Expanding mental health counselling from primary care to reach at-risk youth (Expanding MINDS-Y).

确保罹患抑郁症和危险饮酒等常见精神障碍风险较高的青年（15-24岁）获得心理健康咨询，可以改善他们的情绪健康，防止受伤、感染艾滋病毒等传染病和患上非传染性疾病。与许多低收入和中等收入国家一样，南非面临着如何降低传染病和非传染性疾病的高流行率和影响的挑战，包括在服务有限的情况下减少精神障碍。解决青少年中常见的精神障碍问题对于预防这些未来的身体健康问题非常重要。然而，南南非的心理健康治疗差距很大，尤其是对青少年而言。未能覆盖15-24岁是一个主要的服务差距，因为这往往是常见精神障碍的发病年龄。服务规划人员认识到，他们需要扩大心理健康咨询的覆盖范围，将高危青年包括在内。然而，缺乏关于在何处设立心理健康咨询服务、谁应该提供这些服务以及如何安排服务以确保高危青年的可接受性和利用性的信息，阻碍了向这一关键人群扩大现有服务。向有风险青年提供心理健康咨询的工作也受到拖延，因为缺乏面向青年的、为有风险青年所接受并能有效改善其心理健康的咨询方案。这项研究的目的是通过提供有关青年对心理健康咨询服务的偏好的信息，调整面向成人的方案以满足青年的需求，从而解决这一知识差距；并测试招募年轻人的可行性以及这一心理健康咨询方案的初步结果。通过这项研究，我们希望获得信息，可以直接帮助健康规划者设计和发展对青年友好的心理健康咨询服务，并制定一个可行的、对青年友好的咨询方案，有望减少处于危险中的青年的抑郁和危险的酒精使用。鉴于南非和其他中低收入国家青年的疾病负担、治疗人群和危险行为特征之间的相似性，本研究的结果可能与其他中低收入国家的应用高度相关。这项研究将分为三个阶段。在第一阶段，我们将与服务提供者、风险青年及其照顾者进行深入访谈，以评估青年参与心理健康咨询的障碍，并确定青年对在何处以及如何提供服务的偏好（目标1）。这一阶段的研究结果将用于初步调整我们提出的方案，以解决这些障碍并确保可接受性。在目标2中，我们将在有风险青少年的焦点小组中展示这种经过调整的干预措施，以获得有关如何调整干预措施的内容、结构和布局以满足青少年需求的信息。在第三阶段，我们将测试招募有风险的青少年参加适应性干预的可行性，以及适应性干预对抑郁症和危险酒精使用的初步效果。我们将从贫困社区中招募100名有风险的青少年我们将随机分配他们接受干预或作为对照组。我们将在研究入组后三个月评估干预对抑郁和酒精使用的影响。一旦三个月的评估完成，对照组的参与者将被提供咨询干预。这一阶段的研究结果将用于初步评估干预的可行性和效果（目标3-4）。如果结果是有希望的，研究结果也将用于大型试验的设计，以评估这种干预措施的有效性和成本效益。

Ensuring youth (aged 15-24) who are at high risk for common mental disorders like depression and hazardous alcohol use have access to mental health counselling could improve their emotional well-being and prevent injuries, the acquisition of communicable diseases such as HIV, and the onset of non-communicable diseases (NCDs). Like many low- and middle-income countries (LMICs), South Africa (SA) faces the challenge of how to reduce the high prevalence and impact of communicable diseases and NCDs, including mental disorders where limited services are available. Common mental disorders among youth are important to address to prevent these future physical health problems. Yet, the mental health treatment gap in SA is large, particularly for youth. Failure to reach 15-24 year olds is a major service gap as this is often the age of onset for common mental disorders. Service planners recognise that they need to expand the coverage of mental health counselling to include at-risk youth. However, a lack of information about where to situate mental health counselling services, who should be delivering these services, and how to format services to ensure acceptability to and utilisation by at-risk youth has hampered the expansion of available services to this key population. The expansion of mental health counselling to at-risk youth also has been delayed by a lack of youth-oriented counselling programmes that are acceptable to and effective for improving the mental health of at-risk youth. The goal of this study is to address this knowledge gap by providing information on youth preferences for mental health counselling services, adapting an adult-oriented programme to meet the needs of youth; and testing the feasibility of recruiting youth and initial outcomes of this adapted counselling programme on mental health outcomes. Through this study, we hope to obtain information that can be directly useful to health planners for the design and development of youth-friendly mental health counselling services and have a feasible, youth-friendly counselling programme that shows promise for reducing both depression and hazardous alcohol use among at-risk youth. Findings from this study are likely to be highly relevant for use in other LMICs given similarities between the burden of disease, treatment populations, and profile of risk behaviours among youth in SA and other LMICs.The study will comprise three phases. In the first phase, we will conduct in-depth interviews with service providers, at-risk youth, and their caregivers to assess barriers to youth participation in mental health counselling and to identify youth preferences for where and how services should be delivered (Aim 1). Findings from this phase will be used to initially adapt our proposed programme to address these barriers and ensure acceptability. In Aim 2, we will demonstrate this adapted intervention in focus groups with at-risk youth in order to obtain information on how the intervention content, structure and layout should be adapted to meet the needs of youth. In Phase 3, we will test the feasibility of recruiting at risk youth to participate in the adapted intervention and the initial effect of the adapted intervention on depression and hazardous alcohol use. We will recruit 100 at-risk youth from impoverished community settings and we will randomize them to receive the intervention or be in a control group. We will assess the effect of the intervention on depression and alcohol use three months after study enrolment. Once the three month assessment has been completed, participants in the control group will be offered the counselling intervention. Findings from this phase will be used to initially evaluate the feasibility and effect of the intervention (Aims 3-4). If the outcomes are promising, findings will also be used to inform the design of a large trial to assess the effectiveness and cost-effectiveness of this intervention.