Feasibility and acceptability of a multicomponent, group psychological intervention for adolescents with psychosocial distress in public schools of Pakistan: a feasibility cluster randomized controlled trial (cRCT)

Syed Usman Hamdani, Zill-E Huma, Asad Tamizuddin-Nizami, Um-Ul Baneen, Nadia Suleman, Hashim Javed, Aiysha Malik, Duolao Wang, Samra Mazhar, Shahzad Alam Khan, Fareed Aslam Minhas, Atif Rahman, Syed Usman Hamdani, Zill-E Huma, Asad Tamizuddin-Nizami, Um-Ul Baneen, Nadia Suleman, Hashim Javed, Aiysha Malik, Duolao Wang, Samra Mazhar, Shahzad Alam Khan, Fareed Aslam Minhas, Atif Rahman

Abstract

Background: Child and adolescent mental health problems are a global public mental health priority. However, there is a lack of evidence-based scalable psychological interventions for adolescents living in low resource settings. This trial was designed to evaluate the feasibility and acceptability of delivering the World Health Organization's Early Adolescent Skills for Emotions (EASE) intervention at public schools in a rural sub-district in Rawalpindi, Pakistan.

Methods: A two arm, single blinded, feasibility cluster randomized controlled trial with mixed-methods evaluation was conducted with 59 adolescents and their caregivers from 8 public schools. In the 4 intervention arm schools, 6 non-specialist facilitators delivered the culturally-adapted EASE group sessions to the adolescents (n = 29) and their caregivers with desired fidelity under the supervision of in-country supervisors.

Results: The participation rate of adolescents in the intervention sessions was 83%. The intervention strategies were implemented by the adolescents. However, attending biweekly sessions at schools was challenging for caregivers with only 50% caregivers attending the sessions.

Conclusions: The results of this study support the feasibility and acceptability of delivering this culturally adapted intervention through non-specialist facilitators in school settings in Pakistan and pave the way to conduct a fully powered cluster randomized controlled trial to test the effectiveness of intervention to improve psychological outcomes in adolescents. Trial registration Trial registered with Clinicaltrials.gov prospectively; NCT04254393.

Keywords: Adolescents; Cluster randomized control trial; Feasibility; Low resource school settings; Psychological interventions; Psychosocial distress; School mental health.

Conflict of interest statement

The authors have no competing interests to disclose.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
CONSORT flow diagram of the feasibility trial

References

    1. Acharya B, Maru D, Schwarz R, Citrin D, Tenpa J, Hirachan S, Ekstrand M. Partnerships in mental healthcare service delivery in low-resource settings: developing an innovative network in rural Nepal. Glob Health. 2017;13(1):2–2. doi: 10.1186/s12992-016-0226-0.
    1. Akhtar A, Malik A, Ghatasheh M, Aqel IS, Habashneh R, Dawson KS, Bryant R. Feasibility trial of a brief scalable psychological intervention for Syrian refugee adolescents in Jordan. Eur J Psychotraumatol. 2021;12(1):1901408. doi: 10.1080/20008198.2021.1901408.
    1. Bernal G, Jiménez-Chafey M, Rodríguez M. Cultural adaptation of treatments: a resource for considering culture in evidence-based practice. Prof Psychol Res Pract. 2009;40(4):361–368. doi: 10.1037/a0016401.
    1. Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77–101. doi: 10.1191/1478088706qp063oa.
    1. Browne RH. On the use of a pilot sample for sample size determination. Stat Med. 1995;14(17):1933–1940. doi: 10.1002/sim.4780141709.
    1. Chaudhry Z, Siddiqui S. Health related quality of life assessment in Pakistani paediatric cancer patients using PedsQL™ 4.0 generic core scale and PedsQL™ cancer module. Health Qual Life Outcomes. 2012;10:52. doi: 10.1186/1477-7525-10-52.
    1. Chisholm D, Knapp MRJ, Knudsen HC, Amaddeo F, Gaite L, Van Wijngaarden B, Group ES. Client socio-demographic and service receipt inventory–European version: development of an instrument for international research: EPSILON Study 5. Br J Psychiatry. 2000;177(S39):s28–s33. doi: 10.1192/bjp.177.39.s28.
    1. D’Zurilla TJ, Nezu AM, Maydeu-Olivare A, Olivares A, D’Zurilla T. Social problem-solving inventory–Revised (SPSI–R) North Tonawanda: Multi-Health Systems; 2002.
    1. Das JK, Salam RA, Lassi ZS, Khan MN, Mahmood W, Patel V, Bhutta ZA. Interventions for adolescent mental health: an overview of systematic reviews. J Adolesc Health. 2016;59(4S):S49–S60. doi: 10.1016/j.jadohealth.2016.06.020.
    1. Dawson KS, Watts S, Carswell K, Shehadeh MH, Jordans MJ, Bryant RA, Servili C. Improving access to evidence-based interventions for young adolescents: Early Adolescent Skills for Emotions (EASE) J World Psychiatry. 2019;18(1):105. doi: 10.1002/wps.20594.
    1. Dua T, Barbui C, Clark N, Fleischmann A, Poznyak V, van Ommeren M, Saxena S. Evidence-based guidelines for mental, neurological, and substance use disorders in low- and middle-income countries: summary of WHO recommendations. PLoS Med. 2011;8(11):e1001122. doi: 10.1371/journal.pmed.1001122.
    1. Eldridge SM, Chan CL, Campbell MJ, Bond CM, Hopewell S, Thabane L, Lancaster GA. CONSORT 2010 statement: extension to randomised pilot and feasibility trials. Pilot Feasibility Stud. 2016;2:64. doi: 10.1186/s40814-016-0105-8.
    1. Erskine HE, Baxter AJ, Patton G, Moffitt TE, Patel V, Whiteford HA, Scott JG. The global coverage of prevalence data for mental disorders in children and adolescents. Epidemiol Psychiatr Sci. 2017;26(4):395–402. doi: 10.1017/s2045796015001158.
    1. Fazel M, Hoagwood K, Stephan S, Ford T. Mental health interventions in schools 1: mental health interventions in schools in high-income countries. Lancet Psychiatry. 2014;1(5):377–387. doi: 10.1016/s2215-0366(14)70312-8.
    1. Fazel M, Patel V, Thomas S, Tol W. Mental health interventions in schools in low-income and middle-income countries. Lancet Psychiatry. 2014;1(5):388–398. doi: 10.1016/s2215-0366(14)70357-8.
    1. Ferrari AJ, Norman RE, Freedman G, Baxter AJ, Pirkis JE, Harris MG, Whiteford HA. The burden attributable to mental and substance use disorders as risk factors for suicide: findings from the Global Burden of Disease Study 2010. PLoS ONE. 2014;9(4):e91936–e91936. doi: 10.1371/journal.pone.0091936.
    1. Fine SL, Malik A, Guimond MF, Nemiro A, Temu G, Likindikoki S, Tol WA. Improving mental health in low-resource settings: a feasibility randomized controlled trial of a transdiagnostic psychological intervention among Burundian refugee adolescents and their caregivers. Behav Res Ther. 2021;145:103944. doi: 10.1016/j.brat.2021.103944.
    1. Frick PJ. The Alabama parenting questionnaire. University of Alabama: J Unpublished rating scale; 1991.
    1. Funnell SC, Rogers PJ. Purposeful program theory: effective use of theories of change and logic models. Hoboken: Wiley; 2011.
    1. Gonsalves PP, Hodgson ES, Bhat B, Sharma R, Jambhale A, Michelson D, Patel V. App-based guided problem-solving intervention for adolescent mental health: a pilot cohort study in Indian schools. Evid Based Ment Health. 2021;24(1):11–18. doi: 10.1136/ebmental-2020-300194.
    1. Hamdani SU, Akhtar P, Huma ZE, Nazir H, Minhas FA, Sikander S, Rahman A. WHO Parents Skills Training (PST) programme for children with developmental disorders and delays delivered by Family Volunteers in rural Pakistan: study protocol for effectiveness implementation hybrid cluster randomized controlled trial. Glob Ment Health. 2017;4:e11. doi: 10.1017/gmh.2017.7.
    1. Hamdani SU, Huma ZE, Javed H, Warraitch A, Rahman A, Tameezuddin Nizami A, Minhas FA. Prevalence of psychosocial distress in school going adolescents in rural Pakistan: findings from a cross-sectional epidemiological survey. BJPsych Open. 2021;7(S1):S56–S57. doi: 10.1192/bjo.2021.196.
    1. Hamdani SU, Huma ZE, Suleman N, Warraitch A, Muzzafar N, Farzeen M, Wissow LS. Scaling-up school mental health services in low resource public schools of rural Pakistan: the Theory of Change (ToC) approach. Int J Ment Health Syst. 2021;15(1):8. doi: 10.1186/s13033-021-00435-5.
    1. Hamdani SU, Huma ZE, Tamizuddin-Nizami A. Debate: Child and adolescent mental health services in Pakistan; do we need in-patient mental health facilities for children and young people? Child Adolesc Ment Health. 2021;26(2):182–183. doi: 10.1111/camh.12463.
    1. Hansen NB, Lambert MJ, Forman EM. The psychotherapy dose-response effect and its implications for treatment delivery services. Clin Psychol Sci Pract. 2002;9(3):329. doi: 10.1093/clipsy.9.3.329.
    1. Jellinek MS, Murphy JM, Burns BJ. Brief psychosocial screening in outpatient pediatric practice. J Pediatrics. 1986;109(2):371–378. doi: 10.1016/S0022-3476(86)80408-5.
    1. Jones EAK, Mitra AK, Bhuiyan AR. Impact of COVID-19 on mental health in adolescents: a systematic review. Int J Environ Res Public Health. 2021;18(5):2470. doi: 10.3390/ijerph18052470.
    1. Julious SA. Sample size of 12 per group rule of thumb for a pilot study. Pharmaceut Stat. 2005;4(4):287–291. doi: 10.1002/pst.185.
    1. Keynejad R, Spagnolo J, Thornicroft G. WHO mental health gap action programme (mhGAP) intervention guide: updated systematic review on evidence and impact. Evid Based Mental Health. 2021;24(3):124. doi: 10.1136/ebmental-2021-300254.
    1. Kohrt BA, Jordans MJ, Rai S, Shrestha P, Luitel NP, Ramaiya MK, Patel V. Therapist competence in global mental health: Development of the ENhancing Assessment of Common Therapeutic factors (ENACT) rating scale. Behav Res Ther. 2015;69:11–21. doi: 10.1016/j.brat.2015.03.009.
    1. Martin F, Oliver T. Behavioral activation for children and adolescents: a systematic review of progress and promise. Eur Child Adolesc Psychiatry. 2019;28(4):427–441. doi: 10.1007/s00787-018-1126-z.
    1. Meza RD, Kiche S, Soi C, Khairuzzaman AN, Nales CJR, Whetten K, Dorsey S. Barriers and facilitators of child and guardian attendance in task-shifted mental health services in schools in western Kenya. Glob Ment Health. 2020;7:e16–e16. doi: 10.1017/gmh.2020.9.
    1. Mirza Z, Rahman A. Mental health care in Pakistan boosted by the highest office. Lancet. 2019;394(10216):2239–2240. doi: 10.1016/s0140-6736(19)32979-4.
    1. Murray LK, Dorsey S, Bolton P, Jordans MJ, Rahman A, Bass J, Verdeli H. Building capacity in mental health interventions in low resource countries: an apprenticeship model for training local providers. Int J Ment Health Syst. 2011;5(1):30. doi: 10.1186/1752-4458-5-30.
    1. Murray LK, Skavenski S, Michalopoulos LM, Bolton PA, Bass JK, Familiar I, Cohen J. Counselor and client perspectives of Trauma-focused Cognitive Behavioral Therapy for children in Zambia: a qualitative study. J Clin Child Adolesc Psychol. 2014;43(6):902–914. doi: 10.1080/15374416.2013.859079.
    1. Naveed S, Waqas A, Memon AR, Jabeen M, Sheikh MH. Cross-cultural validation of the Urdu translation of the Patient Health Questionnaire for Adolescents among children and adolescents at a Pakistani school. Public Health. 2019;168:59–66. doi: 10.1016/j.puhe.2018.11.022.
    1. Otto C, Reiss F, Voss C, Wüstner A, Meyrose AK, Hölling H, Ravens-Sieberer U. Mental health and well-being from childhood to adulthood: design, methods and results of the 11-year follow-up of the BELLA study. Eur Child Adolesc Psychiatry. 2020 doi: 10.1007/s00787-020-01630-4.
    1. Patel V, Chowdhary N, Rahman A, Verdeli H. Improving access to psychological treatments: lessons from developing countries. Behav Res Ther. 2011;49(9):523–528. doi: 10.1016/j.brat.2011.06.012.
    1. Population Council [Pakistan] Landscape analysis of family planning situation in Pakistan: brief summary of findings: district. Pakistan: Population Council; 2016.
    1. Razzouk D, Sharan P, Gallo C, Gureje O, Lamberte EE, de Jesus Mari J, Saxena S. Scarcity and inequity of mental health research resources in low-and-middle income countries: a global survey. Health Policy. 2010;94(3):211–220. doi: 10.1016/j.healthpol.2009.09.009.
    1. Richardson LP, McCauley E, Grossman DC, McCarty CA, Richards J, Russo JE, Katon W. Evaluation of the Patient Health Questionnaire-9 Item for detecting major depression among adolescents. J Pediatr. 2010;126(6):1117–1123. doi: 10.1542/peds.2010-0852.
    1. Sharma P, Mehta M, Sagar R. Efficacy of transdiagnostic cognitive-behavioral group therapy for anxiety disorders and headache in adolescents. J Anxiety Disord. 2017;46:78–84. doi: 10.1016/j.janxdis.2016.11.001.
    1. Skivington K, Matthews L, Simpson SA, Craig P, Baird J, Blazeby JM, Moore L. A new framework for developing and evaluating complex interventions: update of Medical Research Council guidance. BMJ. 2021;374:n2061. doi: 10.1136/bmj.n2061.
    1. Slavin LA. Validation studies of the PEPSS, a measure of perceived emotional support for use with adolescents. J Adolesc Res. 1991;6(3):316–335. doi: 10.1177/074355489163004.
    1. Tennant R, Hiller L, Fishwick R, Platt S, Joseph S, Weich S, Stewart-Brown S. The Warwick-Edinburgh mental well-being scale (WEMWBS): development and UK validation. J Health Qual Life Outcomes. 2007;5(1):63. doi: 10.1186/1477-7525-5-63.
    1. The Lancet P. A good enough measure. Lancet Psychiatry. 2020;7(10):825. doi: 10.1016/s2215-0366(20)30395-3.
    1. UN DESA . World population prospects: the 2015 revision, key findings and advance tables. New York: UN DESA; 2015.
    1. Varni JW, Seid M, Rode CA. The PedsQL™: measurement model for the pediatric quality of life inventory. J Med Care. 1999 doi: 10.1097/00005650-199902000-00003.
    1. Werner-Seidler A, Perry Y, Calear AL, Newby JM, Christensen H. School-based depression and anxiety prevention programs for young people: a systematic review and meta-analysis. Clin Psychol Rev. 2017;51:30–47. doi: 10.1016/j.cpr.2016.10.005.
    1. Whiteford HA, Degenhardt L, Rehm J, Baxter AJ, Ferrari AJ, Erskine HE, Johns N. Global burden of disease attributable to mental and substance use disorders: findings from the Global Burden of Disease Study 2010. Lancet. 2013;382(9904):1575–1586. doi: 10.1016/S0140-6736(13)61611-6.
    1. Whiteford HA, Harris MG, McKeon G, Baxter A, Pennell C, Barendregt JJ, Wang J. Estimating remission from untreated major depression: a systematic review and meta-analysis. Psychol Med. 2013;43(8):1569–1585. doi: 10.1017/s0033291712001717.
    1. WHO . WHO-AIMS report on mental health system in Pakistan: a report of the assessment of the mental health system in Pakistan using the World Health Organization-Assessment Instrument for Mental Health Systems. Geneva: WHO; 2009.
    1. WHO . mhGAP intervention guide for mental, neurological and substance use disorders in non-specialized health settings: mental health Gap Action Programme (mhGAP) Geneva: World Health Organization; 2016.
    1. WHO . Pakistan marks World Mental Health Day with Presidential initiative. Egypt: WHO; 2019.
    1. WHO . WHO guidelines approved by the guidelines review committee. Geneva: WHO; 2020.
    1. Wynne C, Doyle C, Kenny R, Brosnan E, Sharry J. A first-level evaluation of a family intervention for adolescent social, emotional and behavioural difficulties in Child and Adolescent Mental Health Services. J Child Adolesc Ment Health. 2016;28(1):33–46. doi: 10.2989/17280583.2015.1135804.

Source: PubMed

Спонсоры и соавторы

Заболевания

Медикаментозные вмешательства

Подписаться