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Abstract：
BACKGROUND: Emotional problems in adolescents living in low-income and middle-income countries (LMICs) remain largely unaddressed; key reasons include a scarcity of trained mental health professionals and unavailability of evidence-based, scalable psychological interventions. We aimed to evaluate the effectiveness of a non-specialist-delivered, group psychological intervention to reduce psychosocial distress in school-going adolescents in Pakistan.
METHODS: In a two-arm, single-blind, cluster randomised controlled trial, eligible public school clusters from a rural subdistrict of Gujar Khan, Rawalpindi, Pakistan, were randomised (1:1, stratified by sex) using permuted block randomisation into intervention (n=20) and wait-list control (n=20) groups. Adolescents aged 13-15 years who provided informed assent and caregivers\' consent were screened for psychosocial distress using the youth-reported Pediatric Symptoms Checklist (PSC; total psychosocial distress scores from 0 to 70), and those scoring 28 or more and their caregivers were enrolled into the trial. Adolescents in the intervention group received seven weekly group sessions and their caregivers received three biweekly group sessions in school settings from trained non-specialists. The primary outcome was change from baseline in the total PSC scores at 3 months post-intervention. The trial was registered prospectively with the International Standard Randomised Controlled Trial Number registry, ISRCTN17755448.
RESULTS: From the 40 school clusters that were included, 282 adolescents in the intervention group and 284 adolescents in the wait-list control group were enrolled between Nov 2 and Nov 30, 2021. At 3 months, adolescents in the intervention group had significantly lower mean total score on the PSC compared with adolescents in the control group (mean difference in change from baseline 3·48 [95% CI 1·66-5·29], p=0·0002, effect size 0·38 [95% CI 0·18-0·57]; adjusted mean difference 3·26 (95% CI 1·46-5·06], p=0·0004, effect size 0·35 (0·16-0·55). No adverse events were reported in either group.
CONCLUSIONS: The group psychological intervention most likely represents a feasible and effective option for adolescents with psychosocial distress in school settings.
BACKGROUND: UK Medical Research Council, Foreign Commonwealth and Development Office, Department of Health and Social Care.
UNASSIGNED: For the Urdu translation of the abstract see Supplementary Materials section.
METHODS: In a two-arm, single-blind, cluster randomised controlled trial, eligible public school clusters from a rural subdistrict of Gujar Khan, Rawalpindi, Pakistan, were randomised (1:1, stratified by sex) using permuted block randomisation into intervention (n=20) and wait-list control (n=20) groups. Adolescents aged 13-15 years who provided informed assent and caregivers\' consent were screened for psychosocial distress using the youth-reported Pediatric Symptoms Checklist (PSC; total psychosocial distress scores from 0 to 70), and those scoring 28 or more and their caregivers were enrolled into the trial. Adolescents in the intervention group received seven weekly group sessions and their caregivers received three biweekly group sessions in school settings from trained non-specialists. The primary outcome was change from baseline in the total PSC scores at 3 months post-intervention. The trial was registered prospectively with the International Standard Randomised Controlled Trial Number registry, ISRCTN17755448.
RESULTS: From the 40 school clusters that were included, 282 adolescents in the intervention group and 284 adolescents in the wait-list control group were enrolled between Nov 2 and Nov 30, 2021. At 3 months, adolescents in the intervention group had significantly lower mean total score on the PSC compared with adolescents in the control group (mean difference in change from baseline 3·48 [95% CI 1·66-5·29], p=0·0002, effect size 0·38 [95% CI 0·18-0·57]; adjusted mean difference 3·26 (95% CI 1·46-5·06], p=0·0004, effect size 0·35 (0·16-0·55). No adverse events were reported in either group.
CONCLUSIONS: The group psychological intervention most likely represents a feasible and effective option for adolescents with psychosocial distress in school settings.
BACKGROUND: UK Medical Research Council, Foreign Commonwealth and Development Office, Department of Health and Social Care.
UNASSIGNED: For the Urdu translation of the abstract see Supplementary Materials section.
摘要：
背景：生活在低收入和中等收入国家（LMICs）的青少年的情绪问题在很大程度上仍未得到解决；关键原因包括缺乏训练有素的心理健康专业人员和缺乏循证证据，可扩展的心理干预。我们的目标是评估非专业人员交付的有效性，团体心理干预，以减少巴基斯坦在校青少年的社会心理困扰。
方法：在双臂中，单盲,集群随机对照试验，来自GujarKhan农村街道的合格公立学校群，拉瓦尔品第,巴基斯坦,采用置换区组随机化方法(1:1,按性别分层)分为干预组(n=20)和等待列表对照组(n=20)。使用青少年报告的儿科症状清单（PSC；心理社会困扰总评分从0到70），对13-15岁提供知情同意和照顾者同意的青少年进行心理社会困扰筛查，而那些评分为28分或以上的患者及其看护者被纳入试验.干预组的青少年每周接受7次小组会议，其护理人员在学校环境中接受了3次双周小组会议。主要结果是干预后3个月的总PSC评分相对于基线的变化。该试验在国际标准随机对照试验编号登记处进行了前瞻性登记，ISRCTN17755448。
结果：从包括的40个学校集群中，在2021年11月2日至11月30日之间，干预组的282名青少年和等待名单对照组的284名青少年被纳入。3个月时,与对照组的青少年相比，干预组的青少年的PSC平均总分显着降低（与基线的平均差异为3·48[95％CI1·66-5·29]，p=0·0002，效应大小0·38[95%CI0·18-0·57]；调整后平均差3·26(95%CI1·46-5·06]，p=0·0004，效应大小0·35（0·16-0·55）。两组均未报告不良事件。
结论：团体心理干预最有可能代表了在学校环境中有心理社会困扰的青少年的可行和有效的选择。
背景：英国医学研究委员会，外交联邦和发展办公室，卫生和社会关怀部。
■有关摘要的乌尔都语翻译，请参见补充材料部分。
方法：在双臂中，单盲,集群随机对照试验，来自GujarKhan农村街道的合格公立学校群，拉瓦尔品第,巴基斯坦,采用置换区组随机化方法(1:1,按性别分层)分为干预组(n=20)和等待列表对照组(n=20)。使用青少年报告的儿科症状清单（PSC；心理社会困扰总评分从0到70），对13-15岁提供知情同意和照顾者同意的青少年进行心理社会困扰筛查，而那些评分为28分或以上的患者及其看护者被纳入试验.干预组的青少年每周接受7次小组会议，其护理人员在学校环境中接受了3次双周小组会议。主要结果是干预后3个月的总PSC评分相对于基线的变化。该试验在国际标准随机对照试验编号登记处进行了前瞻性登记，ISRCTN17755448。
结果：从包括的40个学校集群中，在2021年11月2日至11月30日之间，干预组的282名青少年和等待名单对照组的284名青少年被纳入。3个月时,与对照组的青少年相比，干预组的青少年的PSC平均总分显着降低（与基线的平均差异为3·48[95％CI1·66-5·29]，p=0·0002，效应大小0·38[95%CI0·18-0·57]；调整后平均差3·26(95%CI1·46-5·06]，p=0·0004，效应大小0·35（0·16-0·55）。两组均未报告不良事件。
结论：团体心理干预最有可能代表了在学校环境中有心理社会困扰的青少年的可行和有效的选择。
背景：英国医学研究委员会，外交联邦和发展办公室，卫生和社会关怀部。
■有关摘要的乌尔都语翻译，请参见补充材料部分。
