通过由非专业顾问提供的课堂敏感干预措施增加学校心理咨询需求：印度新德里的一项阶梯式楔形集群随机对照试验。

Increasing demand for school counselling through a lay counsellor-delivered classroom sensitisation intervention: a stepped-wedge cluster randomised controlled trial in New Delhi, India.

机构信息

Department of Clinical, Neuro and Developmental Psychology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.

Sangath, Delhi, India.

出版信息

BMJ Glob Health. 2021 Jun;6(6). doi: 10.1136/bmjgh-2020-003902.

DOI:10.1136/bmjgh-2020-003902

PMID:34172486

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8237731/

Abstract

INTRODUCTION

We evaluated a classroom-based sensitisation intervention that was designed to reduce demand-side barriers affecting referrals to a school counselling programme. The sensitisation intervention was offered in the context of a host trial evaluating a low-intensity problem-solving treatment for common adolescent mental health problems.

METHODS

We conducted a stepped-wedge, cluster randomised controlled trial with 70 classes in 6 secondary schools serving low-income communities in New Delhi, India.The classes were randomised to receive a classroom sensitisation session involving a brief video presentation and moderated group discussion, delivered by a lay counsellor over one class period (intervention condition, IC), in two steps of 4 weeks each. The control condition (CC) was whole-school sensitisation (teacher-meetings and whole-school activities such as poster displays). The primary outcome was the proportion of students referred into the host trial. Secondary outcomes were the proportion of students who met mental health caseness criteria and the proportion of self-referred adolescents.

RESULTS

Between 20 August 2018 and 9 December 2018, 835 students (23.3% of all students) were referred into the host trial. The referred sample included 591 boys (70.8%), and had a mean age of 15.8 years, SD=0.06; 194 students (31.8% of 610 with complete data) met mental health caseness criteria. The proportion of students referred in each trial conditionwas significantly higher in the IC (IC=21.7%, CC=1.5%, OR=111.36, 95% CI 35.56 to 348.77, p<0.001). The proportion of self-referred participants was also higher in the IC (IC=98.1%, CC=89.1%, Pearson χ (1)=16.92, p<0.001). Although the proportion of referred students meeting caseness criteria was similar in both conditions (IC=32.0% vs CC=28.1%), the proportion weighted for the total student population was substantially higher in the IC (IC=5.2%, CC=0.3%, OR=52.39, 95% CI 12.49 to 219.66,p<0.001).

CONCLUSION

A single, lay counsellor-delivered, classroom sensitisation session increased psychological help-seeking for common mental health problems among secondary school pupils from urban, low-income communities in India.

TRIAL REGISTRATION NUMBER

NCT03633916.

摘要

介绍

我们评估了一项基于课堂的敏化干预措施，旨在减少影响向学校咨询计划转介的需求方障碍。敏化干预措施是在一项评估针对青少年常见心理健康问题的低强度解决问题治疗的现场试验的背景下提供的。

方法

我们在印度新德里的 6 所服务于低收入社区的中学进行了一项分阶段楔形、集群随机对照试验，共有 70 个班级。这些班级被随机分配接受课堂敏化课程，包括由一名兼职辅导员在一个班级课程中进行的简短视频演示和小组讨论（干预条件，IC），分两个 4 周的步骤进行。对照组（CC）是全校敏化（教师会议和全校活动，如海报展示）。主要结局是被转介到现场试验的学生比例。次要结局是符合心理健康病例标准的学生比例和自我转介青少年的比例。

结果

2018 年 8 月 20 日至 12 月 9 日期间，835 名学生（所有学生的 23.3%）被转介到现场试验。转介样本包括 591 名男生（70.8%），平均年龄为 15.8 岁，标准差为 0.06；194 名学生（610 名完成数据的学生中有 31.8%）符合心理健康病例标准。在每个试验条件中，IC 中的学生转介比例显著更高（IC=21.7%，CC=1.5%，OR=111.36，95%CI 35.56 至 348.77，p<0.001）。IC 中的自我转介参与者比例也更高（IC=98.1%，CC=89.1%，Pearson χ（1）=16.92，p<0.001）。尽管两种条件下符合病例标准的转介学生比例相似（IC=32.0% vs CC=28.1%），但 IC 中加权的总学生人群比例明显更高（IC=5.2%，CC=0.3%，OR=52.39，95%CI 12.49 至 219.66，p<0.001）。