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
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
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DOI：
10.1016/s2352-4642(20)30173-5
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发表时间：
2020-08-01
影响因子：
36.4
通讯作者：
Patel, Vikram
中科院分区：
文献类型：
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作者：
Michelson, Daniel;Malik, Kanika;Patel, Vikram
背景心理健康问题是世界范围内青少年残疾的主要原因。解决问题是一种在许多人群中经过充分测试的心理健康干预措施。我们的目的是调查一个简短的，transdiagnosis解决问题的干预措施，为常见的青少年心理健康问题时，由非专业学校辅导员在新德里，印度。方法这个随机试验是在6个政府开办的学校（三个全男校，两个全女校，一个男女同校），服务于低收入社区。我们招募了9至12年级（12-20岁）的参与者，选择心理健康症状持续升高并伴有痛苦或功能障碍的学生。临床合格性标准由研究助理使用印地语版本的优势和困难问卷（SDQ）进行评估，参考当地验证的SDQ总困难量表上男孩的临界临界值≥ 19分，女孩的临界值≥ 20分，SDQ影响量表上的异常评分≥ 2分，以及SDQ慢性指数持续超过1个月。参与者被随机分配（1：1）到通过简短（2-3周）辅导员引导的干预与支持印刷材料（干预组），或通过印刷小册子单独提供解决问题（对照组）。主要结果是第6周时报告的精神健康症状（SDQ总困难量表）和具体的心理社会问题（青年最大问题[YTP]）。在6周终点时，基于意向治疗进行主要分析。该试验在ClinicalTrials.gov注册，NCT 03630471。结果参与者于2018年8月20日至12月4日期间入组。283名符合条件的青少年被转介至试验，其中251名（89%）入组（平均年龄15.61岁; 174名[69%]男孩）。125名参与者被分配到每组（考虑到干预组中1名参与者在随机化后撤回知情同意书）。245名（98%）参与者的主要结局数据可用。第6周时，干预组的平均YTP评分为3.52（SD 2.66），对照组为4.60（2.75）（调整后的平均差异为-1.01，95%CI为-1.63至-0.38;调整后的效应量为0.36，95%CI为0.11至0.61; p=0.0015）。干预组和对照组的平均SDQ总难度评分分别为17.48（5.45）和18.33（5.45）（-0.86，-2.14至0.41; 0.16，-0.09至0.41; p=0.18）。我们没有观察到不良事件。解释一个简短的奠定辅导员提供的解决问题的干预与印刷的小册子相结合，似乎有一个温和的影响与不同的心理健康问题的青少年之间的心理社会结果相比，单独解决问题的小册子。这种咨询师提供的干预可能是一个合适的一线干预措施，在一个阶梯式护理方法，这是正在进行的研究进行评估。
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.