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

抑郁和焦虑是常见的心理健康问题，影响着四分之一的人在他们生命中的某个阶段。经历抑郁和焦虑的人数在青春期大大增加，尤其是那些经历过压力事件的人。这包括生活在低收入和中等收入国家的青少年。事实上，抑郁和焦虑是中低收入国家青少年致残的主要原因。尽管抑郁和焦虑有负面影响，但治疗差距仍然存在。中低收入国家中只有不到一半的抑郁症和焦虑症患者获得治疗。即使人们得到了治疗，也只有一小部分人（20%）得到了最低标准的护理。这通常是由于缺乏资源，包括缺乏足够的受过专门训练的工作人员和服务来帮助人们。因此，为了改善患有抑郁和焦虑的青少年的健康结果，需要新的方法。这些新办法必须低成本、有效，并有可能被各种工作人员使用。我们致力于实现这一目标。总体目标是通过调整现有的有效干预措施，改善哥伦比亚患有抑郁症和焦虑症的青少年的健康状况。为实现这一目标，我们的目标是：调整现有的干预措施，开发一种新的方法来治疗青少年的抑郁和焦虑。2. 通过在哥伦比亚的两个地方进行测试来评估新干预措施的可接受性和可行性。制定计划，帮助其他服务、地区和国家使用干预措施（实施计划）。透过建立互动艺术项目，让青少年参与研究。方法将该项目分为四个工作包。在WP1中，我们将在焦点小组和访谈中询问人们对现有干预措施（DIALOG+）的意见。我们将要求8名青年工作者、心理健康或教育人员对24名患有抑郁和焦虑的青少年使用DIALOG+。这些定性信息将帮助我们“重新定位”干预措施，使其适合青少年。新的干预措施将被称为DIALOG-A。我们将在WP2患者的一项随机对照试验（RCT）中评估DIALOG-A。这项随机对照试验将在哥伦比亚的两个地区进行，一个是贫困的内城地区，另一个是农村地区。我们将包括18名从事精神卫生、教育或青年工作的工作人员和90名青少年。12名工作人员和60名青少年将使用DIALOG-A，其余6名工作人员和30名青少年将处于对照状态。为了测试DIALOG-A是否能帮助患有抑郁和焦虑的青少年，我们将要求参与者在研究开始时、6个月和12个月时完成问卷调查。我们将收集有关心理健康结果的数据，包括抑郁和焦虑症状、生活质量、社会状况和自尊。为了帮助其他中低收入国家开展对话- a，我们将询问工作人员和青少年的经历，以及哪些有效，哪些无效。这将有助于我们制定实施计划（WP3）。最后，我们想让青少年参与我们的研究。为此，我们将开展一个以艺术为基础的项目，我们将邀请患有抑郁症和焦虑症的年轻人拍摄他们的经历的照片和电影。我们将举办展览，展示青少年的摄影作品和短片。我们希望这将鼓励其他年轻人参与研究。预期结果如果成功，该项目将开发一种新的干预措施，以改善患有抑郁和焦虑的青少年的心理健康。这将提高他们的生活质量。该项目将重点关注哥伦比亚的两个地区。然而，如果干预措施取得成功，它可以在哥伦比亚、拉丁美洲和全世界的其他地方使用，那里的年轻人面临着类似的困难。我们的沟通方法将确保研究得到广泛传播，以改善青少年的健康，特别是那些生活在世界各地的中低收入国家的青少年。

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.