Safeguarding adolescent mental health in India: a co-designed feasibility study of a systems intervention targeting youth anxiety and depression.

良好的心理健康对一个人享受生活、建立人际关系和工作能力至关重要。焦虑和抑郁等心理健康问题很常见，有证据表明，这些问题往往始于青少年时期，并持续到成年。印度是世界上青少年人数最多的国家（2.43亿），其中许多人精神健康状况不佳。据估计，980万13-17岁的印度人有可诊断的心理健康问题，通常是焦虑和抑郁。在印度，人们普遍关注年轻人的心理健康，因为自杀是青少年死亡的主要原因。在印度，上学的年轻人心理健康状况不佳的风险更大，因为印度的学校文化给年轻人施加了极大的压力，并且普遍使用体罚。年轻人报告说，这些对他们的心理健康有严重影响。家庭或学校社区对心理健康的了解也很少，而且印度没有学校心理健康规划，尽管有证据表明这些规划可以保护和改善心理健康。迫切需要找到改善印度学校心理健康文化的解决办法，以保障印度青少年的心理健康。我们的项目名为SAMA（梵语中意为平等），旨在开发和测试以学校为基础的干预措施，为印度青少年提供照顾他们心理健康的信息和策略，并改善学校文化，以支持福祉。我们知道，当干预措施由将参与或受其影响的人设计时，干预措施是最有效的。因此，在SAMA的第一年，我们将与年轻人、家长、教师、学校领导、心理健康专业人员、政策制定者以及印度卫生和教育部门的代表共同设计干预措施。我们将以现有的国际证据和干预措施为基础。我们计划有四个干预：(1)帮助年轻人了解和管理自己的心理健康，特别是焦虑和抑郁；(2)帮助教师减少体罚行为，提高对青少年心理健康的认识；(3)改善学校心理健康氛围，减少心理健康污名化；(4)提高家长对青少年心理健康的认识，为青少年提供支持。我们将制定实施和评估这些干预措施的计划，密切关注对实施这些干预措施的人员的培训，以及如何为干预措施在学校的“软着陆”做准备，以增加成功的机会。在第二学年，我们将在班加罗尔招收八所中学。我们将测试这些干预措施在这些学校一起实施时的可行性和可接受性，并确定成本影响。在第三年，我们将与社区合作，了解我们需要做些什么来改进干预措施，以便我们可以进行试验，以确定干预措施是否有效。SAMA还将学习如何在印度卫生政策中更多地使用关于学校心理健康方案的证据。在整个SAMA中，倾听年轻人的声音将是核心。除了参与设计和评估干预措施外，其他年轻人将成为我们的青年顾问小组成员，还有一些年轻人将参与社区电影制作。电影将给局外人一个了解印度青少年心理健康和学校的内部视角。它们将与社交媒体和社区活动一起被用来提高人们的意识，并在印度学校内开展更好的精神卫生保健活动。我们的英印合作伙伴包括国家心理健康和神经科学研究所（班加罗尔）、Sangath（果阿邦的非政府组织）、圣雄甘地研究所（普都切里）以及利兹大学、布拉德福德大学、伯明翰大学和牛津大学。SAMA将加强中低收入国家学校心理健康研究的研究能力。

Good mental health is essential to one's enjoyment of life, ability to have relationships and capacity for work. Mental health conditions like anxiety and depression are common, and evidence shows that these often start during the teenage years and continue into adulthood. India has the largest number of adolescents in the world (243 million) and many experience poor mental health. It is estimated that 9.8 million Indian 13-17 year olds have a diagnosable mental health condition, often anxiety and depression. There is widespread concern in India about the mental health of young people as suicide is the leading cause of death among adolescents. Young people in India who attend school are at even greater risk of poor mental health as Indian school culture places extreme pressure on young people and there widespread use of corporal punishment. Young people report that these have serious effects on their mental health. There is also little understanding of mental health in families or school communities and there is no school mental health programme in India, even though evidence shows that these can protect and improve mental health. There is an urgent need to find solutions to improve the mental health culture of Indian schools in order to safeguard the mental health of Indian young people. Our project, called SAMA (meaning equal in Sanskrit) aims to develop and test school-based interventions to provide Indian adolescents with information and strategies to take care of their mental health and to improve school cultures to support well-being. We know that interventions are most effective when they are designed by the people who will be involved or affected by them. Therefore, in Year 1 of SAMA, we will co-design interventions with young people, parents, teachers, school leaders, mental health professional, policy makers and representatives from Indian health and education departments. We will build on international evidence and interventions where available. We plan to have four interventions that (1) help young people understand and manage their own mental health, especially anxiety and depression; (2) help teachers reduce their use of corporal punishment and improve their understanding of adolescent mental health; (3) improve the school climate for mental health and reduce mental health stigma; and (4) improve parents' understanding of adolescent mental health to support their young person. We will develop plans to implement and evaluate these interventions, with close attention to training people who deliver them and how to prepare an intervention's 'soft landing' in school to increase chances of success. In Year 2, we will recruit eight secondary schools in Bangalore. We will test how feasible and acceptable the interventions are when delivered together in these schools and identify the cost implications. In Year 3, we will work with the communities to learn about what we need to do to improve interventions so that we can build towards a trial to determine if the interventions are effective. SAMA will also learn how to increase the use of evidence on school mental health programmes in Indian health policy. Throughout SAMA, listening to young people will be central. As well as being involved in the design and evaluation of interventions, other young people will be on our Youth Advisory Panel and still others will be involved in community filmmaking. Films will give outsiders an insider view into adolescent mental health and school in India. They will be used, along social media and community events, to raise awareness and campaign for better mental health care within Indian schools. Our UK-India partnership includes the National Institute of Mental Health and Neuroscience (Bangalore), Sangath (NGO in Goa), Mahatma Gandhi Institute (Puducherry) and the Universities of Leeds, Bradford, Birmingham and Oxford. SAMA will strengthen research capacity for school mental health research in low-and-middle income countries.