目标:心理健康问题在非洲青少年中普遍存在,但专业治疗能力有限。沙米里,有效的非专业提供者提供的干预,在以前的随机对照试验中,抑郁和焦虑症状显著减少。我们调查了Shamiri全面干预及其组成部分的影响(仅限生长,只有感恩,和仅值),反对学习技能控制。
方法:在肯尼亚高中青少年的五组RCT中,焦虑,抑郁症,并且通过8个月的随访自我报告健康状况。RCT发生在意料之外的政府强制关闭COVID后,将三年的学业分为两年,不断升级的学术压力。
结果:参与者(N=1,252;48.72%的女性)被分配到:增长(n=249),感恩(n=237),值(n=265),Shamiri(n=250),和学习技能(n=251)。纵向多层次模型表明,在所有条件下,焦虑评分在中点显著改善(B=-0.847),终点(B=-2.948),一个月(B=-1.587),三个月(B=-2.374),和八个月(B=-1.917)的随访。抑郁评分也在中点显著改善(B=-0.796),终点(B=-3.126),一个月(B=-2.382),三个月(B=-2.521),8个月(B=-2.237)随访。健康评分在中点显著提高(B=1.73),终点(B=3.44),一个月(B=2.21),三个月(B=1.78),8个月(B=1.59)随访。Shamiri的症状减轻与COVID前试验相匹配,但学习技能导致的症状减轻远远超过COVID相关学校停课前的试验(焦虑减轻31%,抑郁减轻60%).因此,与以前的RCT相比,这项COVID时代试验显示,任何干预组和主动对照组的结局均无显著差异.
结论:我们的RCT在COVID后学业压力增加的时期进行,产生了意想不到的结果。青少年报告的焦虑和抑郁的改善与Shamiri之前的试验一致,但明显大于以前的研究技能试验。“控制干预”教学生活技能可能会在传达特定上下文相关的技能时产生心理健康益处。
OBJECTIVE: Mental health problems are prevalent among African adolescents, but professional treatment capacity is limited. Shamiri, an efficient lay provider-delivered intervention, has significantly reduced depression and anxiety symptoms in previous randomized controlled trials (RCTs). This trial investigated effects of the full Shamiri intervention and its components (growth-only, gratitude-only, and values-only) against a study skills control.
METHODS: In a 5-group RCT with adolescents from Kenyan high schools, anxiety, depression, and well-being were self-reported through 8-month follow-up. The RCT occurred immediately after an unanticipated government-mandated COVID-19 shutdown forced 3 years of schoolwork into 2 years, escalating academic pressures.
RESULTS: Participants (N = 1,252; 48.72% female) were allocated to: growth (n = 249), gratitude (n = 237), values (n = 265), Shamiri (n = 250), and study skills (n = 251) conditions. Longitudinal multilevel models showed that, across all conditions, anxiety scores significantly improved at midpoint (B = -0.847), end point (B = -2.948), 1-month (B = -1.587), 3-month (B = -2.374), and 8-month (B = -1.917) follow-ups. Depression scores also improved significantly at midpoint (B = -0.796), end point (B = -3.126), 1-month (B = -2.382), 3-month (B = -2.521), and 8-month (B = -2.237) follow-ups. Well-being scores improved significantly at midpoint (B = 1.73), end point (B = 3.44), 1-month (B = 2.21), 3-month (B = 1.78), and 8-month (B = 1.59) follow-ups. Symptom reduction with Shamiri matched that of pre-COVID-19 trials, but symptom reduction with study skills far outpaced that of trials before the COVID-19-related school shutdown (31% greater anxiety reduction and 60% greater depression reduction). Thus, in contrast to previous RCTs, this COVID-19-era trial showed no significant differences between outcomes in any intervention and active control groups.
CONCLUSIONS: Our RCT conducted during a post-COVID-19 period of heightened academic pressure produced unexpected results. Improvements in youth-reported anxiety and depression were consistent with previous trials for Shamiri, but markedly larger than in previous trials for study skills. Control interventions teaching life skills may produce mental health benefits when they convey skills of particular contextual relevance.
CONCLUSIONS: A large five-group randomized controlled trial involved comparing the Shamiri Intervention to its component interventions (growth mindset, gratitude, and values affirmation) and a study-skills control. In contrast to previous studies of Shamiri, similar effects were observed across all groups (p<.05). This trial was conducted right after an unanticipated government-mandated COVID shutdown forced three years of schoolwork into two. Benchmarking analyses against previous trials showed approximately equal effects of Shamiri over time, but a 31% greater anxiety reduction and 60% greater depression reduction for the study-skills condition; this highlights the potential of interventions teaching highly relevant life-skills for improving mental health.
BACKGROUND: Five-Arm Shamiri Trial; https://pactr.samrc.ac.za/; PACTR202104716135752.