Youth Culturally adapted Manual Assisted Problem Solving Training (YCMAP) in Pakistani adolescent with a history of self-harm: protocol for multicentre clinical and cost-effectiveness randomised controlled trial

Nusrat Husain, Sehrish Tofique, Imran B Chaudhry, Tayyeba Kiran, Peter Taylor, Christopher Williams, Rakhshi Memon, Shilpa Aggarwal, Mohsin Hassan Alvi, S Ananiadou, Moin Ahmad Ansari, Saadia Aseem, Andrew Beck, Sumira Alam, Erminia Colucci, Kate Davidson, Sarah Edwards, Richard Emsley, Jonathan Green, Anil Gumber, Keith Hawton, Farhat Jafri, Ayesha Khaliq, Thomas Mason, Ann Mcreath, Ayesha Minhas, Farooq Naeem, Haider Ali Naqvi, Amna Noureen, Maria Panagioti, Anita Patel, Aaron Poppleton, Tinevimbo Shiri, Mima Simic, Sarwat Sultan, Asad Tamizuddin Nizami, Zainab Zadeh, Shehla Naeem Zafar, Nasim Chaudhry, Nusrat Husain, Sehrish Tofique, Imran B Chaudhry, Tayyeba Kiran, Peter Taylor, Christopher Williams, Rakhshi Memon, Shilpa Aggarwal, Mohsin Hassan Alvi, S Ananiadou, Moin Ahmad Ansari, Saadia Aseem, Andrew Beck, Sumira Alam, Erminia Colucci, Kate Davidson, Sarah Edwards, Richard Emsley, Jonathan Green, Anil Gumber, Keith Hawton, Farhat Jafri, Ayesha Khaliq, Thomas Mason, Ann Mcreath, Ayesha Minhas, Farooq Naeem, Haider Ali Naqvi, Amna Noureen, Maria Panagioti, Anita Patel, Aaron Poppleton, Tinevimbo Shiri, Mima Simic, Sarwat Sultan, Asad Tamizuddin Nizami, Zainab Zadeh, Shehla Naeem Zafar, Nasim Chaudhry

Abstract

Introduction: Suicide is a global health concern. Sociocultural factors have an impact on self-harm and suicide rates. In Pakistan, both self-harm and suicide are considered as criminal offence's and are condemned on both religious and social grounds. The proposed intervention 'Youth Culturally Adapted Manual Assisted Problem Solving Training (YCMAP)' is based on principles of problem-solving and cognitive-behavioural therapy. YCMAP is a brief, culturally relevant, scalable intervention that can be implemented in routine clinical practice if found to be effective.

Method and analysis: A multicentre rater blind randomised controlled trial to evaluate the clinical and cost-effectiveness of YCMAP including a sample of 652 participants, aged 12-18 years, presenting to general physicians/clinicians, emergency room after self harm or self referrals. We will test the effectiveness of 8-10 individual sessions of YCMAP delivered over 3 months compared with treatment as usual. Primary outcome measure is repetition of self-harm at 12 months. The seconday outcomes include reduction in suicidal ideation, hopelessness and distress and improvement in health related quality of life. Assessments will be completed at baseline, 3, 6, 9 and 12 months postrandomisation. The nested qualitative component will explore perceptions about management of self-harm and suicide prevention among adolescents and investigate participants' experiences with YCMAP. The study will be guided by the theory of change approach to ensure that the whole trial is centred around needs of the end beneficiaries as key stakeholders in the process.

Ethics and dissemination: Ethics approval has been obtained from the Ethics Committee of University of Manchester, the National Bioethics Committee in Pakistan. The findings of this study will be disseminated through community workshops, social media, conference presentations and peer-reviewed journals.

Trial registration number: NCT04131179.

Keywords: child & adolescent psychiatry; mental health; suicide & self-harm.

Conflict of interest statement

Competing interests: NH, former Trustee of 'Pakistan Institute of Living and Learning (PILL)', 'Abaseen Foundation (UK)' and 'Lancashire Mind (UK)'. At 'Manchester Global Foundation', he is the Chair of Board of Trustees. He is also a member of the executive committee for the Faculty of Academic Psychiatry, at the Royal College of Psychiatrists. NH is a NIHR Senior Investigator. NC is Associate Director of Global Mental Health and Cultural Psychiatry Research Group. IBC, former Trustee of 'PILL' is Honorary Professor at the University of Manchester. NH, IBC and NC have received support for educational programmes and/or travel support and/or speaker fees from pharmaceutical companies. CW is the author of a book aimed at suicide prevention, and has written a range of books and online CBT-based course resources that are available as both, free access and on a commercial basis. NH, NC, IBC and TK’s time is partially funded by the Global Challenges Research Fund 'South Asia Harm Reduction Movement-SAHAR M' (MR/P028144/1).

© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published by BMJ.

Figures

Figure 1
Figure 1
Flow diagram of the YCMAP study. TAU, treatment as usual; YCMAP, Youth Culturally Adapted Manual Assisted Problem Solving Training.
Figure 2
Figure 2
Theory of change. GP, general practitioner; PILL, Pakistan Institute of Living and Learning;SH, Self-Harm.

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