Abstract
BackgroundMental illness is a leading cause of the disease burden among young people. Poor mental health is linked to childhood adversity such as gender inequality, poverty and low educational attainment. Psycho-social assets in adolescents can moderate these impacts and be strengthened. The aim of this study was to assess the effectiveness of a brief mental health and resilience intervention among disadvantaged young women in urban North India.MethodsWe used an uncontrolled repeated measures design to evaluate the effectiveness of the 15-module mental health and resilience curriculum among young women residing in a slum in Dehradun, Uttarakhand. Standardised psychometric assessments were done to assess outcomes of the intervention at three time-points: pre-intervention (T1), post-intervention (T2), and 8-months post-intervention (T3), covering domains of self-efficacy, resilience, anxiety, depression and gender attitudes.ResultsYoung women completing the intervention (n = 106) had all left school before 10th class. A statistically significant improvement in all psychometric measures was found at T2. These improvements were sustained at T3 in the areas of anxiety, depression and gender equality attitudes, while the measures of resilience and self-efficacy had declined to baseline.ConclusionsThis intervention delivered by community-based peers among highly disadvantaged young women can lead to sustained improvements in anxiety and depression and attitudes to gender equality. While other studies in LMIC have shown increased adolescent resilience through peer-led curriculums, this study demonstrates improvements in mental health and gender attitudes can endure 8-months post-intervention. This low-cost, brief intervention can improve mental health resiliency and self-efficacy among disadvantaged young people. Further research should explore how to bring sustained improvements in resilience.
Highlights
Mental illness is a leading cause of the disease burden among young people
This study evaluates a pilot implementation of the Nae Disha intervention using psycho-metric measures of anxiety, depression, self-efficacy, resilience and gender attitudes at baseline, end-line and follow-up among a group of highly disadvantaged young women living in an inner-city slum in North India
The Girls First youth resilience curriculum implemented in Bihar among young women attending government schools [12, 18] did not achieve improvements in anxiety and depression measures, and it may be that the presence of two modules focused on mental health in Nae Disha may have contributed to the improvements in depression (PHQ-9) and anxiety (GAD-7) achieved and sustained 8 months later, in this study
Summary
Mental illness is a leading cause of the disease burden among young people. Poor mental health is linked to childhood adversity such as gender inequality, poverty and low educational attainment. Mental distress is a leading cause of health-related burden for India’s young people [1], which is aggravated by a high prevalence of socio-economic adversity such as physical and sexual abuse, poverty, low education and gender inequality [1, 2]. India is one of the most gender unequal countries in the world [6], meaning Indian young women have multiple pathways to disadvantage that cumulatively and differentially impact wellbeing [7] In this part of the world they are likely to be economically and socially vulnerable with poorer health, education and livelihood outcomes compared to young men [7,8,9]. Young women are at greater risk of mental distress, which is related to hegemonic masculinity that values males and disadvantages females [8]
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