Community-based psychological treatment for adolescents with anxiety and depression in India

焦虑和抑郁是常见的精神障碍，也是全球青少年患病和致残的两个主要原因。在印度，7%至12%的青少年患有焦虑和抑郁，但很少有人能够获得治疗，因为心理学家和精神科医生太少，获得精神卫生服务的机会也很少。我们知道心理治疗可以帮助减轻青少年的焦虑和抑郁症状。我们也知道，“非专业”工作者（即没有受过专门心理健康培训的人）可以在社区提供有效的心理治疗。然而，我们不知道如何在社区中识别患有焦虑和抑郁的青少年，在许多脆弱的青少年生活的农村和城市贫民窟的印度环境中，非专业人员可以使用哪些具体治疗方法，或者如何最好地为已经康复或有严重焦虑和抑郁症状的青少年组织转诊。在这个项目中，我们的目标是了解青少年、他们的家庭和当地卫生服务提供者如何看待青少年的焦虑和抑郁，确定在社区中筛查青少年焦虑和抑郁的工具，与青少年、他们的家庭和当地非专业工作者合作，采用现有的五种心理治疗方法中的一种，并开发转诊途径。最后，我们将对青少年进行为期9个月的试验，以确定以这种方式提供治疗是否可以接受和可行，并减少青少年的焦虑和抑郁症状。我们还将收集有关筛查、心理治疗和转诊费用的数据。我们将重点关注有轻度或中度焦虑和抑郁症状的青少年，并将症状较严重或有自杀念头的青少年转介到精神卫生服务机构。通过这个项目，我们希望极大地扩大治疗机会，帮助印度农村和城市中患有焦虑和抑郁的青少年。

Anxiety and depression are common mental disorders and two leading causes of illness and disability among adolescents globally.In India, between 7 and 12% of adolescents have anxiety and depression, but very few have access to treatment because there are too few psychologists and psychiatrists, and poor access to mental health services. We know that psychological treatments can help reduce symptoms of anxiety and depression in adolescents. We also know that 'non-specialist' workers (i.e. those with no specialised mental health training) can provide effective psychological treatments in the community. However, we not know how to identify adolescents with anxiety and depression in the community, which specific treatment could be used by non-specialists in rural and urban slum Indian settings, where many vulnerable adolescents live, or how best to organise referrals for adolescents who do recover or have severe symptoms of anxiety and depression.In this project, we aim to understand how adolescents, their families, and local health providers think about anxiety and depression in adolescents, identify tools to screen adolescents for anxiety and depression in the community, adapt one of five existing psychological treatments in partnership with adolescents, their families and local non-specialist workers, and develop referral pathways. Finally, we will pilot this adapted psychological treatment - as well as the screening tool and referrals - with adolescents over a period of nine months to find out if providing treatment in this way is acceptable, feasible, and leads to a reduction in symptoms of anxiety and depression in adolescents. We will also collect data on the costs of the screening, psychological treatment and referrals.We will focus on adolescents with mild or moderate symptoms of anxiety and depression, and refer those with more severe symptoms or suicidal thoughts to mental health services.Through this project, we hope to greatly expand access for treatment to help adolescents with anxiety and depression in rural and urban India.