Shamiri Institute, Allston, Massachusetts.
Department of Psychology, Harvard University, Cambridge, Massachusetts.
JAMA Psychiatry. 2021 Aug 1;78(8):829-837. doi: 10.1001/jamapsychiatry.2021.1129.
Low-cost interventions for adolescent depression and anxiety are needed in low-resource countries such as those in Sub-Saharan Africa.
To assess whether Shamiri, a 4-week layperson-delivered group intervention that teaches growth mindset, gratitude, and value affirmation, can alleviate depression and anxiety symptoms in symptomatic Kenyan adolescents.
DESIGN, SETTING, AND PARTICIPANTS: This school-based randomized clinical trial included outcomes assessed at baseline, posttreatment, and 2-week and 7-month follow-up from 4 secondary schools in Nairobi and Kiambu County, Kenya. Adolescents aged 13 to 18 years with elevated symptoms on standardized depression or anxiety measures were eligible. Intent-to-treat analyses were used to analyze effects. Recruitment took place in June 2019; follow-up data were collected in August 2019 and February 2020.
Adolescents were randomized to the Shamiri intervention or to a study skills control. All adolescents in both conditions met in groups (mean group size, 9) for 60 minutes per week for 4 weeks.
Primary outcomes were depression (Patient Health Questionnaire-8 item) and anxiety (Generalized Anxiety Disorder-7 item) symptoms. Analyses of imputed data were hypothesized to reveal significant reductions in depression and anxiety symptoms for adolescents assigned to Shamiri compared with those in the study skills group.
Of 413 adolescents, 205 (49.6%) were randomized to Shamiri and 208 (50.4%) to study skills. The mean (SD) age was 15.5 (1.2) years, and 268 (65.21%) were female. A total of 307 youths completed the 4-week intervention. Both Shamiri and study skills were rated highly useful (4.8/5.0) and reduced symptoms of depression and anxiety, but analyses with imputed data revealed that youths receiving Shamiri showed greater reductions in depressive symptoms at posttreatment (Cohen d = 0.35 [95% CI, 0.09-0.60]), 2-week follow-up (Cohen d = 0.28 [95% CI, 0.04-0.54]), and 7-month follow-up (Cohen d = 0.45 [95% CI, 0.19-0.71]) and greater reductions in anxiety symptoms at posttreatment (Cohen d = 0.37 [95% CI, 0.11-0.63]), 2-week follow-up (Cohen d = 0.26 [95% CI, -0.01 to 0.53]), and 7-month follow-up (Cohen d = 0.44 [95% CI, 0.18-0.71]).
Both the Shamiri intervention and a study skills control group reduced depression and anxiety symptoms; the low-cost Shamiri intervention had a greater effect, with effects lasting at least 7 months. If attrition is reduced and the clinical significance of outcome differences is established, this kind of intervention may prove useful in other global settings where there are limited resources, mental illness stigma, or a shortage of professionals and limited access to mental health care.
Pan-African Clinical Trials Registry Identifier: PACTR201906525818462.
在资源匮乏的国家（如撒哈拉以南非洲国家），需要低成本的干预措施来治疗青少年的抑郁和焦虑。
评估 Shamiri（一种由非专业人员提供的为期 4 周的团体干预措施，教授成长思维、感恩和价值肯定）是否可以减轻肯尼亚有症状的青少年的抑郁和焦虑症状。
设计、地点和参与者：这项基于学校的随机临床试验包括在肯尼亚内罗毕和基安布县的 4 所中学进行的基线、治疗后以及 2 周和 7 个月随访时评估的结果。符合标准的是在标准化的抑郁或焦虑测量中出现升高症状的 13 至 18 岁青少年。使用意向治疗分析来分析效果。招募工作于 2019 年 6 月进行；随访数据于 2019 年 8 月和 2020 年 2 月收集。
青少年被随机分配到 Shamiri 干预组或学习技能对照组。两组的所有青少年都在每周 60 分钟的团体中见面，为期 4 周。
主要结果是抑郁（患者健康问卷-8 项）和焦虑（广泛性焦虑症-7 项）症状。假设对插补数据的分析将显示与学习技能组相比，接受 Shamiri 干预的青少年的抑郁和焦虑症状显著减轻。
在 413 名青少年中，有 205 名（49.6%）被随机分配到 Shamiri 组，208 名（50.4%）被分配到学习技能组。平均（SD）年龄为 15.5（1.2）岁，268 名（65.21%）为女性。共有 307 名青少年完成了为期 4 周的干预。Shamiri 和学习技能组都被评为非常有用（4.8/5.0），并减轻了抑郁和焦虑症状，但插补数据的分析显示，接受 Shamiri 治疗的青少年在治疗后（Cohen d=0.35 [95%CI，0.09-0.60]）、2 周随访（Cohen d=0.28 [95%CI，0.04-0.54]）和 7 个月随访（Cohen d=0.45 [95%CI，0.19-0.71]）时，抑郁症状的减轻更大，在治疗后（Cohen d=0.37 [95%CI，0.11-0.63]）、2 周随访（Cohen d=0.26 [95%CI，-0.01 至 0.53]）和 7 个月随访（Cohen d=0.44 [95%CI，0.18-0.71]）时，焦虑症状的减轻更大。
Shamiri 干预和学习技能对照组均减轻了抑郁和焦虑症状；低成本的 Shamiri 干预效果更大，效果至少持续 7 个月。如果减少流失，并且确定了结果差异的临床意义，那么这种干预措施可能在其他资源有限、精神疾病污名化、专业人员短缺和心理健康服务获取有限的全球环境中证明有用。
泛非临床试验注册中心标识符：PACTR201906525818462。
