Abstract
BackgroundTreatments for youth mental disorders are a public health priority, especially in sub-Saharan Africa (SSA), where treatment options remain limited due to high cost, elevated stigma, and lack of trained mental health professionals. Brief, accessible, and non-stigmatizing community-based interventions delivered by lay providers may help address treatment needs in SSA. One such intervention, the Shamiri Intervention, consisting of three elements (growth mindset, gratitude, and value affirmation) has been tested in randomized controlled trials with school-going Kenyan adolescents. This three-element Shamiri Intervention has been shown to significantly reduce depression and anxiety symptoms and improve social support and academic performance relative to a control group. In this trial, we aim to investigate the effects of each element of the Shamiri Intervention.MethodsIn this five-arm randomized controlled trial, we will test each of the intervention components (growth mindset, gratitude, and value affirmation) against the full Shamiri Intervention and against a study skills control intervention. Students (Nplanned = 1288) at participating secondary schools who are interested in participating in this universal intervention will be randomized in equal numbers into the five groups. The students will meet in groups of 8–15 students led by local high school graduate lay providers. These lay providers will receive a brief training, plus expert supervision once a week throughout the intervention delivery. Multi-level models will be used to compare trajectories over time of the primary outcomes (depressive symptoms, anxiety symptoms, academic performance, and wellness) and secondary outcomes in each intervention group to the control group. Multi-level models will also be used to compare trajectories over time of the primary outcomes (depressive symptoms, anxiety symptoms, academic performance, and wellness) and secondary outcomes of participants in the single-element interventions compared to the full Shamiri Intervention. Finally, effect sizes (calculated as mean gain scores) will be used to compare all groups on all measures.DiscussionThis trial will shed light on the mechanisms and outcomes targeted by each individual intervention, helping prioritize which mental health interventions are most important to disseminate.Trial registrationPACTR Trial ID: PACTR202104716135752. Approved on 4/19/2021.
Highlights
Background and rationale {6a} Many epidemiological studies have shown that common mental health problems are prevalent among adolescents aged 13-to-19 in low-income regions of Sub-Saharan Africa [1,2,3]
In a well-powered replication (N = 413) [21], we found that youths assigned to the Shamiri intervention reported significantly greater improvement in depression and anxiety symptoms than youth in the control group
We described the design of a comparative effectiveness randomized controlled trial designed to evaluate four school-based mental health promotion interventions delivered by lay counselors
Summary
Background and rationale {6a} Many epidemiological studies have shown that common mental health problems are prevalent among adolescents aged 13-to-19 in low-income regions of Sub-Saharan Africa [1,2,3] These youths often cannot access treatment because of barriers such as societal stigma [4], lack of culturally appropriate treatment options [5], the length and cost of traditional treatments [6,7,8], and a paucity of trained mental health care providers [9]. Accessible, and non-stigmatizing community-based interventions delivered by lay providers may help address treatment needs in SSA One such intervention, the Shamiri Intervention, consisting of three elements (growth mindset, gratitude, and value affirmation) has been tested in randomized controlled trials with schoolgoing Kenyan adolescents. We aim to investigate the effects of each element of the Shamiri Intervention
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