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Senapati RE, Jena S, Parida J, Panda A, Patra PK, Pati S, Kaur H, Acharya SK. The patterns, trends and major risk factors of suicide among Indian adolescents - a scoping review. BMC Psychiatry 2024; 24:35. [PMID: 38195413 PMCID: PMC10775453 DOI: 10.1186/s12888-023-05447-8] [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] [Received: 07/06/2023] [Accepted: 12/06/2023] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND Adolescence is an essential stage for the development of mental health, and suicide is among the leading cause of mortality for adolescents around the world. In India, the suicide rate among adolescents has been increasing in recent years. The scoping review was conducted to map the evidence and address gaps by examining the existing pattern, and trends, and identify the major risk factors of suicide among Indian adolescents. METHODS The study was conducted as per the Arksey and O'Malley scoping review framework and the Joanna Briggs Institute Reviewers' manual. The systematic search was performed using electronic databases such as PubMed, Google Scholar, EMBASE, and PsycINFO, by using specific keywords. After the screening, 35 articles were identified according to the inclusion criteria. RESULTS The evidence on the trends of suicide among adolescents showed that the suicide rate has shown an alarming increase in recent years. The evidence pattern showed that hanging and poisoning were the commonly selected methods used by adolescents. The most commonly reported risk factors were mental health problems (54.28%), negative or traumatic familiar issues (34.28%), academic stress (22.85%), social/lifestyle factors (20%), violence (22.85%), economic distresses (8.75%), relationship factor (8.75%). CONCLUSION By synthesizing and summarising the patterns, trends, and key risk factors of suicide among Indian adolescents, this scoping review provides a broad understanding of the literature already in existence. In order to effectively tackle these issues, the finding highlights the urgent need for extensive and targeted suicide prevention measures.
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Affiliation(s)
- Rachel Elizabeth Senapati
- ICMR- Regional Medical Research Centre, NALCO Nagar, Chandrasekharpur, Bhubaneswar, Odisha, 751023, India
| | - Susangita Jena
- ICMR- Regional Medical Research Centre, NALCO Nagar, Chandrasekharpur, Bhubaneswar, Odisha, 751023, India
| | - Jayashree Parida
- ICMR- Regional Medical Research Centre, NALCO Nagar, Chandrasekharpur, Bhubaneswar, Odisha, 751023, India
| | - Arpita Panda
- ICMR- Regional Medical Research Centre, NALCO Nagar, Chandrasekharpur, Bhubaneswar, Odisha, 751023, India
| | | | - Sanghamitra Pati
- ICMR- Regional Medical Research Centre, NALCO Nagar, Chandrasekharpur, Bhubaneswar, Odisha, 751023, India
| | - Harpreet Kaur
- Division of Epidemiology and Communicable Diseases (ECD-Tribal Health), Indian Council of Medical Research (ICMR), New Delhi, India
| | - Subhendu Kumar Acharya
- ICMR- Regional Medical Research Centre, NALCO Nagar, Chandrasekharpur, Bhubaneswar, Odisha, 751023, India.
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Anyanwu MU. Psychological distress in adolescents: prevalence and its relation to high-risk behaviors among secondary school students in Mbarara Municipality, Uganda. BMC Psychol 2023; 11:5. [PMID: 36624544 PMCID: PMC9830719 DOI: 10.1186/s40359-023-01039-z] [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: 09/03/2021] [Accepted: 01/03/2023] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Psychological distress among adolescents negatively affects their academic performance, relationships with family and friends, and ability to participate fully in the community. Stressful life events in low-income countries and risk-taking behavior of adolescents have raised concerns regarding the impact of psychological distress among adolescents. Therefore, the present study estimated the prevalence of psychological distress and examined the high-risk behaviors associated with psychological distress among Ugandan adolescents. METHODS A community based cross-sectional study was conducted among secondary school students in Mbarara Municipality, Uganda. Multistage cluster sampling was used to recruit 921 adolescents from 12 schools. Psychological distress was assessed using the 10-item Kessler Psychological Distress Scale (K10). Logistic regression was used with p-value estimating regression coefficient and 95% confidence interval for odds ratio and adjusted odds ratio (AOR). RESULTS The prevalence of psychological distress using the K10 was 57%. Logistic regression analyses showed that risky sexual behavior [AOR = 1.52; 95% confidence interval (CI) 1.02-2.28], substance use (AOR = 2.06; 95% CI 1.49-2.84) were associated with psychological distress. Students in mixed schools (comprising both sexes) (AOR = 1.94; 95% CI 1.19-3.15) and adolescents with chronic illness (AOR = 1.68; 95% CI 1.18-2.38) were more likely to report psychological distress. CONCLUSION The prevalence of psychological distress among school-going adolescents is high. Risky sexual behavior, substance use as well as chronic illness were associated with psychological distress. In addition, the type of school was significantly associated with psychological distress. The findings suggest the need for policy makers and stakeholders in health and education sectors to institute measures that will address mental health issues among adolescents.
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Affiliation(s)
- Michael U. Anyanwu
- grid.33440.300000 0001 0232 6272Department of Community Health, Mbarara University of Science and Technology, P.O Box 1410, Mbarara, Uganda
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Mayya SS, Mayya A, Martis M, Lakshmi RV. Academic stress and associated sociodemographic variables: A study of pre-university students in Karnataka, India. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2022; 11:230. [PMID: 36177424 PMCID: PMC9514250 DOI: 10.4103/jehp.jehp_87_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 05/03/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Academic stress is a predominant phenomenon among grade 11 and 12 students. The performance in Grade 12 is important for entry to higher education programs in India. The purpose of the study was to assess the magnitude of the perceived academic stress and identify the main stressors and the sociodemographic variables associated with the perceived academic stress among adolescents enrolled in the science stream in coastal Karnataka. MATERIALS AND METHODS Upon Institutional Ethical Committee approval, a cross-sectional survey was carried out among pre-university students (science stream) of coastal Karnataka during February-April 2021. The study used Manipal Inventory of Academic Stress (MIAS) scale to collect data on perceived academic stress from 1859 students (response rate 68.3%). Stratified cluster sampling method was used to collect data from the study participants. IBM Statistical Package for the Social Sciences (SPSS) 26.0 was used to analyze the data. Descriptive statistics, unpaired t-test, one-way analysis of variance (ANOVA), and multiple linear regression analyses were used to study the association between academic stress and various demographic variables. RESULTS The study revealed that 28% of the Grade 11 students and 26% of the Grade 12 students experienced high or extreme stress. The significant stressors were lack of time for revision, queries from neighbors or relatives, and parental expectations on academic performance. Gender, residence, and the medium of instruction until Grade 10 were associated with academic stress. CONCLUSION Measures at the institutional and national levels are necessary to reduce the academic stress in higher secondary education. The integrated curriculum proposed in the National Educational Policy 2020 addresses a few stressors identified in this study.
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Affiliation(s)
- Shreemathi S. Mayya
- Department of Data Science, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Arun Mayya
- Department of Conservative Dentistry and Endodontics, A J Institute of Dental Sciences, Mangaluru, Karnataka, India
| | - Maxie Martis
- Nursing College, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - R Vani Lakshmi
- Department of Data Science, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Musa S, Dergaa I. A Narrative Review on Prevention and Early Intervention of Challenging Behaviors in Children with a Special Emphasis on COVID-19 Times. Psychol Res Behav Manag 2022; 15:1559-1571. [PMID: 35769177 PMCID: PMC9234312 DOI: 10.2147/prbm.s354428] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 04/08/2022] [Indexed: 11/23/2022] Open
Abstract
Background COVID-19 and the measures stemming from efforts to control it have affected the psychosocial wellbeing of children and adolescents. The increasing trend of challenging behavior has exerted further pressure on parents and schools. Understanding socioemotional development and interrelating triggers is the key to management. Early interventions prevent the future threat of mental illness and risky acts. Effective strategies are ones that primarily focus on strengthening parent-child interactions. Aim The purpose of this paper is to review the literature on the (i) psychosocial and behavioral impacts of COVID-19 on children/adolescents and (ii) approaches to identify determinants of challenging behaviors as a principal guide to effective interventional strategies for children and their families. Methodology Electronic database searches of PubMed, ScienceDirect, Medline, and Scopus were conducted to identify studies meeting the inclusion criteria that address the impact of COVID-19 on behaviors, contributing factors, and management in the context of families/schools. The content of the selected articles was themed under five categories, namely the developmental milestones, the Pyramid Model, the Positive Behavioral Support, the management strategies, and the impact of COVID-19 on children/adolescents' behavior. Results The present review demonstrates considerable influence of COVID-19 on children and adolescents' behavior and mental wellbeing. It stresses the importance of early family-based interventions focusing on the triggers of challenging behavior. Functional Behavioral Assessment and Behavioral Intervention Plan provide a systematic analysis with a strategic plan that support children's self-regulation and socioemotional intelligence. Regular behavioral screening is vital to promote prevention and early management. Conclusion Managing behavioral difficulties remains an area of deficit for parents, teachers, and health care providers. With a quality support, parents and schools will be able to clearly characterize the challenging behavior, understand the causes, reinforce parent-child interactions, and consequently, gain the strategic skills required to apply it within natural settings. Timely interventions will limit the risk of future misconduct and mental disorders.
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Affiliation(s)
- Sarah Musa
- Department of Preventative Health, Primary Health Care Corporation, Doha, Qatar
| | - Ismail Dergaa
- Department of Preventative Health, Primary Health Care Corporation, Doha, Qatar
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Ramakrishna M, Singh P, Bambling M, Edirippulige S, Teoh HJ. Behavioural concerns in the classrooms in Delhi NCR, India: An explorative study through the lens of parents and teachers. CURRENT PSYCHOLOGY 2022. [DOI: 10.1007/s12144-022-03251-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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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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Chakradhar V, Lakshmana R, Sruthi Y, Harika P. Occlusal stress. Br Dent J 2021; 230:790. [PMID: 34172844 DOI: 10.1038/s41415-021-3199-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Psychosocial and behavioral problems of children and adolescents in the early stage of reopening schools after the COVID-19 pandemic: a national cross-sectional study in China. Transl Psychiatry 2021; 11:342. [PMID: 34083509 PMCID: PMC8172553 DOI: 10.1038/s41398-021-01462-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 04/22/2021] [Accepted: 05/04/2021] [Indexed: 12/28/2022] Open
Abstract
This study aims to explore the psychosocial and behavioral problems of children and adolescents in the early stage of reopening schools. In this national cross-sectional study, a total of 11072 students from China were naturally divided into two groups based on their schooling status: reopened schools (RS) and home schooling (HS) group. The psychosocial and behavioral functioning were measured by Achenbach Child Behaviour Checklist (CBCL) and compared in these two groups. Multivariable logistic regression analyses were conducted to explore the independent predictors associated with the psychosocial and behavioral problems. Our results showed that the students in the RS group had more adverse behaviors than that of HS group. The RS group had the higher rates of parent-offspring conflict, prolonged homework time, increased sedentary time and sleep problems (all p < 0.001). When separate analyses were conducted in boys and girls, the RS group had the higher scores for (1) overall behavioral problems (p = 0.02 and p = 0.01), internalizing (p = 0.02 and p = 0.02) and externalizing (p = 0.02 and p = 0.004) behaviors in the 6-11 age group; (2) externalizing (p = 0.049 and p = 0.006) behaviors in the 12-16 age group. Multivariable regression showed parent-offspring conflict and increased sedentary time were the most common risk factors, while physical activity and number of close friends were protective factors for behavior problems in RS students (p < 0.01 or 0.05). The present study revealed that students' psychosocial and behavioral problems increased in the early stage of schools reopened unexpectedly. These findings suggest that close attention must be paid and holistic strategies employed in the school reopening process of post-COVID-19 period.
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Trevethan M, Lin KL, Raval VV, Li X, Hu J, Deo N. Mothers' emotion socialization profiles and relation to adolescent socio-emotional functioning in China and India. JOURNAL OF APPLIED DEVELOPMENTAL PSYCHOLOGY 2021. [DOI: 10.1016/j.appdev.2021.101259] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Stress management training and gratitude journaling in the classroom: an initial investigation in Indian context. CURRENT PSYCHOLOGY 2021; 40:5737-5748. [PMID: 34522074 PMCID: PMC8430282 DOI: 10.1007/s12144-020-01242-w] [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] [Accepted: 11/26/2020] [Indexed: 01/07/2023]
Abstract
Stress and allied difficulties are pervasive among school students in present times. This concern is further magnified in the Indian context with the large represention of young people in the population and limited resources to match. The present study aimed to evaluate the impact of a classroom based stress management training and gratitude journaling intervention (Flinchbaugh et al., 2012) among Indian adolescents. The intervention curriculum was adapted to suit the study context. A total of 238 students (57% males) from Grades 7–9 participated in this study. Participants were recruited from two schools, and their age ranged from 11 to 14 years. In each participating school, students were randomised at the classroom level into three intervention groups (Stress Management Training, Gratitude Journaling, combination of both), and one control group. Using a pre-test – post-test design, intervention impact on measures of well-being, life satisfaction, perceived stress, meaning, and engagement in the classroom was evaluated. Results suggested limited effectiveness of stress management training and gratitude journaling among participants in the present context. Plausible explanations for these findings are discussed. The study emphasizes the need for customised interventions to obtain optimal outcomes among diverse populations.
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Nagabharana TK, Joseph S, Rizwana A, Krishna M, Barker M, Fall C, Kumaran K, Krishnaveni GV. What stresses adolescents? A qualitative study on perceptions of stress, stressors and coping mechanisms among urban adolescents in India. Wellcome Open Res 2021; 6:106. [PMID: 34095512 PMCID: PMC8170530 DOI: 10.12688/wellcomeopenres.16818.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2021] [Indexed: 11/20/2022] Open
Abstract
Background: In India, stress levels are increasing steadily among youth. We aimed to explore the factors that contribute to psychological stress and coping strategies among adolescents in Mysore, India to inform the development of an intervention. Methods: We recruited 16 volunteers in Mysore, India including 6 younger (12-15 years; 3 girls) and 10 older adolescents/ young adults (17-25 years; 5 girls) using a purposive sampling technique. Older adolescents were recruited from ongoing birth cohort study, and the younger adolescents by word-of-mouth from the community. Individual in-depth interviews were carried out based on a semi-structured interview guide comprising open-ended questions. The interviews were analysed to derive themes and emerging constructs related to stress and coping strategies. Results: Adolescents generally perceived stress in their daily lives. Family conflicts and academic pressures were the main triggers for increased stress. Issues around peer relationships, and social position were also important contributors. Adolescents reported that they had robust coping strategies. These included stress release through rationalising and acceptance of the situation, distraction activities, spirituality, and self-comforting methods. However, they felt the need for further support from their family, and the society in general. In particular they expressed the need for a space to share their concerns and obtain guidance through healthy discussions with adults. Conclusions: Our study indicates that adolescents in India are exposed to a wide range of stressors in their daily lives. The conflict between 'traditional' society's opinions of what adolescents should do and the new age adolescents' aspirations for autonomy to find 'informed' solutions for their issues may hinder the stress management efforts. Moving forward, we propose to develop a culturally acceptable intervention tool that accommodates adolescents' perspectives and psychosocial context.
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Affiliation(s)
- T K Nagabharana
- Epidemiology Research Unit, CSI Holdsworth Memorial Hospital, MYSORE, Karnataka, 570022, India
| | - Shama Joseph
- Epidemiology Research Unit, CSI Holdsworth Memorial Hospital, MYSORE, Karnataka, 570022, India
| | - Azeez Rizwana
- Epidemiology Research Unit, CSI Holdsworth Memorial Hospital, MYSORE, Karnataka, 570022, India
| | - Murali Krishna
- Foundation for Research and Advocacy in Mental Health (FRAMe), MYSORE, Karnataka, 570022, India
| | - Mary Barker
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, Hampshire, SO16 6YD, UK
| | - Caroline Fall
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, Hampshire, SO16 6YD, UK
| | - Kalyanaraman Kumaran
- Epidemiology Research Unit, CSI Holdsworth Memorial Hospital, MYSORE, Karnataka, 570022, India.,MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, Hampshire, SO16 6YD, UK
| | - G V Krishnaveni
- Epidemiology Research Unit, CSI Holdsworth Memorial Hospital, MYSORE, Karnataka, 570022, India
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Boustani MM, Daleiden E, Bernstein A, Michelson D, Gellatly R, Malik K, Patel V, Chorpita B. Using relevance mapping methodology to design an adolescent mental health intervention in India. Glob Health Action 2020; 13:1775062. [PMID: 32588780 PMCID: PMC7480414 DOI: 10.1080/16549716.2020.1775062] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Adolescents in low and middle-income countries experience pronounced mental health needs in contexts where infrastructure and resources are scarce. While evidence-based treatment are readily available, they may not fit the unique needs of certain contexts. OBJECTIVE This manuscript illustrates the systematic process of applying 'relevance mapping' methodology to leverage the youth mental health evidence base to identify candidate practices for inclusion in the development of a contextually appropriate psychological treatment protocol for common adolescent mental health problems in India. METHODS The practice identification was informed by two datasets obtained from adolescent samples in India. The first was an epidemiological dataset from a large community sample in Goa (N = 2,048); the second incorporated 'youth top problems' reported by service-seeking students presenting to school counsellors in Goa and Delhi (N = 78). Problems identified in each dataset were categorized using structured codes. Problem codes and youth demographics were then indexed against a database of hundreds of evidence-based psychological treatments and their associated clinical trials. This methodology revealed the most common practice elements (discrete therapeutic strategies) and their most efficient combinations with evidence of effectiveness matching the demographics and diagnostic category (anxiety, disruptive behaviors and depression) prevalent in the planned treatment population. RESULTS For anxiety, the most common practice elements for this age group were exposure, cognitive coping, and psychoeducation. For disruptive behaviors, the most common practices were problem-solving, goal-setting, and rapport-building. For depression, cognitive coping, behavioral activation, and psychoeducation were the most common practice elements. CONCLUSION These practice elements provided the treatment development team with a preliminary list of candidate content for the development of an intensive psychological treatment within a stepped care service model to address common adolescent mental health problems in schools in India.
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Affiliation(s)
- Maya M Boustani
- Department of Psychology, Loma Linda University , Loma Linda, CA, USA
| | | | | | | | - Resham Gellatly
- Department of Psychology, University of California , Los Angeles, CA, USA
| | | | - Vikram Patel
- Sangath , Goa, India.,Department of Global Health and Population, Harvard Medical School , Cambridge, MA, USA
| | - Bruce Chorpita
- Department of Psychology, University of California , Los Angeles, CA, USA
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Gaiha SM, Taylor Salisbury T, Koschorke M, Raman U, Petticrew M. Stigma associated with mental health problems among young people in India: a systematic review of magnitude, manifestations and recommendations. BMC Psychiatry 2020; 20:538. [PMID: 33198678 PMCID: PMC7667785 DOI: 10.1186/s12888-020-02937-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 10/28/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Globally, 20% of young people experience mental disorders. In India, only 7.3% of its 365 million youth report such problems. Although public stigma associated with mental health problems particularly affects help-seeking among young people, the extent of stigma among young people in India is unknown. Describing and characterizing public stigma among young people will inform targeted interventions to address such stigma in India, and globally. Thus, we examined the magnitude and manifestations of public stigma, and synthesised evidence of recommendations to reduce mental-health-related stigma among young people in India. METHOD A systematic review and meta-analysis of observational studies was conducted. Nine electronic databases were searched and 30 studies (n = 6767) met inclusion criteria. RESULTS Most studies (66%) focused on youth training to become health professionals. One-third of young people display poor knowledge of mental health problems and negative attitudes towards people with mental health problems and one in five had actual/intended stigmatizing behavior (I2>=95%). Young people are unable to recognize causes and symptoms of mental health problems and believe that recovery is unlikely. People with mental health problems are perceived as dangerous and irresponsible, likely due to misinformation and misunderstanding of mental health problems as being solely comprised of severe mental disorders (e.g. schizophrenia). However, psychiatric labels are not commonly used/understood. CONCLUSION Public education may use symptomatic vignettes (through relatable language and visuals) instead of psychiatric labels to improve young people's understanding of the range of mental health problems. Recommended strategies to reduce public stigma include awareness campaigns integrated with educational institutions and content relevant to culture and age-appropriate social roles.
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Affiliation(s)
- Shivani Mathur Gaiha
- Indian Institute of Public Health- Hyderabad, Public Health Foundation of India, Hyderabad, India.
- Department of Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK.
| | - Tatiana Taylor Salisbury
- Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK
| | - Mirja Koschorke
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK
| | - Usha Raman
- Department of Communication, Sarojini Naidu School of Arts & Communication, University of Hyderabad, Hyderabad, India
| | - Mark Petticrew
- Department of Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
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Chorpita BF, Daleiden EL, Malik K, Gellatly R, Boustani MM, Michelson D, Knudsen K, Mathur S, Patel VH. Design process and protocol description for a multi-problem mental health intervention within a stepped care approach for adolescents in India. Behav Res Ther 2020; 133:103698. [PMID: 32858304 DOI: 10.1016/j.brat.2020.103698] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 06/30/2020] [Accepted: 07/27/2020] [Indexed: 01/18/2023]
Abstract
This paper documents the collaborative design of a mental health intervention for adolescents in India with anxiety, depression, or anger-related concerns. The process was characterized by three phases of formative activities: (1) an intensive review of the service context, (2) selection of an overall design strategy (e.g., whether to choose existing evidence-based treatments or build new treatments in context), and (3) a period of prototyping, testing, and refining. Each phase resulted in specific outputs, which were, respectively, (1) a detailed articulation of values and preferences (setting expectations for what the ideal protocol should be), (2) a set of build parameters representing a blueprint that managed strategic compromises for this context, and (3) a working protocol. We outline the steps of this design process, summarize data from an open-trial clinical case series, and illustrate the resulting working protocol, which will be tested in a future larger trial. We conclude with insights and observations likely to be relevant to protocol design activity in a variety of contexts, most particularly those in low-and-middle-income countries such as India.
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Affiliation(s)
- Bruce F Chorpita
- Department of Psychology, University of California, Los Angeles, USA.
| | | | | | - Resham Gellatly
- Department of Psychology, University of California, Los Angeles, USA
| | | | | | - Kendra Knudsen
- Department of Psychology, University of California, Los Angeles, USA
| | | | - Vikram H Patel
- Department of Global Health and Social Medicine, Harvard Medical School, USA
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Michelson D, Malik K, Parikh R, Weiss HA, Doyle AM, Bhat B, Sahu R, Chilhate B, Mathur S, Krishna M, Sharma R, Sudhir P, King M, Cuijpers P, Chorpita B, Fairburn CG, Patel V. Effectiveness of a brief lay counsellor-delivered, problem-solving intervention for adolescent mental health problems in urban, low-income schools in India: a randomised controlled trial. THE LANCET. CHILD & ADOLESCENT HEALTH 2020; 4:571-582. [PMID: 32585185 PMCID: PMC7386943 DOI: 10.1016/s2352-4642(20)30173-5] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 05/14/2020] [Accepted: 05/19/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND Mental health problems are a leading cause of disability in adolescents worldwide. Problem solving is a well-tested mental health intervention in many populations. We aimed to investigate the effectiveness of a brief, transdiagnostic problem-solving intervention for common adolescent mental health problems when delivered by non-specialist school counsellors in New Delhi, India. METHODS This randomised trial was done in six government-run schools (three all-boys schools, two all-girls schools, and one co-educational school) that serve low-income communities. We recruited participants from grades 9 to 12 (ages 12-20 years) by selecting students with persistently elevated mental health symptoms accompanied by distress or functional impairment. Clinical eligibility criteria were assessed by research assistants using the Hindi-language version of the Strengths and Difficulties Questionnaire (SDQ), with reference to locally validated borderline cutoff scores of 19 or greater for boys and 20 or greater for girls on the SDQ Total Difficulties scale, an abnormal score of 2 or more on the SDQ Impact scale, and persistence of more than 1 month on the SDQ Chronicity index. Participants were randomly allocated (1:1) to problem solving delivered through a brief (2-3 week) counsellor-led intervention with supporting printed materials (intervention group), or problem solving delivered via printed booklets alone (control group). Primary outcomes were adolescent-reported mental health symptoms (SDQ Total Difficulties scale) and idiographic psychosocial problems (Youth Top Problems [YTP]) at 6 weeks. Primary analyses were done on an intention-to-treat basis at the 6-week endpoint. The trial is registered with ClinicalTrials.gov, NCT03630471. FINDINGS Participants were enrolled between Aug 20, and Dec 4, 2018. 283 eligible adolescents were referred to the trial, and 251 (89%) of these were enrolled (mean age 15·61 years; 174 [69%] boys). 125 participants were allocated to each group (after accounting for one participant in the intervention group who withdrew consent after randomisation). Primary outcome data were available for 245 (98%) participants. At 6 weeks, the mean YTP scores were 3·52 (SD 2·66) in the intervention group and 4·60 (2·75) in the control group (adjusted mean difference -1·01, 95% CI -1·63 to -0·38; adjusted effect size 0·36, 95% CI 0·11 to 0·61; p=0·0015). The mean SDQ Total Difficulties scores were 17·48 (5·45) in the intervention group and 18·33 (5·45) in the control group (-0·86, -2·14 to 0·41; 0·16, -0·09 to 0·41; p=0·18). We observed no adverse events. INTERPRETATION A brief lay counsellor-delivered problem-solving intervention combined with printed booklets seemed to have a modest effect on psychosocial outcomes among adolescents with diverse mental health problems compared with problem-solving booklets alone. This counsellor-delivered intervention might be a suitable first-line intervention in a stepped care approach, which is being evaluated in ongoing studies. FUNDING Wellcome Trust.
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Affiliation(s)
| | | | - Rachana Parikh
- Sagath, New Delhi, India,Department of Clinical Psychology, Vrije Universiteit, Amsterdam, Netherlands
| | - Helen A Weiss
- Medical Research Council Tropical Epidemiology Group, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Aoife M Doyle
- Medical Research Council Tropical Epidemiology Group, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | | | | | | | | | | | | | - 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, UK
| | - Pim Cuijpers
- Department of Clinical Psychology, Vrije Universiteit, Amsterdam, Netherlands
| | - Bruce Chorpita
- Department of Psychology, University of California, Los Angeles, CA, USA
| | | | - Vikram Patel
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA,Harvard TH Chan School of Public Health, Boston, MA, USA,Correspondence to: Prof Vikram Patel, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA 02115, USA
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17
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Michelson D, Malik K, Krishna M, Sharma R, Mathur S, Bhat B, Parikh R, Roy K, Joshi A, Sahu R, Chilhate B, Boustani M, Cuijpers P, Chorpita B, Fairburn CG, Patel V. Development of a transdiagnostic, low-intensity, psychological intervention for common adolescent mental health problems in Indian secondary schools. Behav Res Ther 2020; 130:103439. [PMID: 31466693 PMCID: PMC7322400 DOI: 10.1016/j.brat.2019.103439] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 06/29/2019] [Accepted: 07/14/2019] [Indexed: 01/18/2023]
Abstract
BACKGROUND The PRIDE programme aims to establish a suite of transdiagnostic psychological interventions organised around a stepped care system in Indian secondary schools. This paper describes the development of a low-intensity, first-line component of the PRIDE model. METHOD Contextual and global evidence informed an intervention 'blueprint' with problem solving as the primary practice element. Successive iterations were tested and modified across two pilot cohort studies (N = 45; N = 39). Participants were aged 13-20 years and presenting with elevated mental health symptoms in New Delhi schools. RESULTS The first iteration of the intervention, based on a guided self-help modality, showed promising outcomes and user satisfaction when delivered by psychologists. However, delivery was not feasible within the intended 6-week schedule, and participants struggled to use materials outside 'guidance' sessions. In Pilot 2, a modified counsellor-led problem-solving intervention was implemented by less experienced counsellors over a 3-4 week schedule. Outcomes were maintained, with indications of enhanced feasibility and acceptability. High demand was observed across both pilots, leading to more stringent eligibility criteria and a modified sensitisation plan. DISCUSSION Findings have shaped a first-line intervention for common adolescent mental health problems in low-resource settings. A forthcoming randomised controlled trial will test its effectiveness.
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Affiliation(s)
| | | | | | | | | | | | - Rachana Parikh
- Sangath, Goa and New Delhi, India; Department of Clinical Psychology, Vrije Universiteit, Amsterdam, Netherlands
| | | | | | | | | | - Maya Boustani
- Department of Psychology, Loma Linda University, Los Angeles, USA
| | - Pim Cuijpers
- Department of Clinical Psychology, Vrije Universiteit, Amsterdam, Netherlands
| | - Bruce Chorpita
- Department of Psychology, University of California at Los Angeles, Los Angeles, USA
| | | | - Vikram Patel
- Sangath, Goa and New Delhi, India; Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA; Harvard TH Chan School of Public Health, Boston, USA.
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Parikh R, Michelson D, Malik K, Shinde S, Weiss HA, Hoogendoorn A, Ruwaard J, Krishna M, Sharma R, Bhat B, Sahu R, Mathur S, Sudhir P, King M, Cuijpers P, Chorpita BF, Fairburn CG, Patel V. The effectiveness of a low-intensity problem-solving intervention for common adolescent mental health problems in New Delhi, India: protocol for a school-based, individually randomized controlled trial with an embedded stepped-wedge, cluster randomized controlled recruitment trial. Trials 2019; 20:568. [PMID: 31533783 PMCID: PMC6751586 DOI: 10.1186/s13063-019-3573-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 07/11/2019] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Conduct, anxiety, and depressive disorders account for over 75% of the adolescent mental health burden globally. The current protocol will test a low-intensity problem-solving intervention for school-going adolescents with common mental health problems in India. The protocol also tests the effects of a classroom-based sensitization intervention on the demand for counselling services in an embedded recruitment trial. METHODS/DESIGN We will conduct a two-arm, individually randomized controlled trial in six Government-run secondary schools in New Delhi. The targeted sample is 240 adolescents in grades 9-12 with persistent, elevated mental health symptoms and associated distress/impairment. Participants will receive either a brief problem-solving intervention delivered over 3 weeks by lay counsellors (intervention) or enhanced usual care comprised of problem-solving booklets (control). Self-reported adolescent mental health symptoms and idiographic problems will be assessed at 6 weeks (co-primary outcomes) and again at 12 weeks post-randomization. In addition, adolescent-reported distress/impairment, perceived stress, mental wellbeing, and clinical remission, as well as parent-reported adolescent mental health symptoms and impact scores, will be assessed at 6 and 12 weeks post-randomization. We will also complete a parallel process evaluation, including estimations of the costs of delivering the interventions. An embedded recruitment trial will apply a stepped-wedge, cluster (class)-randomized controlled design in 70 classes across the six schools. This will evaluate the added effect of a classroom-based sensitization intervention over and above school-level sensitization activities on the primary outcome of referral rate into the host trial. Other outcomes will be the proportion of referrals eligible to participate in the host trial, proportion of self-generated referrals, and severity and pattern of symptoms among referred adolescents in each condition. Power calculations were undertaken separately for each trial. A detailed statistical analysis plan will be developed separately for each trial prior to unblinding. DISCUSSION Both trials were initiated on 20 August 2018. A single research protocol for both trials offers a resource-efficient methodology for testing the effectiveness of linked procedures to enhance uptake and outcomes of a school-based psychological intervention for common adolescent mental health problems. TRIAL REGISTRATION Both trials are registered prospectively with the National Institute of Health registry ( www.clinicaltrials.gov ), registration numbers NCT03633916 and NCT03630471 , registered on 16th August, 2018 and 14th August, 2018 respectively).
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Affiliation(s)
- Rachana Parikh
- Sangath, C-1/52, 1st Floor, Safdarjung Development Area, New Delhi, Delhi 110016 India
- Department of Clinical, Neuro and Developmental Psychology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, van der Boechorstraat 1, 1081 BT Amsterdam, The Netherlands
| | - Daniel Michelson
- School of Psychology, University of Sussex, Falmer, Brighton, BN1 9RH UK
| | - Kanika Malik
- Sangath, C-1/52, 1st Floor, Safdarjung Development Area, New Delhi, Delhi 110016 India
| | - Sachin Shinde
- Sangath, C-1/52, 1st Floor, Safdarjung Development Area, New Delhi, Delhi 110016 India
| | - Helen A. Weiss
- MRC Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - Adriaan Hoogendoorn
- Amsterdam UMC, Amsterdam Public Health research institute, Vrije Universitiet, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
- GGZ inGeest Specialized Mental Health Care, Oldenaller 1, 1081 HL Amsterdam, The Netherlands
| | - Jeroen Ruwaard
- Amsterdam UMC, Amsterdam Public Health research institute, Vrije Universitiet, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
- GGZ inGeest Specialized Mental Health Care, Oldenaller 1, 1081 HL Amsterdam, The Netherlands
| | - Madhuri Krishna
- Sangath, C-1/52, 1st Floor, Safdarjung Development Area, New Delhi, Delhi 110016 India
| | - Rhea Sharma
- Sangath, C-1/52, 1st Floor, Safdarjung Development Area, New Delhi, Delhi 110016 India
| | - Bhargav Bhat
- Sangath, C-1/52, 1st Floor, Safdarjung Development Area, New Delhi, Delhi 110016 India
| | - Rooplata Sahu
- Sangath, C-1/52, 1st Floor, Safdarjung Development Area, New Delhi, Delhi 110016 India
| | - Sonal Mathur
- Sangath, C-1/52, 1st Floor, Safdarjung Development Area, New Delhi, Delhi 110016 India
| | - Paulomi Sudhir
- Department of Clinical Psychology, National Institute of Mental Health and Neurosciences, Hosur Road, Bangalore, Karnataka 560029 India
| | - Michael King
- Division of Psychiatry, Faculty of Brain Sciences, University College London, Maple House, 149 Tottenham Court Rd, London, W1T 7NF UK
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, van der Boechorstraat 1, 1081, BT Amsterdam, The Netherlands
| | - Bruce F. Chorpita
- Department of Psychology, University of California, Los Angeles, 3227 Franz Hall, Los Angeles, CA 90095-1563 USA
| | | | - Vikram Patel
- Sangath, C-1/52, 1st Floor, Safdarjung Development Area, New Delhi, Delhi 110016 India
- Department of Global Health and Social Medicine, Harvard Medical School, 641, Huntington Avenue, Boston, MA 02115 USA
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Gonsalves PP, Hodgson ES, Kumar A, Aurora T, Chandak Y, Sharma R, Michelson D, Patel V. Design and Development of the " POD Adventures" Smartphone Game: A Blended Problem-Solving Intervention for Adolescent Mental Health in India. Front Public Health 2019; 7:238. [PMID: 31508404 PMCID: PMC6716539 DOI: 10.3389/fpubh.2019.00238] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 08/08/2019] [Indexed: 12/11/2022] Open
Abstract
Introduction: Digital technology platforms offer unparalleled opportunities to reach vulnerable adolescents at scale and overcome many barriers that exist around conventional service provision. This paper describes the design and development of POD Adventures, a blended problem-solving game-based intervention for adolescents with or at risk of anxiety, depression and conduct difficulties in India. This intervention was developed as part of the PRemIum for ADolEscents (PRIDE) research programme, which aims to establish a suite of transdiagnostic psychological interventions organized around a stepped care system in Indian secondary schools. Methods and Materials: Intervention development followed a person-centered approach consisting of four iterative activities: (i) review of recent context-specific evidence on mental health needs and preferences for the target population of school-going Indian adolescents, including a multiple stakeholder analysis of school counseling priorities and pilot studies of a brief problem-solving intervention; (ii) new focus group discussions with N = 46 student participants and N = 8 service providers; (iii) co-design workshops with N = 22 student participants and N = 8 service providers; and (iv) user-testing with N = 50 student participants. Participants were aged 12-17 years and recruited from local schools in New Delhi and Goa, including a subgroup with self-identified mental health needs (N = 6). Results: Formative data from existing primary sources, new focus groups and co-design workshops supported a blended format for delivering a brief problem-solving intervention, with counselors supporting use of a game-based app on "offline" smartphones. User-testing with prototypes identified a need for simplification of language, use of concrete examples of concepts and practice elements to enhance engagement. There were also indications that participants most valued relatability and interactivity within real-world stories with judicious support from an in-app guide. The final prototype comprised a set of interactive and gamified vignettes and a structured set of problem-solving questions to consolidate and generalize learning while encouraging real-world application. Discussion: Findings shaped the design of POD Adventures and its delivery as an open-access blended intervention for secondary school students with a felt need for psychological support, consistent with an early intervention paradigm. A randomized controlled trial is planned to evaluate processes and impacts of POD Adventures when delivered for help-seeking students in low-resource school settings.
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Affiliation(s)
| | | | | | | | | | | | - Daniel Michelson
- School of Psychology, University of Sussex, Brighton, United Kingdom
| | - Vikram Patel
- Sangath, New Delhi, India
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States
- Harvard TH Chan School of Public Health, Boston, MA, United States
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Parikh R, Michelson D, Sapru M, Sahu R, Singh A, Cuijpers P, Patel V. Priorities and preferences for school-based mental health services in India: a multi-stakeholder study with adolescents, parents, school staff, and mental health providers. Glob Ment Health (Camb) 2019; 6:e18. [PMID: 31531228 PMCID: PMC6737585 DOI: 10.1017/gmh.2019.16] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 05/31/2019] [Accepted: 07/10/2019] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Schools are important settings for increasing reach and uptake of adolescent mental health interventions. There is limited consensus on the focus and content of school-based mental health services (SBMHSs), particularly in low-resource settings. This study elicited the views of diverse stakeholders in two urban settings in India about their priorities and preferences for SBMHSs. METHODS We completed semi-structured interviews and focus group discussions with adolescents (n = 191), parents (n = 9), teachers (n = 78), school counsellors (n = 15), clinical psychologists/psychiatrists (n = 7) in two urban sites in India (Delhi and Goa). Qualitative data were obtained on prioritized outcomes, preferred content and delivery methods, and indicated barriers. RESULTS All stakeholders indicated the need for and acceptability of SBMHSs. Adolescents prioritized resolution of life problems and exhibited a preference for practical guidance. Parents and teachers emphasized functional outcomes and preferred to be involved in interventions. In contrast, adolescents' favored limited involvement from parents and teachers, was related to widespread concerns about confidentiality. Face-to-face counselling was deemed to be the most acceptable delivery format; self-help was less frequently endorsed but was relatively more acceptable if blended with guidance or delivered using digital technology. Structured sensitization was recommended to promote adolescent's engagement. Providers endorsed a stepped care approach to address different levels of mental health need among adolescents. CONCLUSION SBMHSs are desired by adolescents and adult stakeholders in this setting where few such services exist. Sensitization activities are required to support implementation. School counsellors have an important role in identifying and treating adolescents with different levels of mental health needs, and a suite of interventions is needed to target these needs effectively and efficiently.
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Affiliation(s)
- R. Parikh
- Sangath, C-1/52, 1st Floor, Safdarjung Development Area, New Delhi, Delhi, India
- Department of Clinical, Neuro and Developmental Psychology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, van der Boechorstraat 1, Amsterdam, The Netherlands
| | - D. Michelson
- School of Psychology, University of Sussex, Falmer, Brighton, UK
| | - M. Sapru
- Evalueserve.com Private Limited, Tower 6, 8th Floor, Candor Gurgaon One Realty Projects Pvt. Ltd., IT/ITES SEZ, Candor TechSpace, Tikri, Sector-48, Gurgaon, Haryana, India
| | - R. Sahu
- Sangath, C-1/52, 1st Floor, Safdarjung Development Area, New Delhi, Delhi, India
| | - A. Singh
- International Rescue Committee, No 69/54, Oat Tha Phaya Street, Kyaikkasan Quarter, Bahan Township, Yangon, Myanmar
| | - P. Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, van der Boechorstraat 1, Amsterdam, The Netherlands
| | - V. Patel
- Sangath, C-1/52, 1st Floor, Safdarjung Development Area, New Delhi, Delhi, India
- Department of Global Health and Social Medicine, Harvard Medical School, 641, Huntington Avenue, Boston, MA, USA
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