J Am Acad Child Adolesc Psychiatry. 2024 Jun 3:S0890-8567(24)00309-5. doi: 10.1016/j.jaac.2024.04.015. Online ahead of print.
ABSTRACT
OBJECTIVE: Mental health problems are prevalent among African adolescents, but professional treatment capacity is limited. Shamiri, an efficient lay-provider-delivered intervention, has significantly reduced depression and anxiety symptoms in previous RCTs. We investigated effects of the full Shamiri intervention and its components (growth-only, gratitude-only, and values-only), against a study-skills control.
METHOD: In a five-group RCT with adolescents from Kenyan high-schools, anxiety, depression, and wellbeing were self-reported through eight-month follow-up. The RCT occurred immediately after an unanticipated government-mandated COVID shutdown forced three years of schoolwork into two, escalating academic pressures.
RESULTS: Participants (N=1,252; 48.72% female) were allocated to: growth (n=249), gratitude (n=237), values (n=265), Shamiri (n=250), and study-skills (n=251). Longitudinal multilevel models showed that, across all conditions, anxiety scores significantly improved at midpoint (B=-0.847), endpoint (B=-2.948), one-month (B=-1.587), three-month (B=-2.374), and eight-month (B=-1.917) follow-ups. Depression scores also improved significantly at midpoint (B=-0.796), endpoint (B=-3.126), one-month (B=-2.382), three-month (B=-2.521), and eight-month (B=-2.237) follow-ups. Wellbeing scores improved significantly at midpoint (B=1.73), endpoint (B=3.44), one-month (B=2.21), three-month (B=1.78), and eight-month (B=1.59) follow-ups. Symptom-reduction with Shamiri matched that of pre-COVID trials, but symptom-reduction with study-skills far outpaced that of trials before the COVID-related school shutdown (31% greater anxiety reduction and 60% greater depression reduction). Thus, in contrast to previous RCTs, this COVID-era trial showed no significant differences between outcomes in any intervention and active control groups.
CONCLUSION: Our RCT conducted during a post-COVID period of heightened academic pressure produced unexpected results. Improvements in youth-reported anxiety and depression were consistent with previous trials for Shamiri, but markedly larger than in previous trials for study-skills. “Control interventions” teaching life-skills may produce mental health benefits when they convey skills of particular contextual relevance.
PMID:38851382 | DOI:10.1016/j.jaac.2024.04.015
