Adaptation and Feasibility assessment of a primary suicide prevention intervention for school adolescents in Nigeria

自杀是全世界青少年死亡的第二大原因。虽然自杀是可以预防的，但79%的自杀发生在低收入和中等收入国家(LMIC)，那里帮助有需要的人的资源和人员稀缺。世界卫生组织(WHO)最近的一份出版物显示，尼日利亚是世界上自杀率最高的国家之一，估计每10万人中有15人自杀。在自杀行为发生之前提供的初级预防干预措施是许多LMIC的首选战略。它们大多具有成本效益，可以提供给所有年轻人，而且不需要筛查。最重要的是，由于精神疾病是自杀行为的主要危险因素，50%的受影响个人在14岁之前发病，因此在这一关键发展时期提供初级预防干预措施至关重要。青少年自杀的初级预防方案往往侧重于社会技能建设、减少耻辱、提高自杀意识、寻求帮助和心理健康知识，而学校在处理自杀行为发生之前减少风险因素和促进保护因素方面尤为重要，因为自杀行为有可能降低青少年自杀率。学校也是在扩大到失学青少年之前在特定文化和环境中测试预防干预措施有效性的理想场所。在许多低收入和中等收入国家，使用在西方文化中被证明有效的干预措施可以节省与从头开始产生证据相关的人力和财力资源。然而，在规范、资源和交付结构方面与原来的情况不同，有时使这种外来干预无效，甚至有害。有必要确保这种以证据为基础的干预措施的适当性、可行性和可接受性，因为条件、文化、人员可获得性和卫生保健做法的调解和背景因素不同。在这项研究中，我们希望发现以下几点：(1)如果这种针对青少年自杀的干预措施在欧洲已经开发并已被证明有效，是否能够在文化上适应尼日利亚学校系统的背景？当地的利益相关者(学生、家长、学校工作人员)是否能接受适应的干预措施？干预措施是否具有临床和成本效益(4)在尼日利亚中学适应、实施和实施干预措施可能面临的挑战、障碍和促进者？本研究将评估的干预措施是“青年心理健康意识”(YAM)，这是一种向所有在校青少年提供的普遍预防干预措施。YAM与LMICs学校青少年人口的相关性和适合性，以及最近的证据表明，与欧洲其他自杀预防干预措施相比，其临床和成本效益更高，使其成为LMICs自杀预防的理想选择。通过一系列定性和定量的方法，我们将使干预措施适应尼日利亚学校的情况。我们还将评估尼日利亚学校干预措施的临床和成本效益。我们期望证明，适应性干预是可行的，利益相关者可以接受，并显示出临床和成本效益的证据。我们预计，我们的研究将产生一个有效的、文化上可以接受的、可扩展的干预工具包，它将减少青少年自杀行为的发生率，增加心理健康知识和求助，并改善自尊、同理心和课堂气氛。

Suicide is the second leading cause of death for adolescents worldwide. Although suicide is preventable, 79% of suicides occurred in low- and middle-income countries (LMICs) where resources and personnel to help those in need are scarce. A recent World Health Organization (WHO) publication have suggested that Nigeria have one of the highest rates of suicide in the world with estimated > 15 per 100,000 population. Primary prevention interventions delivered before the onset of suicidal behaviours are the preferred strategy in many LMICs. They are mostly cost effective, can be delivered to all youths, and do not require screening. Most importantly, since mental illnesses which are the major risk factors for suicidal behaviours develop in 50% of affected individuals before the age of 14 years, the delivery of primary prevention intervention at this critical development period is of paramount importance. The primary prevention programme for adolescent suicide often focused on social skill-building, reducing stigma, and increasing suicide awareness, help-seeking, and mental health knowledgeSchools are particularly important in addressing the reduction of risk factors and promotion of protective factors prior to the onset of suicidal behaviours which have the potential to reduce adolescent suicide rate. Schools are also ideal for testing the effectiveness of preventive interventions in a particular culture and environment before scaling up to out-of-school adolescents. In many low and middle income countries, using interventions with proven effectiveness in the western culture can save human and financial resources associated with generating evidence from the scratch. However, the differences in the norms, resources and delivery structure to the original context sometimes render such imported intervention ineffective or even harmful. It is necessary to ensure the appropriateness, feasibility and acceptability of such evidence based intervention due to differences in the mediating and contextual factors for the condition, culture, availability of personnel and health care practices. In this study, we wish to find out the following(1). If such intervention for adolescent suicide , developed and with proven effectiveness in Europe, can be culturally adapted to the context of the school systems of Nigeria ?; (2). If the adapted intervention will be acceptable to the local stakeholders (the pupils, their parents, the school personnel)?(3). If the intervention will be clinically and cost effective (4) The possible challenges, barriers and facilitators to the adaptation, delivery and implementation of the intervention in secondary schools in Nigeria?; The intervention to be evaluated in this study is the "Youth Aware of Mental health" (YAM) which is a universal preventive intervention delivered to all school adolescents. YAM's relevance and fit to the LMICs' school adolescent population and recent evidence of its superior clinical and cost-effectiveness compared with other suicide prevention interventions in Europe make it an ideal choice for suicide prevention in LMICs.Through a series of qualitative and quantitative methods, we will adapt the intervention to the Nigerian school context. We will also evaluate the clinical and cost effectiveness of the intervention in Nigerian schools . We expect to demonstrate that the adapted intervention can be feasibility delivered, acceptable to the stakeholders and show evidence of clinical and cost effectivenessWe envisage that our study will produce an effective, culturally acceptable, and scalable intervention toolkit that will reduce the incidence of adolescent suicidal behaviors, increase mental health knowledge and help-seeking a and improve self-esteem, empathy and classroom climate