Adaptation and Feasibility assessment of a primary suicide prevention intervention for school adolescents in Nigeria

自杀是全世界青少年死亡的第二大原因。尽管自杀是可以预防的，但79%的自杀发生在低收入和中等收入国家，这些国家缺乏资源和人员来帮助有需要的人。世界卫生组织（世卫组织）最近的一份出版物表明，尼日利亚是世界上自杀率最高的国家之一，估计每10万人中有15人以上。在许多低收入国家，在自杀行为发生前提供初级预防干预是首选战略。它们大多具有成本效益，可以提供给所有青少年，不需要筛查。最重要的是，由于精神疾病是自杀行为的主要风险因素，50%的受影响人士在14岁之前发展，因此在这个关键的发展时期提供初级预防干预至关重要。青少年自杀的基层预防计划，往往集中于培养社交技巧、减少污名化、提高自杀意识、寻求帮助和精神健康知识。学校在减少自杀行为发生前的风险因素和促进保护因素方面尤为重要，这有可能降低青少年自杀率。在扩大到校外青少年之前，学校也是测试预防干预措施在特定文化和环境中的有效性的理想场所。在许多低收入和中等收入国家，使用西方文化中已证明有效的干预措施可以节省与从头开始生成证据相关的人力和财力资源。然而，规范、资源和交付结构与原始环境的差异有时使这种外来干预无效，甚至有害。由于条件、文化、人员可用性和医疗保健实践的中介和背景因素存在差异，因此有必要确保此类循证干预的适当性、可行性和可接受性。在本研究中，我们希望了解以下内容（1）。这种针对青少年自杀的干预措施在欧洲已经发展并证明有效，是否可以在文化上适应尼日利亚的学校系统？（二）、当地利益攸关方（学生、家长、学校工作人员）是否能接受经过调整的干预措施？（三）、干预措施是否具有临床效果和成本效益（4）在尼日利亚中学适应、提供和实施干预措施的可能挑战、障碍和促进因素;本研究中评估的干预措施是“青年心理健康意识”，这是一项向所有在校青少年提供的普遍预防干预措施。YAM的相关性和适合LMICs的学校青少年人口和最近的证据表明，其上级的临床和成本效益与其他自杀预防干预措施相比，在欧洲，使其成为一个理想的选择自杀预防在LMICs.Through一系列的定性和定量的方法，我们将调整干预尼日利亚的学校环境。我们还将评估尼日利亚学校干预的临床和成本效益。我们期望证明适应性干预可以提供可行性，为利益相关者所接受，并显示临床和成本效益的证据。我们设想我们的研究将产生一个有效的，文化上可接受的，可扩展的干预工具包，将减少青少年自杀行为的发生率，增加心理健康知识和寻求帮助，并改善自尊，同情和课堂气氛

Suicide is the second leading cause of death for adolescents worldwide. Although suicide is preventable, 79% of suicides occurred in low- and middle-income countries (LMICs) where resources and personnel to help those in need are scarce. A recent World Health Organization (WHO) publication have suggested that Nigeria have one of the highest rates of suicide in the world with estimated > 15 per 100,000 population. Primary prevention interventions delivered before the onset of suicidal behaviours are the preferred strategy in many LMICs. They are mostly cost effective, can be delivered to all youths, and do not require screening. Most importantly, since mental illnesses which are the major risk factors for suicidal behaviours develop in 50% of affected individuals before the age of 14 years, the delivery of primary prevention intervention at this critical development period is of paramount importance. The primary prevention programme for adolescent suicide often focused on social skill-building, reducing stigma, and increasing suicide awareness, help-seeking, and mental health knowledgeSchools are particularly important in addressing the reduction of risk factors and promotion of protective factors prior to the onset of suicidal behaviours which have the potential to reduce adolescent suicide rate. Schools are also ideal for testing the effectiveness of preventive interventions in a particular culture and environment before scaling up to out-of-school adolescents. In many low and middle income countries, using interventions with proven effectiveness in the western culture can save human and financial resources associated with generating evidence from the scratch. However, the differences in the norms, resources and delivery structure to the original context sometimes render such imported intervention ineffective or even harmful. It is necessary to ensure the appropriateness, feasibility and acceptability of such evidence based intervention due to differences in the mediating and contextual factors for the condition, culture, availability of personnel and health care practices. In this study, we wish to find out the following(1). If such intervention for adolescent suicide , developed and with proven effectiveness in Europe, can be culturally adapted to the context of the school systems of Nigeria ?; (2). If the adapted intervention will be acceptable to the local stakeholders (the pupils, their parents, the school personnel)?(3). If the intervention will be clinically and cost effective (4) The possible challenges, barriers and facilitators to the adaptation, delivery and implementation of the intervention in secondary schools in Nigeria?; The intervention to be evaluated in this study is the "Youth Aware of Mental health" (YAM) which is a universal preventive intervention delivered to all school adolescents. YAM's relevance and fit to the LMICs' school adolescent population and recent evidence of its superior clinical and cost-effectiveness compared with other suicide prevention interventions in Europe make it an ideal choice for suicide prevention in LMICs.Through a series of qualitative and quantitative methods, we will adapt the intervention to the Nigerian school context. We will also evaluate the clinical and cost effectiveness of the intervention in Nigerian schools . We expect to demonstrate that the adapted intervention can be feasibility delivered, acceptable to the stakeholders and show evidence of clinical and cost effectivenessWe envisage that our study will produce an effective, culturally acceptable, and scalable intervention toolkit that will reduce the incidence of adolescent suicidal behaviors, increase mental health knowledge and help-seeking a and improve self-esteem, empathy and classroom climate