Digital delivery of Behavioural Activation to overcome depression and facilitate social and economic transitions of adolescents in South Africa

通过数字方式提供行为激活，以克服抑郁症并促进南非青少年的社会和经济转型

• 批准号: MC_PC_MR/S008748/1
• 负责人: Alan Stein
• 金额: $ 32.83万
• 依托单位: University of Oxford
• 依托单位国家: 英国
• 项目类别: Research Grant
• 财政年份: 2019
• 资助国家: 英国
• 起止时间: 2019 至 无数据
• 项目状态: 已结题
• 来源: https://gtr.ukri.org/projects?ref=MC_PC_MR%2FS008748%2F1
• 关键词: Digital; delivery; Behavioural; Activation; overcome

Depression affects 350 million in the world and will soon be the single greatest burden on health with the peak onset during adolescence. Adolescence is a key time period as social cognitions and executive function evolve dramatically affecting inter-personal functioning and risky behaviours such as unprotected sex (potentially leading to HIV infection and early pregnancy). It is also a time when adolescents have to negotiate a successful transition to productive adulthood and depression can impact on key life outcomes such as education, employment and physical health. Depression is also the most common cause of suicide; now recognized as major problem in South Africa. Effective treatments for depression in rural South Africa are not available largely due to a dearth of trained professionals. A psychological treatment for depression called Behavioural Activation (BA) has been shown to be as effective as Cognitive Behavioural Therapy (CBT) (the gold standard therapy for depression). BA targets behaviours rather than cognitive processes and attitudes, making it relatively easy to deliver, to adapt cross-culturally, and BA has now successfully been delivered remotely without face-to-face contact. Smartphones and tablet based treatments provide an opportunity to deliver evidence-based therapy to large numbers of individuals. We aim to develop a scalable digital platform using smartphones and tablets to deliver a culturally adapted version of BA. In the first project phase we will conduct interviews and focus group discussions with adolescents, caregivers, community and education stakeholders to develop a culturally relevant and age appropriate app-based intervention. The functionality, acceptability and usability of the app will be refined through an iterative process with adolescents and schools.In years 2-3 we will conduct a pilot randomized controlled trial of adolescents (n=200) to test the effectiveness of this platform in reducing depression in adolescents aged between 15 and 18 years. Adolescents will be screened in schools using the PHQ-9 and those diagnosed with mild to moderate depression will be recruited. Participants will either receive BA treatment via smart phones or active monitoring of mood also via smart phones (control group). All participants will be offered a low-end smartphone with limited airtime and accessibility or be guided to use tablets at school. The app-based BA intervention will comprise of 6 sessions over 10 weeks and will be supplemented by brief support phone calls. The control group will have their mood and psychological functioning monitored on 6 occasions. Appropriate help will be provided to those who present with risk. Assessments will take place at baseline, end of treatment (12 weeks after baseline) and 24 weeks after end of treatment.The primary outcome will be a reduction in adolescent depression and secondary outcomes include anxiety, risk taking behaviours and a range of economic and decision making measures.To test whether social cognition and executive function mediate the effects of BA, culturally adapted tests will be developed. We also aim to conduct exploratory statistical mediational analyses to test these potential mechanisms. The study will be nested within the Agincourt Health and Demographic Surveillance (HDSS) site in MRC/Wits Rural Public Health and Health Transitions Unit (Mpumalanga province) where we have started working closely with the Community Advisory Group to engage local stakeholders and the community who are strongly supportive of this initiative. Formative work will also take place in the Dikgale HDSS (Limpopo province). This pilot study will ultimately lead to the development of a full-scale treatment trial to support a better management of depression among adolescents living in South Africa. Tackling depression in this way is consistent with the aim of the Department of Health to strengthen primary care and community-based health care systems.

抑郁症影响着世界上3.5亿人，并将很快成为对健康的最大负担，发病高峰在青春期。青春期是一个关键时期，因为社会认知和执行功能的演变极大地影响到人际功能和危险行为，如无保护的性行为（可能导致艾滋病毒感染和早孕）。这也是青少年必须成功过渡到有生产力的成年人的时候，抑郁症可能会影响教育，就业和身体健康等关键的生活成果。抑郁症也是自杀的最常见原因;现在被认为是南非的主要问题。在南非农村，由于缺乏训练有素的专业人员，抑郁症的有效治疗方法无法获得。一种被称为行为激活（BA）的抑郁症心理治疗方法已被证明与认知行为疗法（CBT）（抑郁症的黄金标准疗法）一样有效。BA针对的是行为而不是认知过程和态度，这使得它相对容易提供，适应跨文化，BA现在已经成功地远程交付，而无需面对面的接触。基于智能手机和平板电脑的治疗提供了向大量个体提供循证治疗的机会。我们的目标是使用智能手机和平板电脑开发一个可扩展的数字平台，以提供适应文化的BA版本。在项目的第一阶段，我们将与青少年、照顾者、社区和教育利益相关者进行访谈和焦点小组讨论，以制定一项与文化相关、适合年龄的基于应用程序的干预措施。在第2-3年，我们将对青少年（n=200）进行一项试点随机对照试验，以测试该平台在减少15至18岁青少年抑郁症方面的有效性。学校将使用PHQ-9对青少年进行筛查，并招募那些被诊断患有轻度至中度抑郁症的青少年。参与者将通过智能手机接受BA治疗或通过智能手机主动监测情绪（对照组）。所有参与者都将获得一部通话时间有限的低端智能手机，或被引导在学校使用平板电脑。基于应用程序的BA干预将包括10周内的6次会议，并将通过简短的支持电话进行补充。对照组将在6个场合监测他们的情绪和心理功能。将为有风险的人提供适当的帮助。评估将在基线、治疗结束（基线后12周）和治疗结束后24周进行。主要结果将是青少年抑郁症的减少，次要结果包括焦虑、冒险行为和一系列经济和决策措施。为了测试社会认知和执行功能是否介导BA的影响，将开发文化适应性测试。我们还旨在进行探索性统计中介分析，以测试这些潜在的机制。该研究将嵌套在MRC/Wits农村公共卫生和卫生过渡部门（Mpumalanga省）的Agincourt健康和人口监测（HDSS）站点内，我们已开始与社区咨询小组密切合作，以吸引当地利益相关者和强烈支持该倡议的社区。还将在Dikgale HDSS（林波波省）开展形成性工作。这项试点研究将最终导致开发一个全面的治疗试验，以支持更好地管理生活在南非的青少年抑郁症。以这种方式处理抑郁症与卫生署加强基层医疗和社区医疗系统的目标一致。

项目成果

Digital delivery of behavioural activation therapy to overcome depression and facilitate social and economic transitions of adolescents in South Africa (the DoBAt study): protocol for a pilot randomised controlled trial.

• DOI: 10.1136/bmjopen-2022-065977
• 发表时间: 2022-12-30
• 期刊: BMJ open
• 影响因子: 2.9