Group interpersonal psychotherapy for depression and anxiety among adolescents in rural Nepal: a feasibility and pilot study

我们的研究旨在了解如何使群体人际心理治疗（IPT）干预对尼泊尔农村患有抑郁和焦虑的青少年具有相关性、可行性和可接受性。解决青春期的抑郁和焦虑是改善青少年健康的关键，因为这些疾病是这一年龄组残疾的两个主要原因。抑郁和焦虑也与自杀死亡率有关，并对健康、社会和经济产生长期负面影响。在尼泊尔，由于近期和历史创伤的复杂情况（2015年的两次大地震和1996-2006年的10年内战）以及社会经济剥夺的背景，青少年患抑郁症和焦虑症的风险很高。我们的研究将在Sindhupalchowk进行，Sindhupalchowk是尼泊尔受地震影响最严重的地区之一，许多年轻人失去了家人和朋友，失去了家园和学校。在全球范围内，儿童和青少年心理健康服务缺乏。在包括尼泊尔在内的低收入和中等收入国家尤其如此，因为这些国家的负担最重。世界卫生组织（世卫组织）心理健康差距行动规划概述了包括IPT在内的心理疗法在治疗抑郁症和焦虑症等儿童和青少年情绪障碍方面的作用，但很少有研究将这些疗法适用于低收入和中等收入国家的年轻人。我们的目标是调整和试点世卫组织群体IPT干预措施，该措施最初是为成人开发的。IPT是一种治疗抑郁症的心理疗法，也被证明对治疗焦虑有效。它侧重于解决与可能引发抑郁和焦虑的四个常见问题相关的困难：悲伤、人际纠纷、角色转换和人际隔离。IPT已被证明对青少年心理健康有益，与其他心理疗法相比，它可能更容易被青少年接受。它也由非专业人员在小组环境中提供，这是一个潜在的可扩展模式，适用于尼泊尔等资源匮乏的环境。我们的研究将包括初步的定性研究、IPT手册的翻译和专家主导的修订、实践培训、干预适应研讨会和社区咨询委员会，以及IPT试点小组。定性研究将包括与青少年、其父母/监护人、教师、社区卫生工作者和政府官员进行访谈和焦点小组讨论，以了解青少年如何经历抑郁和焦虑，他们如何寻求帮助以及干预的潜在障碍。根据定性研究结果，我们的尼泊尔和国际调查人员团队，包括精神病学家和心理学家，将根据尼泊尔青少年的文化和发展调整手册。我们将与经验丰富的咨询师进行实践培训，并要求辛杜帕尔乔克的一个社区咨询委员会提供反馈和投入，该委员会由青少年、他们的父母/监护人、一名教师和社区卫生工作者组成。在项目的最后阶段，我们将试点8个IPT小组。我们将试点以社区和学校为基础的团体，以便让在校和校外的青少年参与进来，并确定适当的团体促进者骨干，例如教师或社区保健志愿者。在整个干预过程中，我们将跟踪抑郁和焦虑的症状以及功能，以估计最佳治疗时间。干预后，我们将收集干预可接受性、依从性、质量和成本的数据。我们的研究将产生新的重要发现，这将有助于我们了解如何为中低收入国家的青少年提供心理干预，并使我们能够进行随机对照试验，以评估尼泊尔IPT干预的有效性和成本价值。

Our study seeks to understand how a group interpersonal psychotherapy (IPT) intervention can be made relevant, feasible and acceptable for adolescents with depression and anxiety in rural Nepal. Addressing depression and anxiety in adolescence is key to improving adolescent health since these disorders are two of the leading causes of disability in this age group. Depression and anxiety are also associated with mortality due to suicide, and have negative long-term health, social and economic effects. In Nepal, adolescents are at high risk of depression and anxiety, due to a complex picture of recent and historical trauma (two major earthquakes in 2015 and a 10-year civil war between 1996-2006) on a background of socio-economic deprivation. Our study will take place in Sindhupalchowk, one of the districts in Nepal that was most severely affected by the earthquakes and where many young people lost family and friends, as well as their homes and schools. Globally there is a lack of services for child and adolescent mental health. This is especially true in low-and middle-income countries (LMICs) including Nepal, where the burden is highest. The World Health Organization (WHO) Mental Health Gap Action Programme outlines a role for psychological therapies including IPT in the treatment of child and adolescent emotional disorders such as depression and anxiety, however few studies have adapted these for young people in LMICs. We aim to adapt and pilot the WHO group IPT intervention, which was originally developed for adults. IPT is a psychological therapy to treat depression, and has also been shown to be effective in treating anxiety. It focuses on addressing difficulties linked to four common problems that can trigger depression and anxiety: grief, interpersonal disputes, role transitions and interpersonal isolation. IPT has been shown to be beneficial for adolescent mental health and compared to other psychological therapies it may be more acceptable to adolescents. It has also been delivered by non-specialists in group settings, which is a potentially scalable model for low-resource settings such as Nepal. Our study will involve a preliminary qualitative study, translation and expert-led revision of the IPT manual, practice training, an intervention adaptation workshop and a community advisory board, and pilot IPT groups. The qualitative study will include interviews and focus group discussions with adolescents, their parents/guardians, teachers, community health workers and government officers to understand how adolescents experience depression and anxiety, how they seek help and potential barriers to intervention. Informed by the qualitative study findings, our team of Nepalese and international investigators, including psychiatrists and psychologists, will then culturally and developmentally adapt the manual for adolescents in Nepal. We will conduct practice training with experienced counsellors and ask for feedback and input from a community advisory board in Sindhupalchowk, comprising adolescents, their parents/guardians, a teacher and community health workers. In the final stage of the project, we will pilot eight IPT groups. We will pilot both community- and school-based groups in order to engage in-school and out-of-school adolescents and to identify a suitable cadre of group facilitators, such as teachers or community health volunteers. Throughout the intervention we will track symptoms of depression and anxiety, and functioning, in order to estimate optimal treatment duration. Post-intervention, we will collect data on intervention acceptability, adherence, quality and cost.Our study will generate new and important findings that will help us to understand how to deliver psychological interventions for adolescents in LMICs, and will enable us to conduct a randomised controlled trial to evaluate the effectiveness and cost value of an IPT intervention in Nepal.