Harvard University; Shamiri Institute, Pittsfield, MA.
Harvard University; University of Pennsylvania.
Behav Ther. 2020 Jul;51(4):601-615. doi: 10.1016/j.beth.2019.09.005. Epub 2019 Nov 26.
Youth mental health interventions in low-resource communities may benefit from including empirically supported elements, using stigma-free content, and using trained lay-providers. We developed and evaluated such an intervention, targeting adolescent depression and anxiety in Kenya, where mental health care is limited by social stigma and a paucity of providers. Kenyan adolescents (N = 51, ages 14-17, 60.78% female) from a school in an urban slum in Nairobi with self-reported moderate-to-severe symptoms of depression or anxiety were randomized to the 4-week "Shamiri" ("thrive") group intervention or a study skills control intervention of equal duration. The Shamiri intervention included growth mindset, gratitude, and value affirmation exercises. The content was delivered by recent high school graduates (ages 17-21, 60% male) trained as lay-providers. Participants met in school once-a-week in groups of 9-12 youths (average group size 10). Compared to the study-skills control, Shamiri produced greater reductions in adolescent depression symptoms (p = .038; d = .32) and anxiety symptoms (p = .039; d = .54) from baseline to 4-week follow-up, and greater improvements in academic performance (p = .034; d = .32) from the school-term before versus after the intervention. There were no effects on overall social support or perceived control, but the Shamiri group showed larger increases in perceived social support from friends (p = .028, d = .71). This appears to be the first report that a brief, lay-provider delivered, community-based intervention may reduce internalizing symptoms and improve academic outcomes in high-symptom adolescents in Sub-Saharan Africa. Larger replications with extended follow-ups will help gauge the strength and durability of these effects.
在资源匮乏的社区中，青年心理健康干预可能受益于纳入经过实证支持的元素，使用无污名化的内容，并使用经过培训的非专业人员。我们开发并评估了这样一种干预措施，针对肯尼亚的青少年抑郁和焦虑，在肯尼亚，心理健康护理受到社会污名和提供者稀缺的限制。内罗毕一个城市贫民窟的学校中的肯尼亚青少年（N=51，年龄 14-17 岁，60.78%为女性），自我报告有中度至重度抑郁或焦虑症状，被随机分配到为期 4 周的“Shamiri”（“茁壮成长”）组干预或同等时长的学习技能对照组干预。Shamiri 干预包括成长心态、感恩和价值观肯定练习。内容由最近毕业的高中生（年龄 17-21 岁，60%为男性）作为非专业人员进行传授。参与者每周在学校一次，以 9-12 名青少年为一组（平均每组 10 人）。与学习技能对照组相比，Shamiri 在从基线到 4 周随访期间，青少年抑郁症状（p=0.038；d=0.32）和焦虑症状（p=0.039；d=0.54）的减少更为明显，并且在干预前后的学校学期相比，学业成绩的提高更为明显（p=0.034；d=0.32）。干预对总体社会支持或感知控制没有影响，但 Shamiri 组显示出从朋友那里获得的感知社会支持的更大增加（p=0.028，d=0.71）。这似乎是第一个报道，一个简短的、由非专业人员提供的、基于社区的干预措施可以减少撒哈拉以南非洲高症状青少年的内化症状并提高学业成绩。更大规模的复制和扩展的随访将有助于评估这些效果的强度和持久性。
