Abstract
BackgroundThe 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. MethodContextual 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. ResultsThe 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. DiscussionFindings 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.
Highlights
Turning to children and adolescents, a recent meta-analysis found that self-help was only slightly less effective than face-to-face psychotherapy for common mental health problems, with a magnitude of difference that may not be of clinical significance (Bennett, Cuijpers, Ebert, McKenzie Smith, Coughtrey et al, 2019)
Selfhep may offer a good fit with adolescents' drive towards independence (Rickwood & Bradford, 2012)
More narrowly defined age and clinical criteria, assessed by brief standardised tools: (i) enrolled in grades 9–12; (ii) proficient in written/spoken Hindi; (iii) referral was not primarily for a learning difficulty; and (iv) clinically elevated presentation indicated by Youth Top Problems (YTP) item score ≥6 or Strengths and Difficulties Questionnaire (SDQ) Impact score ≥2
Summary
Around 10% of adolescents aged 10–19 years have a clinically diagnosable mental disorder, with anxiety, depression and conduct difficulties together accounting for over 75% of the total mental health burden in this age group (Erskine et al, 2015). If untreated, these common mental health presentations can exert serious detrimental effects on young people's developmental progress, family life and educational achievement, with long-term implications for poor health, social exclusion and lower economic activity in adulthood (St John, Leon, & McCulloch, 2005).
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