Evaluating a School-based Mental Health Program on Self-esteem, Stress, and Anxiety Among Adolescent Girls in Yemen.

The trial incorporates two schools: an Intervention and an Active Control conducted in two public schools in Sana'a city and was randomly assigned to either an intervention arm or a control arm. The study was conducted in these phases:

1. Pre-test phase (before intervention): Both school's participants completed self-administration questionnaires to assess baseline levels of self-esteem, stress and anxiety.
2. Intervention phase: Two programs were facilitated by the researcher at each target school. A 5-day interventional mental health educational program (Understanding the self, Emotional resilience, Cognitive awareness, Psychosocial self-care and integration and empowerment) 2 to 3 hours per day, for the intervention group (Juwayriyah Bint Al-Harith School) and a 5-day general health program (Personal hygiene, Health emergencies, Cholera awareness, Healthy boundaries and Health systems), 2 to 3 hours per day, for the control group (Ibn Seena School). One teacher assigned from each school administration helped the researcher by providing logistical support while the researcher facilitated the sessions. Each student was gifted a booklet that summarized the program they participated in.
3. First post-test phase (at the end of fifth day): After completing both programs for each school, both groups re-took the same questionnaire to measure changes in the intervention group compared to the control group.
4. Three month follow up phase: Simple follow-up was conducted by the assigned teachers by handing girls a printed paper designed by the researcher that had simple questions and activities about related programs for each school. The participants were encouraged to follow the instructions once a week by the assigned teacher.
5. Second post-test phase: Three months after the programs and follow up, both groups re-took the same self-administrated questionnaire for the third time to measure the effectiveness of the mental health educational program in the longer term.

The intervention school participated in 5-days "Mental health educational program" 2 to 3 hours per day. The program was delivered with lecture-based PowerPoints, interactive activities and role plays, emotional expression exercises, repetition of empowering messages, storytelling, visualization and Islamic integration, breathing and other techniques.

The entire program was developed by the researcher based on a comprehensive review of international and local frameworks and manuals from the WHO (Mental Health in Schools: Manual) (WHO, 2021), UNICEF (Helping Adolescents Thrive Toolkit) (UNICEF, 2022) and (National Community-Based Mental Health and Psychosocial Support Guideline) (MoPHP, 2021) along with peer-review from diverse school interventions in several settings that were taken as structural inspiration. However, the program was independently developed and adapted for the targeted participants.

On the other hand, the control school participated in a 5-day general health program -non mental-(Personal hygiene, Health emergencies, Cholera awareness, Healthy boundaries and Health systems), 2 to 3 hours per day. Similar to the intervention program, the supporting materials of the program were customized simple Arabic PowerPoint presentations, illustration posters and cards, daily blank papers for the girls to do activities given and a booklet (summary of the program subjects) as a gift at the end of the program.

The results were compared between the two groups to evaluate the effectiveness of the "mental health educational program" on self-esteem, stress, and Anxiety.

This study was conducted in two girls' public schools in Sana'a Yemen (Al Sabeen District). The schools selected for the study were Juwayriyah Bint Al-Harith and Ibn Seena Schools. Juwayriyah Bint Al-Harith school was the intervention School and Ibn Seena school was the control group. This was assigned in a simple random selection.