Building resilience in adolescence - improving quality of life for adolescents with mental health problems in Colombia (BRiCs study)

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BackgroundDepression and anxiety are common mental health problems affecting one in four people at some point in their lives. The number of people who experience depression and anxiety greatly increases during adolescence, particularly for those who experience stressful events. This includes adolescents who live in Low and Middle Income Countries (LMICs). In fact, depression and anxiety are the top causes of disability for adolescents in LMICs. Despite the negative impact of depression and anxiety, a treatment gap exists. Less than half of people with depression and anxiety in LMICs access treatment. Even when people do get treatment, only a small proportion (20%) receive a minimum standard of care. This is often due to a lack of resources including enough specially trained staff and services to help people. Therefore, to improve health outcomes for adolescents with depression and anxiety, new approaches are needed. These new approaches need to be low-cost, effective and have the potential to be used by a range of staff. We aim to achieve this goal. ObjectivesThe overall aim is to improve health outcomes for adolescents with depression and anxiety in Colombia by adapting an existing effective intervention. To achieve this, we aim to: 1. Adapt an existing intervention to develop a new approach to treat depression and anxiety in adolescence. 2. Assess the acceptability and feasibility of the new intervention by testing it in two places in Colombia.3. Develop plans to help other services, regions and countries use the intervention (implementation plans).4. Involve adolescents in the research by setting up an interactive arts-based project. MethodsThe project is organised into four work packages (WPs). In WP1, we will ask people their opinions on an existing intervention (DIALOG+) in focus groups and interviews. We will ask 8 youth workers, mental health or education staff to use DIALOG+ with 24 adolescents with depression and anxiety. This qualitative information will help us "repurpose" the intervention so that it is suitable for adolescents. The new intervention will be called DIALOG-A. We will evaluate DIALOG-A in a randomised controlled trial (RCT) in WP2. The RCT will be conducted in two regions of Colombia - one deprived inner city area and one rural location. We will include 18 staff in mental health, education or youth work, and 90 adolescents. 12 staff and 60 adolescents will use DIALOG-A, and the remaining 6 staff and 30 adolescents will be in the control condition. To test whether DIALOG-A helps adolescents with depression and anxiety, we will ask participants to complete questionnaires at the start of the study and at 6 and 12 months. We will collect data on mental health outcomes, including symptoms of depression and anxiety, quality of life, social situation and self-esteem. To help other LMICs deliver DIALOG-A, we will ask staff and adolescents about their experiences, and what worked and did not work. This will help us develop implementation plans (WP3). Finally, we want to involve adolescents in our research. To do this, we will run an arts-based project, where we will ask young people with depression and anxiety to take photographs and films of their experience. We will hold exhibitions to display the photographs and the short-film made by the adolescents. We hope this will encourage other young people to get involved in research. Expected resultsIf successful, the project will develop a new intervention to improve the mental health of adolescents with depression and anxiety. This will improve their quality of life. The project will focus on two areas in Colombia. Yet, if the intervention is successful, it can be used elsewhere in Colombia, Latin America and worldwide, where young people face similar difficulties. Our communication methods will ensure the research is widely disseminated to improve the health of adolescents, especially those living in LMICs across the world.