Acceptability of Bright IDEAS-Young Adults: A Problem-Solving Skills Training Intervention. Cancers (Basel) 2022; 14:cancers14133124. [PMID: 35804896 PMCID: PMC9264826 DOI: 10.3390/cancers14133124] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 06/09/2022] [Accepted: 06/17/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Young adults with cancer are a vulnerable group with unique emotional, social, and practical needs. There is a lack of evidence-based interventions to address their needs and to foster skills that could increase their capacity to cope. Bright IDEAS is a problem-solving skills training intervention that has demonstrated efficacy in improving people's problem-solving ability and reducing distress among caregivers of children with cancer. This study evaluated the feasibility and acceptability of Bright IDEAS adapted for young adults (Bright IDEAS-YA). METHODS Forty young adults recently diagnosed with cancer were enrolled in a single arm feasibility study. RESULTS Feasibility was demonstrated by the adequate enrollment (67.8%), retention (80.0%), and participants' adherence to the intervention (average of 5.2 out of 6 sessions completed). Participants reported satisfaction with the intervention. Qualitative feedback identified the systematic approach to problem-solving and interaction with the trainer as strengths of the intervention. Participants demonstrated improvements in problem-solving skills and symptoms of depression and anxiety. CONCLUSIONS In conclusion, the results support the feasibility of the intervention and an adequately powered randomized controlled trial is needed to determine the efficacy of the intervention on psychosocial outcomes.
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Herrman H, Patel V, Kieling C, Berk M, Buchweitz C, Cuijpers P, Furukawa TA, Kessler RC, Kohrt BA, Maj M, McGorry P, Reynolds CF, Weissman MM, Chibanda D, Dowrick C, Howard LM, Hoven CW, Knapp M, Mayberg HS, Penninx BWJH, Xiao S, Trivedi M, Uher R, Vijayakumar L, Wolpert M. Time for united action on depression: a Lancet-World Psychiatric Association Commission. Lancet 2022; 399:957-1022. [PMID: 35180424 DOI: 10.1016/s0140-6736(21)02141-3] [Citation(s) in RCA: 297] [Impact Index Per Article: 148.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 09/15/2021] [Accepted: 09/21/2021] [Indexed: 12/12/2022]
Affiliation(s)
- Helen Herrman
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia.
| | - Vikram Patel
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA; Sangath, Goa, India; Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Christian Kieling
- Department of Psychiatry, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Child & Adolescent Psychiatry Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Michael Berk
- Deakin University, IMPACT Institute, Geelong, VIC, Australia
| | - Claudia Buchweitz
- Graduate Program in Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Toshiaki A Furukawa
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Brandon A Kohrt
- Department of Psychiatry and Behavioral Sciences, George Washington University, Washington, DC, USA
| | - Mario Maj
- Department of Psychiatry, University of Campania L Vanvitelli, Naples, Italy
| | - Patrick McGorry
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Charles F Reynolds
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Myrna M Weissman
- Columbia University Mailman School of Public Health, New York, NY, USA; Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA
| | - Dixon Chibanda
- Department of Psychiatry, University of Zimbabwe, Harare, Zimbabwe; Centre for Global Mental Health, The London School of Hygiene and Tropical Medicine, London, UK
| | - Christopher Dowrick
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
| | - Louise M Howard
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Christina W Hoven
- Columbia University Mailman School of Public Health, New York, NY, USA; Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA
| | - Martin Knapp
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
| | - Helen S Mayberg
- Departments of Neurology, Neurosurgery, Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Brenda W J H Penninx
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Shuiyuan Xiao
- Central South University Xiangya School of Public Health, Changsha, China
| | - Madhukar Trivedi
- Peter O'Donnell Jr Brain Institute and the Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Rudolf Uher
- Department of Psychiatry, Dalhousie University, Halifax, Canada
| | - Lakshmi Vijayakumar
- Sneha, Suicide Prevention Centre and Voluntary Health Services, Chennai, India
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McQuillin SD, Hagler MA, Werntz A, Rhodes JE. Paraprofessional Youth Mentoring: A Framework for Integrating Youth Mentoring with Helping Institutions and Professions. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2022; 69:201-220. [PMID: 34318526 DOI: 10.1002/ajcp.12546] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The demand for child mental health services, including those provided by psychologists, counselors, and social workers, exceeds the supply. This trend is expected to continue or worsen unless there are substantial structural changes in how mental health services are provided. We propose a framework for paraprofessional youth mentors, defined as a subgroup of professionally supervised, non-expert volunteer or paid mentors to whom aspects of professional helping tasks are delegated. Our proposal is aligned with historical and modern solutions to scaling mental health services, and this framework could simultaneously increase the number of youth receiving evidence-based mental health services and reduce the burden on existing systems of care. The framework defines three plausible tasks for paraprofessional mentors: (1) reducing barriers to mental health service, (2) increasing engagement in services, and (3) providing direct services. The safety and effectiveness of these task-shifting efforts will hinge on competency-based training and evaluation, supervision by professionals, and documentation of services rendered, all of which the field of youth mentoring currently lacks. We describe several requisite scientific, institutional, and regulatory advances that will be necessary to realize this variant of youth mentoring for a subgroup of youth who are presenting for assistance with mental health problems.
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Affiliation(s)
- Samuel D McQuillin
- Department of Psychology, University of South Carolina, Columbia, SC, USA
| | - Matthew A Hagler
- Department of Psychology, University of Massachusetts Boston, Boston, MA, USA
| | - Alexandra Werntz
- Department of Psychology, University of Massachusetts Boston, Boston, MA, USA
| | - Jean E Rhodes
- Department of Psychology, University of Massachusetts Boston, Boston, MA, USA
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Gellatly R, Knudsen K, Boustani MM, Michelson D, Malik K, Mathur S, Nair P, Patel V, Chorpita BF. A qualitative analysis of collaborative efforts to build a school-based intervention for multiple common adolescent mental health difficulties in India. Front Psychiatry 2022; 13:1038259. [PMID: 36506442 PMCID: PMC9731107 DOI: 10.3389/fpsyt.2022.1038259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 11/02/2022] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION In low- and middle-income countries (LMICs), the gap between need for mental health (MH) treatment and access to services is stark, particularly among children and adolescents. In service of addressing this treatment gap, the current study provides an in-depth illustration of later-stage collaborative design of a school-based, transdiagnostic MH intervention in New Delhi and Goa, India, using a combination of contextual insights from local stakeholders and knowledge derived from the global evidence base. METHODS Using an inductive-deductive approach to qualitative thematic analysis, we examined coded data from qualitative sources related to experiences of developing and implementing an intervention prototype. These sources included notes from meetings attended by treatment development team members and providers, written feedback on protocol materials (e.g., provider manual, student handouts), field notes reflecting researcher observations, and minutes from weekly clinical supervision meetings. RESULTS Results revealed that codes involving cultural/contextual considerations, protocol material and content, and intervention complexity arose consistently throughout treatment development and across document types, illustrating their central role in finalizing protocol design. DISCUSSION These findings have implications for the future of mental health treatment development and implementation globally.
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Affiliation(s)
- Resham Gellatly
- Department of Psychiatry, Boston Medical Center, Boston, MA, United States.,Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Kendra Knudsen
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Maya M Boustani
- Department of Psychology, Loma Linda University, Loma Linda, CA, United States
| | - Daniel Michelson
- School of Psychology, University of Sussex, Brighton, United Kingdom
| | - Kanika Malik
- Jindal School of Psychology and Counselling, O.P. Jindal Global University, Sonipat, India.,Sangath, Porvorim, Goa, India
| | | | | | - Vikram Patel
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States
| | - Bruce F Chorpita
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
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School-based group interpersonal therapy for adolescents with depression in rural Nepal: a mixed methods study exploring feasibility, acceptability, and cost. Glob Ment Health (Camb) 2022; 9:416-428. [PMID: 36618751 PMCID: PMC9806967 DOI: 10.1017/gmh.2022.46] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 07/22/2022] [Accepted: 07/28/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Adolescents with depression need access to culturally relevant psychological treatment. In many low- and middle-income countries treatments are only accessible to a minority. We adapted group interpersonal therapy (IPT) for adolescents to be delivered through schools in Nepal. Here we report IPT's feasibility, acceptability, and cost. METHODS We recruited 32 boys and 30 girls (aged 13-19) who screened positive for depression. IPT comprised of two individual and 12 group sessions facilitated by nurses or lay workers. Using a pre-post design we assessed adolescents at baseline, post-treatment (0-2 weeks after IPT), and follow-up (8-10 weeks after IPT). We measured depressive symptoms with the Depression Self-Rating Scale (DSRS), and functional impairment with a local tool. To assess intervention fidelity supervisors rated facilitators' IPT skills across 27/90 sessions using a standardised checklist. We conducted qualitative interviews with 16 adolescents and six facilitators post-intervention, and an activity-based cost analysis from the provider perspective. RESULTS Adolescents attended 82.3% (standard deviation 18.9) of group sessions. All were followed up. Depression and functional impairment improved between baseline and follow-up: DSRS score decreased by 81% (95% confidence interval 70-95); functional impairment decreased by 288% (249-351). In total, 95.3% of facilitator IPT skills were rated superior/satisfactory. Adolescents found the intervention useful and acceptable, although some had concerns about privacy in schools. The estimate of intervention unit cost was US $96.9 with facilitators operating at capacity. CONCLUSIONS School-based group IPT is feasible and acceptable in Nepal. Findings support progression to a randomised controlled trial to assess effectiveness and cost-effectiveness.
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Gonsalves PP, Sharma R, Hodgson E, Bhat B, Jambhale A, Weiss HA, Fairburn CG, Cavanagh K, Cuijpers P, Michelson D, Patel V. A Guided Internet-Based Problem-Solving Intervention Delivered Through Smartphones for Secondary School Pupils During the COVID-19 Pandemic in India: Protocol for a Pilot Randomized Controlled Trial. JMIR Res Protoc 2021; 10:e30339. [PMID: 34586075 PMCID: PMC8496682 DOI: 10.2196/30339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 08/25/2021] [Accepted: 08/25/2021] [Indexed: 01/20/2023] Open
Abstract
Background “POD Adventures” is a gamified mental health intervention delivered via a smartphone app and supported by counsellors for a target population of secondary school students in India. This paper describes the protocol for a pilot randomized controlled trial of a remotely delivered version of the intervention in the context of COVID-19 restrictions. Objective Our objectives are to assess the feasibility of research procedures and intervention delivery and to generate preliminary estimates of the effectiveness of the intervention to inform the sample size calculation of a full-scale trial. Methods We will conduct a parallel, 2-arm, individually randomized pilot controlled trial in 11 secondary schools in Goa, India. This pilot trial aims to recruit 70 participants with a felt need for psychological support. Participants will receive either the POD Adventures intervention delivered over 4 weeks or usual care comprising information about local mental health services and national helplines. Outcomes will be assessed at two timepoints: baseline and 6 weeks post randomization. Results The first participant was enrolled on January 28, 2021, and 6-week assessment completed on April 4, 2021. Owing to a second wave of the COVID-19 pandemic in India, schools in Goa were closed on April 22, 2021. Trial participants are currently receiving the intervention or completing follow-up assessments. Conclusions This pilot trial will help understand the feasibility of implementing and evaluating a remotely delivered digital mental health intervention in a low-resource setting. Our findings will be used to design future trials that can address difficulties of accessing psychosocial support in-person and support wider efforts to scale up evidence-based mental health interventions for young people. Trial Registration ClinicalTrials.gov NCT04672486; https://clinicaltrials.gov/ct2/show/NCT04672486 International Registered Report Identifier (IRRID) DERR1-10.2196/30339
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Affiliation(s)
- Pattie P Gonsalves
- Sangath, New Delhi, India.,School of Psychology, University of Sussex, Brighton, United Kingdom
| | | | | | | | | | - Helen A Weiss
- Medical Research Council Tropical Epidemiology Group, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | - Kate Cavanagh
- School of Psychology, University of Sussex, Brighton, United Kingdom
| | - Pim Cuijpers
- Department of Clinical Psychology, Vrije Universiteit, Amsterdam, Netherlands
| | - Daniel Michelson
- School of Psychology, University of Sussex, Brighton, United Kingdom
| | - Vikram Patel
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States
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Darling KE, Rancourt D, Evans EW, Ranzenhofer LM, Jelalian E. Adolescent Weight Management Intervention in a Nonclinical Setting: Changes in Eating-Related Cognitions and Depressive Symptoms. J Dev Behav Pediatr 2021; 42:579-587. [PMID: 33660668 PMCID: PMC8408271 DOI: 10.1097/dbp.0000000000000929] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 01/01/2021] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The present study was a secondary data analysis of a randomized controlled trial (RCT) to examine changes in depressive symptoms and eating-related cognitions in teens who participated in a nonclinic-based adolescent behavioral weight control treatment delivered by YMCA coaches. Differences in intervention effects were also examined by sex. METHODS Adolescents (N = 66; 13-17 years; 60.6% girls) with overweight (10.6%) or obesity (53.0% with severe obesity) participated in an RCT comparing 2 versions of an evidence-based intervention. Adolescents completed measures of eating-related cognitions (Eating Disorder Examination Questionnaire) and depressive symptoms (Children's Depressive Inventory-2) at baseline and end of active treatment (16 weeks). RESULTS There were no significant effects of group, time, or group by time interaction for depressive symptoms, global eating-related cognitions, dietary restraint, or eating concerns (ps > 0.05). Shape concerns (p = 0.04) and weight concerns (p = 0.02) significantly decreased over the intervention. Significant interactions between sex and time on global eating-related cognitions (p < 0.001), eating (p = 0.002), shape (p = 0.02), and weight concerns (p = 0.004) were detected such that female participants' scores decreased over the course of the treatment, but male participants' scores did not. CONCLUSION The results demonstrate some positive and no detrimental effects of a nonclinic-based behavioral weight control intervention on adolescents' eating-related cognitions and depressive symptoms. The findings may mitigate concerns that dissemination of structured, nonclinic-based weight management programs for adolescents will produce negative eating and mood outcomes; however, replication of results in larger trials is needed.
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Affiliation(s)
- Katherine E. Darling
- Weight Control and Diabetes Research Center, The Miriam Hospital; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University
| | | | - E. Whitney Evans
- Weight Control and Diabetes Research Center, The Miriam Hospital; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University
| | - Lisa M. Ranzenhofer
- Department of Psychiatry, Columbia University Irving Medical Center & New York State Psychiatric Institute
| | - Elissa Jelalian
- Weight Control and Diabetes Research Center, The Miriam Hospital; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University
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Malik K, Michelson D, Doyle AM, Weiss HA, Greco G, Sahu R, E. J. J, Mathur S, Sudhir P, King M, Cuijpers P, Chorpita B, Fairburn CG, Patel V. Effectiveness and costs associated with a lay counselor-delivered, brief problem-solving mental health intervention for adolescents in urban, low-income schools in India: 12-month outcomes of a randomized controlled trial. PLoS Med 2021; 18:e1003778. [PMID: 34582460 PMCID: PMC8478208 DOI: 10.1371/journal.pmed.1003778] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 08/20/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Psychosocial interventions for adolescent mental health problems are effective, but evidence on their longer-term outcomes is scarce, especially in low-resource settings. We report on the 12-month sustained effectiveness and costs of scaling up a lay counselor-delivered, transdiagnostic problem-solving intervention for common adolescent mental health problems in low-income schools in New Delhi, India. METHODS AND FINDINGS Participants in the original trial were 250 school-going adolescents (mean [M] age = 15.61 years, standard deviation [SD] = 1.68), including 174 (69.6%) who identified as male. Participants were recruited from 6 government schools over a period of 4 months (August 20 to December 14, 2018) and were selected on the basis of elevated mental health symptoms and distress/functional impairment. A 2-arm, randomized controlled trial design was used to examine the effectiveness of a lay counselor-delivered, problem-solving intervention (4 to 5 sessions over 3 weeks) with supporting printed booklets (intervention arm) in comparison with problem solving delivered via printed booklets alone (control arm), at the original endpoints of 6 and 12 weeks. The protocol was modified, as per the recommendation of the Trial Steering Committee, to include a post hoc extension of the follow-up period to 12 months. Primary outcomes were adolescent-reported psychosocial problems (Youth Top Problems [YTP]) and mental health symptoms (Strengths and Difficulties Questionnaire [SDQ] Total Difficulties scale). Other self-reported outcomes included SDQ subscales, perceived stress, well-being, and remission. The sustained effects of the intervention were estimated at the 12-month endpoint and over 12 months (the latter assumed a constant effect across 3 follow-up points) using a linear mixed model for repeated measures and involving complete case analysis. Sensitivity analyses examined the effect of missing data using multiple imputations. Costs were estimated for delivering the intervention during the trial and from modeling a scale-up scenario, using a retrospective ingredients approach. Out of the 250 original trial participants, 176 (70.4%) adolescents participated in the 12-month follow-up assessment. One adverse event was identified during follow-up and deemed unrelated to the intervention. Evidence was found for intervention effects on both SDQ Total Difficulties and YTP at 12 months (YTP: adjusted mean difference [AMD] = -0.75, 95% confidence interval [CI] = -1.47, -0.03, p = 0.04; SDQ Total Difficulties: AMD = -1.73, 95% CI = -3.47, 0.02, p = 0.05), with stronger effects over 12 months (YTP: AMD = -0.98, 95% CI = -1.51, -0.45, p < 0.001; SDQ Total Difficulties: AMD = -1.23, 95% CI = -2.37, -0.09; p = 0.03). There was also evidence for intervention effects on internalizing symptoms, impairment, perceived stress, and well-being over 12 months. The intervention effect was stable for most outcomes on sensitivity analyses adjusting for missing data; however, for SDQ Total Difficulties and impairment, the effect was slightly attenuated. The per-student cost of delivering the intervention during the trial was $3 United States dollars (USD; or $158 USD per case) and for scaling up the intervention in the modeled scenario was $4 USD (or $23 USD per case). The scaling up cost accounted for 0.4% of the per-student school budget in New Delhi. The main limitations of the study's methodology were the lack of sample size calculations powered for 12-month follow-up and the absence of cost-effectiveness analyses using the primary outcomes. CONCLUSIONS In this study, we observed that a lay counselor-delivered, brief transdiagnostic problem-solving intervention had sustained effects on psychosocial problems and mental health symptoms over the 12-month follow-up period. Scaling up this resource-efficient intervention is an affordable policy goal for improving adolescents' access to mental health care in low-resource settings. The findings need to be interpreted with caution, as this study was a post hoc extension, and thus, the sample size calculations did not take into account the relatively high attrition rate observed during the long-term follow-up. TRIAL REGISTRATION ClinicalTrials.gov NCT03630471.
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Affiliation(s)
| | - Daniel Michelson
- School of Psychology, University of Sussex, Brighton, United Kingdom
| | - Aoife M. Doyle
- Medical Research Council International Statistics & Epidemiology Group, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Helen A. Weiss
- Medical Research Council International Statistics & Epidemiology Group, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Giulia Greco
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | | | | | - Paulomi Sudhir
- Department of Clinical Psychology, National Institute of Mental Health and Neuro Sciences, Bengaluru, India
| | - Michael King
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, United Kingdom
| | - Pim Cuijpers
- Department of Clinical Psychology, Vrije Universiteit, Amsterdam, the Netherlands
| | - Bruce Chorpita
- Department of Psychology, University of California, Los Angeles, United States of America
| | | | - Vikram Patel
- Sangath, New Delhi, India
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, United States of America
- Harvard TH Chan School of Public Health, Boston, United States of America
- * E-mail:
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Krause KR, Courtney DB, Chan BWC, Bonato S, Aitken M, Relihan J, Prebeg M, Darnay K, Hawke LD, Watson P, Szatmari P. Problem-solving training as an active ingredient of treatment for youth depression: a scoping review and exploratory meta-analysis. BMC Psychiatry 2021; 21:397. [PMID: 34425770 PMCID: PMC8383463 DOI: 10.1186/s12888-021-03260-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 04/28/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Problem-solving training is a common ingredient of evidence-based therapies for youth depression and has shown effectiveness as a versatile stand-alone intervention in adults. This scoping review provided a first overview of the evidence supporting problem solving as a mechanism for treating depression in youth aged 14 to 24 years. METHODS Five bibliographic databases (APA PsycINFO, CINAHL, Embase, MEDLINE, Web of Science) and the grey literature were systematically searched for controlled trials of stand-alone problem-solving therapy; secondary analyses of trial data exploring problem-solving-related concepts as predictors, moderators, or mediators of treatment response within broader therapies; and clinical practice guidelines for youth depression. Following the scoping review, an exploratory meta-analysis examined the overall effectiveness of stand-alone problem-solving therapy. RESULTS Inclusion criteria were met by four randomized trials of problem-solving therapy (524 participants); four secondary analyses of problem-solving-related concepts as predictors, moderators, or mediators; and 23 practice guidelines. The only clinical trial rated as having a low risk of bias found problem-solving training helped youth solve personal problems but was not significantly more effective than the control at reducing emotional symptoms. An exploratory meta-analysis showed a small and non-significant effect on self-reported depression or emotional symptoms (Hedges' g = - 0.34; 95% CI: - 0.92 to 0.23) with high heterogeneity. Removing one study at high risk of bias led to a decrease in effect size and heterogeneity (g = - 0.08; 95% CI: - 0.26 to 0.10). A GRADE appraisal suggested a low overall quality of the evidence. Tentative evidence from secondary analyses suggested problem-solving training might enhance outcomes in cognitive-behavioural therapy and family therapy, but dedicated dismantling studies are needed to corroborate these findings. Clinical practice guidelines did not recommend problem-solving training as a stand-alone treatment for youth depression, but five mentioned it as a treatment ingredient. CONCLUSIONS On its own, problem-solving training may be beneficial for helping youth solve personal challenges, but it may not measurably reduce depressive symptoms. Youth experiencing elevated depressive symptoms may require more comprehensive psychotherapeutic support alongside problem-solving training. High-quality studies are needed to examine the effectiveness of problem-solving training as a stand-alone approach and as a treatment ingredient.
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Affiliation(s)
- Karolin R Krause
- Cundill Centre for Child and Youth Depression, Centre for Addiction and Mental Health (CAMH), 80 Workman Way, Toronto, ON, M6J 1H4, Canada.
- Evidence Based Practice Unit, University College London and Anna Freud National Centre for Children and Families, London, UK.
| | - Darren B Courtney
- Cundill Centre for Child and Youth Depression, Centre for Addiction and Mental Health (CAMH), 80 Workman Way, Toronto, ON, M6J 1H4, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | | | - Sarah Bonato
- Cundill Centre for Child and Youth Depression, Centre for Addiction and Mental Health (CAMH), 80 Workman Way, Toronto, ON, M6J 1H4, Canada
| | - Madison Aitken
- Cundill Centre for Child and Youth Depression, Centre for Addiction and Mental Health (CAMH), 80 Workman Way, Toronto, ON, M6J 1H4, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Jacqueline Relihan
- Cundill Centre for Child and Youth Depression, Centre for Addiction and Mental Health (CAMH), 80 Workman Way, Toronto, ON, M6J 1H4, Canada
| | - Matthew Prebeg
- Cundill Centre for Child and Youth Depression, Centre for Addiction and Mental Health (CAMH), 80 Workman Way, Toronto, ON, M6J 1H4, Canada
| | - Karleigh Darnay
- Cundill Centre for Child and Youth Depression, Centre for Addiction and Mental Health (CAMH), 80 Workman Way, Toronto, ON, M6J 1H4, Canada
| | - Lisa D Hawke
- Cundill Centre for Child and Youth Depression, Centre for Addiction and Mental Health (CAMH), 80 Workman Way, Toronto, ON, M6J 1H4, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Priya Watson
- Cundill Centre for Child and Youth Depression, Centre for Addiction and Mental Health (CAMH), 80 Workman Way, Toronto, ON, M6J 1H4, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Peter Szatmari
- Cundill Centre for Child and Youth Depression, Centre for Addiction and Mental Health (CAMH), 80 Workman Way, Toronto, ON, M6J 1H4, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Hospital for Sick Children, Toronto, ON, Canada
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van Ginneken N, Chin WY, Lim YC, Ussif A, Singh R, Shahmalak U, Purgato M, Rojas-García A, Uphoff E, McMullen S, Foss HS, Thapa Pachya A, Rashidian L, Borghesani A, Henschke N, Chong LY, Lewin S. Primary-level worker interventions for the care of people living with mental disorders and distress in low- and middle-income countries. Cochrane Database Syst Rev 2021; 8:CD009149. [PMID: 34352116 PMCID: PMC8406740 DOI: 10.1002/14651858.cd009149.pub3] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Community-based primary-level workers (PWs) are an important strategy for addressing gaps in mental health service delivery in low- and middle-income countries. OBJECTIVES: To evaluate the effectiveness of PW-led treatments for persons with mental health symptoms in LMICs, compared to usual care. SEARCH METHODS: MEDLINE, Embase, CENTRAL, ClinicalTrials.gov, ICTRP, reference lists (to 20 June 2019). SELECTION CRITERIA: Randomised trials of PW-led or collaborative-care interventions treating people with mental health symptoms or their carers in LMICs. PWs included: primary health professionals (PHPs), lay health workers (LHWs), community non-health professionals (CPs). DATA COLLECTION AND ANALYSIS: Seven conditions were identified apriori and analysed by disorder and PW examining recovery, prevalence, symptom change, quality-of-life (QOL), functioning, service use (SU), and adverse events (AEs). Risk ratios (RRs) were used for dichotomous outcomes; mean difference (MDs), standardised mean differences (SMDs), or mean change differences (MCDs) for continuous outcomes. For SMDs, 0.20 to 0.49 represented small, 0.50 to 0.79 moderate, and ≥0.80 large clinical effects. Analysis timepoints: T1 (<1 month), T2 (1-6 months), T3 ( >6 months) post-intervention. MAIN RESULTS: Description of studies 95 trials (72 new since 2013) from 30 LMICs (25 trials from 13 LICs). Risk of bias Most common: detection bias, attrition bias (efficacy), insufficient protection against contamination. Intervention effects *Unless indicated, comparisons were usual care at T2. "Probably", "may", or "uncertain" indicates "moderate", "low," or "very low" certainty evidence. Adults with common mental disorders (CMDs) LHW-led interventions a. may increase recovery (2 trials, 308 participants; RR 1.29, 95%CI 1.06 to 1.56); b. may reduce prevalence (2 trials, 479 participants; RR 0.42, 95%CI 0.18 to 0.96); c. may reduce symptoms (4 trials, 798 participants; SMD -0.59, 95%CI -1.01 to -0.16); d. may improve QOL (1 trial, 521 participants; SMD 0.51, 95%CI 0.34 to 0.69); e. may slightly reduce functional impairment (3 trials, 1399 participants; SMD -0.47, 95%CI -0.8 to -0.15); f. may reduce AEs (risk of suicide ideation/attempts); g. may have uncertain effects on SU. Collaborative-care a. may increase recovery (5 trials, 804 participants; RR 2.26, 95%CI 1.50 to 3.43); b. may reduce prevalence although the actual effect range indicates it may have little-or-no effect (2 trials, 2820 participants; RR 0.57, 95%CI 0.32 to 1.01); c. may slightly reduce symptoms (6 trials, 4419 participants; SMD -0.35, 95%CI -0.63 to -0.08); d. may slightly improve QOL (6 trials, 2199 participants; SMD 0.34, 95%CI 0.16 to 0.53); e. probably has little-to-no effect on functional impairment (5 trials, 4216 participants; SMD -0.13, 95%CI -0.28 to 0.03); f. may reduce SU (referral to MH specialists); g. may have uncertain effects on AEs (death). Women with perinatal depression (PND) LHW-led interventions a. may increase recovery (4 trials, 1243 participants; RR 1.29, 95%CI 1.08 to 1.54); b. probably slightly reduce symptoms (5 trials, 1989 participants; SMD -0.26, 95%CI -0.37 to -0.14); c. may slightly reduce functional impairment (4 trials, 1856 participants; SMD -0.23, 95%CI -0.41 to -0.04); d. may have little-to-no effect on AEs (death); e. may have uncertain effects on SU. Collaborative-care a. has uncertain effects on symptoms/QOL/SU/AEs. Adults with post-traumatic stress (PTS) or CMDs in humanitarian settings LHW-led interventions a. may slightly reduce depression symptoms (5 trials, 1986 participants; SMD -0.36, 95%CI -0.56 to -0.15); b. probably slightly improve QOL (4 trials, 1918 participants; SMD -0.27, 95%CI -0.39 to -0.15); c. may have uncertain effects on symptoms (PTS)/functioning/SU/AEs. PHP-led interventions a. may reduce PTS symptom prevalence (1 trial, 313 participants; RR 5.50, 95%CI 2.50 to 12.10) and depression prevalence (1 trial, 313 participants; RR 4.60, 95%CI 2.10 to 10.08); b. may have uncertain effects on symptoms/functioning/SU/AEs. Adults with harmful/hazardous alcohol or substance use LHW-led interventions a. may increase recovery from harmful/hazardous alcohol use although the actual effect range indicates it may have little-or-no effect (4 trials, 872 participants; RR 1.28, 95%CI 0.94 to 1.74); b. may have little-to-no effect on the prevalence of methamphetamine use (1 trial, 882 participants; RR 1.01, 95%CI 0.91 to 1.13) and functional impairment (2 trials, 498 participants; SMD -0.14, 95%CI -0.32 to 0.03); c. probably slightly reduce risk of harmful/hazardous alcohol use (3 trials, 667 participants; SMD -0.22, 95%CI -0.32 to -0.11); d. may have uncertain effects on SU/AEs. PHP/CP-led interventions a. probably have little-to-no effect on recovery from harmful/hazardous alcohol use (3 trials, 1075 participants; RR 0.93, 95%CI 0.77 to 1.12) or QOL (1 trial, 560 participants; MD 0.00, 95%CI -0.10 to 0.10); b. probably slightly reduce risk of harmful/hazardous alcohol and substance use (2 trials, 705 participants; SMD -0.20, 95%CI -0.35 to -0.05; moderate-certainty evidence); c. may have uncertain effects on prevalence (cannabis use)/SU/AEs. PW-led interventions for alcohol/substance dependence a. may have uncertain effects. Adults with severe mental disorders *Comparisons were specialist-led care at T1. LHW-led interventions a. may have little-to-no effect on caregiver burden (1 trial, 253 participants; MD -0.04, 95%CI -0.18 to 0.11); b. may have uncertain effects on symptoms/functioning/SU/AEs. PHP-led or collaborative-care a. may reduce functional impairment (7 trials, 874 participants; SMD -1.13, 95%CI -1.78 to -0.47); b. may have uncertain effects on recovery/relapse/symptoms/QOL/SU. Adults with dementia and carers PHP/LHW-led carer interventions a. may have little-to-no effect on the severity of behavioural symptoms in dementia patients (2 trials, 134 participants; SMD -0.26, 95%CI -0.60 to 0.08); b. may reduce carers' mental distress (2 trials, 134 participants; SMD -0.47, 95%CI -0.82 to -0.13); c. may have uncertain effects on QOL/functioning/SU/AEs. Children with PTS or CMDs LHW-led interventions a. may have little-to-no effect on PTS symptoms (3 trials, 1090 participants; MCD -1.34, 95%CI -2.83 to 0.14); b. probably have little-to-no effect on depression symptoms (3 trials, 1092 participants; MCD -0.61, 95%CI -1.23 to 0.02) or on functional impairment (3 trials, 1092 participants; MCD -0.81, 95%CI -1.48 to -0.13); c. may have little-or-no effect on AEs. CP-led interventions a. may have little-to-no effect on depression symptoms (2 trials, 602 participants; SMD -0.19, 95%CI -0.57 to 0.19) or on AEs; b. may have uncertain effects on recovery/symptoms(PTS)/functioning. AUTHORS' CONCLUSIONS PW-led interventions show promising benefits in improving outcomes for CMDs, PND, PTS, harmful alcohol/substance use, and dementia carers in LMICs.
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Affiliation(s)
- Nadja van Ginneken
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
| | - Weng Yee Chin
- Department of Family Medicine and Primary Care, The University of Hong Kong, Pokfulam, Hong Kong
| | | | - Amin Ussif
- Norwegian Institute of Public Health, Oslo, Norway
| | - Rakesh Singh
- Department of Community Health Sciences, School of Medicine and School of Public Health, Patan Academy of Health Sciences, Lalitpur, Nepal
| | - Ujala Shahmalak
- Division of Population Health, Health Services Research & Primary Care, The University of Manchester, Manchester, UK
| | - Marianna Purgato
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Antonio Rojas-García
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
| | - Eleonora Uphoff
- Cochrane Common Mental Disorders, Centre for Reviews and Dissemination, University of York, York, UK
| | - Sarah McMullen
- Division of Population Health, Health Services Research & Primary Care, The University of Manchester, Manchester, UK
| | | | - Ambika Thapa Pachya
- Department of Community Health Sciences, School of Medicine and School of Public Health, Patan Academy of Health Sciences, Lalitpur, Nepal
| | | | - Anna Borghesani
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | | | - Lee-Yee Chong
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Simon Lewin
- Norwegian Institute of Public Health, Oslo, Norway
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
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Parikh R, Hoogendoorn A, Michelson D, Ruwaard J, Sharma R, Bhat B, Malik K, Sahu R, Cuijpers P, Patel V. Increasing demand for school counselling through a lay counsellor-delivered classroom sensitisation intervention: a stepped-wedge cluster randomised controlled trial in New Delhi, India. BMJ Glob Health 2021; 6:bmjgh-2020-003902. [PMID: 34172486 PMCID: PMC8237731 DOI: 10.1136/bmjgh-2020-003902] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 05/27/2021] [Indexed: 01/20/2023] Open
Abstract
Introduction We evaluated a classroom-based sensitisation intervention that was designed to reduce demand-side barriers affecting referrals to a school counselling programme. The sensitisation intervention was offered in the context of a host trial evaluating a low-intensity problem-solving treatment for common adolescent mental health problems. Methods We conducted a stepped-wedge, cluster randomised controlled trial with 70 classes in 6 secondary schools serving low-income communities in New Delhi, India. The classes were randomised to receive a classroom sensitisation session involving a brief video presentation and moderated group discussion, delivered by a lay counsellor over one class period (intervention condition, IC), in two steps of 4 weeks each. The control condition (CC) was whole-school sensitisation (teacher-meetings and whole-school activities such as poster displays). The primary outcome was the proportion of students referred into the host trial. Secondary outcomes were the proportion of students who met mental health caseness criteria and the proportion of self-referred adolescents. Results Between 20 August 2018 and 9 December 2018, 835 students (23.3% of all students) were referred into the host trial. The referred sample included 591 boys (70.8%), and had a mean age of 15.8 years, SD=0.06; 194 students (31.8% of 610 with complete data) met mental health caseness criteria. The proportion of students referred in each trial conditionwas significantly higher in the IC (IC=21.7%, CC=1.5%, OR=111.36, 95% CI 35.56 to 348.77, p<0.001). The proportion of self-referred participants was also higher in the IC (IC=98.1%, CC=89.1%, Pearson χ2 (1)=16.92, p<0.001). Although the proportion of referred students meeting caseness criteria was similar in both conditions (IC=32.0% vs CC=28.1%), the proportion weighted for the total student population was substantially higher in the IC (IC=5.2%, CC=0.3%, OR=52.39, 95% CI 12.49 to 219.66, p<0.001). Conclusion A single, lay counsellor-delivered, classroom sensitisation session increased psychological help-seeking for common mental health problems among secondary school pupils from urban, low-income communities in India. Trial registration number NCT03633916.
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Affiliation(s)
- Rachana Parikh
- Department of Clinical, Neuro and Developmental Psychology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Sangath, Delhi, India.,PATH, Delhi, India
| | - Adriaan Hoogendoorn
- GGZ inGeest, Amsterdam, The Netherlands.,Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | | | - Jeroen Ruwaard
- GGZ inGeest, Amsterdam, The Netherlands.,Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | | | | | | | | | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Vikram Patel
- Sangath, Porvorim, Goa, India .,Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA.,Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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Osborn TL, Venturo-Conerly KE, Arango G. S, Roe E, Rodriguez M, Alemu RG, Gan J, Wasil AR, Otieno BH, Rusch T, Ndetei DM, Wasanga C, Schleider JL, Weisz JR. Effect of Shamiri Layperson-Provided Intervention vs Study Skills Control Intervention for Depression and Anxiety Symptoms in Adolescents in Kenya: A Randomized Clinical Trial. JAMA Psychiatry 2021; 78:829-837. [PMID: 34106239 PMCID: PMC8190694 DOI: 10.1001/jamapsychiatry.2021.1129] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
IMPORTANCE Low-cost interventions for adolescent depression and anxiety are needed in low-resource countries such as those in Sub-Saharan Africa. OBJECTIVE To assess whether Shamiri, a 4-week layperson-delivered group intervention that teaches growth mindset, gratitude, and value affirmation, can alleviate depression and anxiety symptoms in symptomatic Kenyan adolescents. DESIGN, SETTING, AND PARTICIPANTS This school-based randomized clinical trial included outcomes assessed at baseline, posttreatment, and 2-week and 7-month follow-up from 4 secondary schools in Nairobi and Kiambu County, Kenya. Adolescents aged 13 to 18 years with elevated symptoms on standardized depression or anxiety measures were eligible. Intent-to-treat analyses were used to analyze effects. Recruitment took place in June 2019; follow-up data were collected in August 2019 and February 2020. INTERVENTION Adolescents were randomized to the Shamiri intervention or to a study skills control. All adolescents in both conditions met in groups (mean group size, 9) for 60 minutes per week for 4 weeks. MAIN OUTCOMES AND MEASURES Primary outcomes were depression (Patient Health Questionnaire-8 item) and anxiety (Generalized Anxiety Disorder-7 item) symptoms. Analyses of imputed data were hypothesized to reveal significant reductions in depression and anxiety symptoms for adolescents assigned to Shamiri compared with those in the study skills group. RESULTS Of 413 adolescents, 205 (49.6%) were randomized to Shamiri and 208 (50.4%) to study skills. The mean (SD) age was 15.5 (1.2) years, and 268 (65.21%) were female. A total of 307 youths completed the 4-week intervention. Both Shamiri and study skills were rated highly useful (4.8/5.0) and reduced symptoms of depression and anxiety, but analyses with imputed data revealed that youths receiving Shamiri showed greater reductions in depressive symptoms at posttreatment (Cohen d = 0.35 [95% CI, 0.09-0.60]), 2-week follow-up (Cohen d = 0.28 [95% CI, 0.04-0.54]), and 7-month follow-up (Cohen d = 0.45 [95% CI, 0.19-0.71]) and greater reductions in anxiety symptoms at posttreatment (Cohen d = 0.37 [95% CI, 0.11-0.63]), 2-week follow-up (Cohen d = 0.26 [95% CI, -0.01 to 0.53]), and 7-month follow-up (Cohen d = 0.44 [95% CI, 0.18-0.71]). CONCLUSIONS AND RELEVANCE Both the Shamiri intervention and a study skills control group reduced depression and anxiety symptoms; the low-cost Shamiri intervention had a greater effect, with effects lasting at least 7 months. If attrition is reduced and the clinical significance of outcome differences is established, this kind of intervention may prove useful in other global settings where there are limited resources, mental illness stigma, or a shortage of professionals and limited access to mental health care. TRIAL REGISTRATION Pan-African Clinical Trials Registry Identifier: PACTR201906525818462.
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Affiliation(s)
- Tom L. Osborn
- Shamiri Institute, Allston, Massachusetts,Department of Psychology, Harvard University, Cambridge, Massachusetts,Shamiri Institute, Nairobi, Kenya
| | - Katherine E. Venturo-Conerly
- Shamiri Institute, Allston, Massachusetts,Department of Psychology, Harvard University, Cambridge, Massachusetts,Shamiri Institute, Nairobi, Kenya
| | - Susana Arango G.
- Department of Psychology, Harvard University, Cambridge, Massachusetts
| | - Elizabeth Roe
- Department of Psychology, Harvard University, Cambridge, Massachusetts
| | - Micaela Rodriguez
- Department of Psychology, Harvard University, Cambridge, Massachusetts
| | - Rediet G. Alemu
- Department of Psychology, Harvard University, Cambridge, Massachusetts
| | - Jenny Gan
- Department of Psychology, Harvard University, Cambridge, Massachusetts
| | - Akash R. Wasil
- Department of Psychology, University of Pennsylvania, Philadelphia
| | - Benny H. Otieno
- Shamiri Institute, Allston, Massachusetts,Shamiri Institute, Nairobi, Kenya
| | - Thomas Rusch
- Department of Psychology, Harvard University, Cambridge, Massachusetts,Competence Center for Empirical Research Methods, WU Vienna University of Economics and Business, Vienna, Austria
| | - David M. Ndetei
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya,Africa Mental Health Research and Training Foundation, Nairobi, Kenya
| | | | | | - John R. Weisz
- Department of Psychology, Harvard University, Cambridge, Massachusetts
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Darling S, Dawson G, Quach J, Smith R, Perkins A, Connolly A, Smith A, Moore CL, Ride J, Oberklaid F. Mental health and wellbeing coordinators in primary schools to support student mental health: protocol for a quasi-experimental cluster study. BMC Public Health 2021; 21:1467. [PMID: 34320975 PMCID: PMC8316894 DOI: 10.1186/s12889-021-11467-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 07/09/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Half of mental health disorders begin before the age of 14, highlighting the importance of prevention and early-intervention in childhood. Schools have been identified globally by policymakers as a platform to support good child mental health; however, the majority of the research is focused on secondary schools, with primary schools receiving very little attention by comparison. The limited available evidence on mental health initiatives in primary schools is hindered by a lack of rigorous evaluation. This quasi-experimental cluster study aims to examine the implementation and effectiveness of a Mental Health and Wellbeing Co-ordinator role designed to build mental health capacity within primary schools. METHODS This is a primary (ages 5-12) school-based cluster quasi-experimental study in Victoria, Australia. Before baseline data collection, 16 schools selected by the state education department will be allocated to intervention, and another 16 matched schools will continue as 'Business as Usual'. In intervention schools, a mental health and well-being coordinator will be recruited and trained, and three additional school staff will also be selected to receive components of the mental health training. Surveys will be completed by consenting staff (at 2-, 5-, 10- and 17-months post allocation) and by consenting parents/carers (at 3-, 10- and 17-months post allocation) in both intervention and business as usual schools. The primary objective is to assess the change in teacher's confidence to support student mental health and wellbeing using the School Mental Health Self-Efficacy Teacher Survey. Secondary objectives are to assess the indirect impact on systemic factors (level of support, prioritisation of child mental health), parent and teachers' mental health literacy (stigma, knowledge), care access (school engagement with community-based services), and student mental health outcomes. Implementation outcomes (feasibility, acceptability, and fidelity) and costs will also be evaluated. DISCUSSION The current study will examine the implementation and effectiveness of having a trained Mental Health and Wellbeing Coordinator within primary schools. If the intervention increases teachers' confidence to support student mental health and wellbeing and builds the capacity of primary schools it will improve student mental health provision and inform large-scale mental health service reform. TRIAL REGISTRATION The trial was retrospectively registered in the Australian New Zealand Clinical Trials Registry (ANZCTR) on July 6, 2021. The registration number is ACTRN12621000873820 .
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Affiliation(s)
- S Darling
- Centre for Community Child Health, Murdoch Children's Research Institute, Royal Children's Hospital, 50 Flemington Rd, Parkville, VIC, 3052, USA
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, 3010, USA
| | - G Dawson
- Centre for Program Evaluation, Melbourne Graduate School of Education, University of Melbourne, Carlton, VIC, 3053, USA
| | - J Quach
- Centre for Community Child Health, Murdoch Children's Research Institute, Royal Children's Hospital, 50 Flemington Rd, Parkville, VIC, 3052, USA
- Centre for Program Evaluation, Melbourne Graduate School of Education, University of Melbourne, Carlton, VIC, 3053, USA
| | - R Smith
- Centre for Community Child Health, Murdoch Children's Research Institute, Royal Children's Hospital, 50 Flemington Rd, Parkville, VIC, 3052, USA.
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, 3010, USA.
| | - A Perkins
- Centre for Community Child Health, Murdoch Children's Research Institute, Royal Children's Hospital, 50 Flemington Rd, Parkville, VIC, 3052, USA
| | - A Connolly
- Centre for Community Child Health, Murdoch Children's Research Institute, Royal Children's Hospital, 50 Flemington Rd, Parkville, VIC, 3052, USA
| | - A Smith
- Centre for Community Child Health, Murdoch Children's Research Institute, Royal Children's Hospital, 50 Flemington Rd, Parkville, VIC, 3052, USA
| | - C L Moore
- Centre for Community Child Health, Murdoch Children's Research Institute, Royal Children's Hospital, 50 Flemington Rd, Parkville, VIC, 3052, USA
| | - J Ride
- Centre for Community Child Health, Murdoch Children's Research Institute, Royal Children's Hospital, 50 Flemington Rd, Parkville, VIC, 3052, USA
- Health Economics Unit, Centre for Health Policy, Melbourne School of Population and Global Health, 207 Bouverie St, Parkville, VIC, 3010, USA
| | - F Oberklaid
- Centre for Community Child Health, Murdoch Children's Research Institute, Royal Children's Hospital, 50 Flemington Rd, Parkville, VIC, 3052, USA
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, 3010, USA
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Desai S, Pandey N, Singh RJ, Bhasin S. Gender inequities in treatment-seeking for sexual and reproductive health amongst adolescents: Findings from a cross-sectional survey in India. SSM Popul Health 2021; 14:100777. [PMID: 33997240 PMCID: PMC8095180 DOI: 10.1016/j.ssmph.2021.100777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 03/10/2021] [Accepted: 03/12/2021] [Indexed: 11/22/2022] Open
Abstract
CONTEXT India's adolescent health policy aims to improve sexual and reproductive health, especially amongst the most vulnerable. There is limited evidence on how gender influences treatment-seeking patterns amongst unmarried adolescents. METHODS We analyzed data from 11,651 unmarried adolescent boys and girls aged 15-19 from a cross-sectional survey conducted in two large states of India. We conducted sex-disaggregated analyses to estimate the prevalence of symptoms of genital infections and compare treatment-seeking patterns. We identified correlates through multivariable regression and used a conceptual framework to explore structural, household, social and individual factors that influence gender inequities in adolescent sexual and reproductive health. RESULTS One in five unmarried adolescents reported symptoms of genital infections, such as burning or discharge, in the past three months. Factors associated with reporting symptoms varied between boys and girls, except for a common correlation with symptoms of depression. At least two-thirds of boys sought treatment, compared to approximately one in four girls (rural: 66.2% boys, 23.1% girls; urban: 69.4% boys, 30.7% girls). Boys primarily sought care from medical shops or private facilities, while girls used both private and government services. Amongst boys, having friends and being in school was associated with seeking treatment (aOR: 11.47; 95% CI: 2.75, 47.87; aOR: 1.95; 95% CI: 1.24, 3.07, respectively). Odds of seeking treatment were higher amongst girls with exposure to any mass media (aOR: 1.93; 95% CI: 1.25, 2.99) and who had discussed puberty with a parent (aOR: 1.98; 95% CI: 1.32, 2.98). CONCLUSION Stark sex differentials in factors associated with symptoms and in treatment-seeking illustrate how structural gender inequities, such as access to economic resources and education, influence sexual and reproductive health amongst adolescents. Along with health system interventions, addressing gender inequities calls for strategies to strengthen parental engagement, social support and girls' access to resources.
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Zheng Y, Wang W, Zhong Y, Wu F, Zhu Z, Tham YC, Lamoureux E, Xiao L, Zhu E, Liu H, Jin L, Liang L, Luo L, He M, Morgan I, Congdon N, Liu Y. A Peer-to-Peer Live-Streaming Intervention for Children During COVID-19 Homeschooling to Promote Physical Activity and Reduce Anxiety and Eye Strain: Cluster Randomized Controlled Trial. J Med Internet Res 2021; 23:e24316. [PMID: 33882021 PMCID: PMC8092026 DOI: 10.2196/24316] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 01/31/2021] [Accepted: 04/14/2021] [Indexed: 01/19/2023] Open
Abstract
Background The COVID-19 pandemic has led to worldwide school closures, with millions of children confined to online learning at home. As a result, children may be susceptible to anxiety and digital eye strain, highlighting a need for population interventions. Objective The objective of our study was to investigate whether a digital behavior change intervention aimed at promoting physical activity could reduce children’s anxiety and digital eye strain while undergoing prolonged homeschooling during the COVID-19 pandemic. Methods In this cluster randomized controlled trial, homeschooled grade 7 students at 12 middle schools in southern China were recruited through local schools and randomly assigned by the school to receive (1:1 allocation): (1) health education information promoting exercise and ocular relaxation, and access to a digital behavior change intervention, with live streaming and peer sharing of promoted activities (intervention), or (2) health education information only (control). The primary outcome was change in self-reported anxiety score. Secondary outcomes included change in self-reported eye strain and sleep quality. Results On March 16, 2020, 1009 children were evaluated, and 954 (94.5%) eligible children of consenting families were included in the intention-to-treat analysis. Children in the intervention (n=485, 6 schools) and control (n=469, 6 schools) groups were aged 13.5 (SD 0.5) years, and 52.3% (n=499) were male. The assigned interventions were completed by 896 children (intervention: n=467, 96.3%; control: n=429, 91.5%). The 2-week change in square-root–transformed self-reported anxiety scores was greater in the intervention (–0.23, 95% CI –0.27 to –0.20) vs control group (0.12, 95% CI 0.09-0.16; unadjusted difference –0.36, 95% CI –0.63 to –0.08; P=.02). There was a significant reduction in square-root–transformed eye strain in the intervention group (–0.08, 95% CI –0.10 to 0.06) compared to controls (0.07, 95% CI 0.05-0.09; difference –0.15, 95% CI –0.26 to –0.03; P=.02). Change in sleep quality was similar between the two groups. Conclusions This digital behavior change intervention reduced children’s anxiety and eye strain during COVID-19–associated online schooling. Trial Registration ClinicalTrials.gov NCT04309097; http://clinicaltrials.gov/ct2/show/NCT04309097
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Affiliation(s)
- Yingfeng Zheng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.,Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangzhou, China.,Research Units of Ocular Development and Regeneration, Chinese Academy of Medical Sciences, Guangzhou, China
| | - Wei Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Yuxin Zhong
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Fengchun Wu
- Department of Psychiatry, Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China.,Department of Psychiatry, Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
| | - Zhuoting Zhu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Yih-Chung Tham
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
| | - Ecosse Lamoureux
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
| | - Liang Xiao
- Zhaoqing Education Bureau, Zhaoqing, China
| | - Erta Zhu
- Zhaoqing Education Bureau, Zhaoqing, China
| | - Haoning Liu
- Duanzhou District Education Bureau, Zhaoqing, China
| | - Ling Jin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Linyi Liang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Lixia Luo
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Mingguang He
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Ian Morgan
- Research School of Biology, Australian National University, Canberra, Australia
| | - Nathan Congdon
- Centre for Public Health, Queen's University Belfast, Belfast, Ireland
| | - Yizhi Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
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Ataullahjan A, Samara M, Betancourt TS, Bhutta ZA. Mitigating toxic stress in children affected by conflict and displacement. BMJ 2020; 371:m2876. [PMID: 33214156 PMCID: PMC7673909 DOI: 10.1136/bmj.m2876] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Anushka Ataullahjan
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | | | - Theresa S Betancourt
- Research Program on Children and Adversity, Boston College School of Social Work, Boston, USA
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
- Centre of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
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Gonsalves PP, Hodgson ES, Bhat B, Sharma R, Jambhale A, Michelson D, Patel V. App-based guided problem-solving intervention for adolescent mental health: a pilot cohort study in Indian schools. EVIDENCE-BASED MENTAL HEALTH 2020; 24:11-18. [PMID: 33208507 PMCID: PMC7958086 DOI: 10.1136/ebmental-2020-300194] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 10/26/2020] [Accepted: 10/27/2020] [Indexed: 12/11/2022]
Abstract
Background This paper describes the pilot evaluation of ‘POD Adventures’, a lay counsellor-guided problem-solving intervention delivered via a smartphone app in Indian secondary schools. Objective To test the feasibility and acceptability of POD Adventures for adolescents with a felt need for psychological support, and to explore the intervention’s effects on self-reported mental health symptoms, prioritised problems, stress and well-being. Methods We used a mixed-methods pre-post cohort design. Participants were self-referred from grades 9–12 in two coeducational government-aided secondary schools in Goa, India. The intervention was delivered in two formats, ‘mixed’ (comprising individual and small group sessions) and ‘group’ (small group sessions only). Findings 248 participants enrolled in the study and 230 (92.7%) completed the intervention. Outcomes at 4 weeks showed significant improvements on all measures that were maintained at 12 weeks. Large effects were observed on problem severity scores (4 weeks, d=1.47; 12 weeks, d=1.53) while small to moderate effects were seen on mental health symptoms, stress and well-being. 22 students completed qualitative interviews about their experience of the intervention. Participants found POD Adventures easy to use, engaging and helpful in solving their problems. They were satisfied with the guidance provided by the counsellor irrespective of delivery format. Conclusions POD Adventures was feasible to deliver with guidance from lay counsellors in Indian schools, acceptable to participants and associated with large improvements in problem severity and mental health symptom severity. Clinical implications POD Adventures has promise as an early intervention for adolescents with a felt need for psychological support in low-resource settings.
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Affiliation(s)
- Pattie P Gonsalves
- Sangath, New Delhi, India .,Psychology, University of Sussex, Brighton, Brighton and Hove, UK
| | | | | | | | | | | | - Vikram Patel
- Sangath, Porvorim, Goa, India.,Harvard Medical School, Boston, Massachusetts, USA
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Rose-Clarke K, Pradhan I, Shrestha P, B K P, Magar J, Luitel NP, Devakumar D, Rafaeli AK, Clougherty K, Kohrt BA, Jordans MJD, Verdeli H. Culturally and developmentally adapting group interpersonal therapy for adolescents with depression in rural Nepal. BMC Psychol 2020; 8:83. [PMID: 32787932 PMCID: PMC7425581 DOI: 10.1186/s40359-020-00452-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 07/27/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Evidence-based interventions are needed to reduce depression among adolescents in low- and middle-income countries (LMICs). One approach could be cultural adaptation of psychological therapies developed in high-income countries. We aimed to adapt the World Health Organization's Group Interpersonal Therapy (IPT) Manual for adolescents with depression in rural Nepal. METHODS We used a participatory, multi-stage adaptation process involving: translation and clinical review of the WHO Manual; desk reviews of adaptations of IPT in LMICs, and literature on child and adolescent mental health interventions and interpersonal problems in Nepal; a qualitative study to understand experiences of adolescent depression and preferences for a community-based psychological intervention including 25 interviews with adolescent boys and girls aged 13-18 with depression, four focus group discussions with adolescents, four with parents/caregivers and two with teachers, six interviews with community health workers and one with a representative from a local non-governmental organisation (total of 126 participants); training of IPT trainers and facilitators and practice IPT groups; and consultation with a youth mental health advisory board. We used the Ecological Validity Framework to guide the adaptation process. RESULTS We made adaptations to optimise treatment delivery and emphasise developmental and cultural aspects of depression. Key adaptations were: integrating therapy into secondary schools for delivery by school nurses and lay community members; adding components to promote parental engagement including a pre-group session with the adolescent and parent to mobilise parental support; using locally acceptable terms for mental illness such as udas-chinta (sadness and worry) and man ko samasya (heart-mind problem); framing the intervention as a training programme to de-stigmatise treatment; and including activities to strengthen relationships between group members. We did not adapt the therapeutic goals of IPT and conserved IPT-specific strategies and techniques, making edits only to the way these were described in the Manual. CONCLUSIONS Group IPT can be adapted for adolescents in Nepal and delivered through the education system. A randomised controlled trial is needed to assess the impact and costs of the intervention in this setting. Future research in LMICs to adapt IPT for adolescents could use this adapted intervention as a starting point.
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Affiliation(s)
- Kelly Rose-Clarke
- Department of Global Health and Social Medicine, King's College London, London, WC2B 4BG, UK.
| | - Indira Pradhan
- Transcultural Psychosocial Organization Nepal, Kathmandu, Nepal
| | - Pragya Shrestha
- Transcultural Psychosocial Organization Nepal, Kathmandu, Nepal
| | - Prakash B K
- Transcultural Psychosocial Organization Nepal, Kathmandu, Nepal
| | - Jananee Magar
- Transcultural Psychosocial Organization Nepal, Kathmandu, Nepal
| | | | - Delan Devakumar
- Institute for Global Health, University College London, London, UK
| | - Alexandra Klein Rafaeli
- Psychological Services, Ruth and Allen Ziegler Student Services Division, Tel Aviv University, Tel Aviv, Israel
| | - Kathleen Clougherty
- Global Mental Health Lab, Teachers College, Columbia University, New York, NY, USA
| | - Brandon A Kohrt
- Department of Psychiatry and Behavioral Sciences, and Department of Global Health, George Washington University, Washington, DC, USA
| | - Mark J D Jordans
- Transcultural Psychosocial Organization Nepal, Kathmandu, Nepal.,Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neurosciences, King's College London, London, UK
| | - Helen Verdeli
- Global Mental Health Lab, Teachers College, Columbia University, New York, NY, USA
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Cluver L. Solving the global challenge of adolescent mental ill-health. THE LANCET CHILD & ADOLESCENT HEALTH 2020; 4:556-557. [PMID: 32585187 PMCID: PMC7308755 DOI: 10.1016/s2352-4642(20)30205-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 06/10/2020] [Indexed: 11/02/2022]
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