基于学校的心理干预对撒哈拉以南非洲青少年抑郁、焦虑和创伤后应激障碍的治疗效果：一项随机对照试验的系统评价。
Effectiveness of school-based psychological interventions for the treatment of depression, anxiety and post-traumatic stress disorder among adolescents in sub-Saharan Africa: A systematic review of randomized controlled trials.
机构信息
Psychiatry Department, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia.
Department of Psychiatry, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
出版信息
PLoS One. 2023 Nov 20;18(11):e0293988. doi: 10.1371/journal.pone.0293988. eCollection 2023.
BACKGROUND
Mental disorders among adolescents represent a high burden and early onset. They compromise their physical health, survival, and future potential. On the other hand, young people have inadequate access to essential health services in sub-Saharan Africa. We aimed to review school-based psychological interventions, contents, delivery, and evidence of effectiveness designed to treat depression, anxiety, or posttraumatic stress symptoms among adolescents and young adults aged 10-24.
METHOD
We searched articles on the following databases: PubMed, Scopus, Embase, and Science Direct from 17/10/2022 to 30/12/2022. Furthermore, relevant studies were searched from advanced google scholar, google and identified reference lists. We used MeSH browser for key words: psychological interventions, depression, anxiety, posttraumatic stress disorder and lists of Sub-Saharan Africa countries. We combined words using standard Boolean operators (OR, AND). The quality of studies was evaluated using the Cochrane Collaboration's risk of bias tool and the results were presented as a narrative synthesis since the interventions were very heterogenous.
RESULTS
Fourteen randomized controlled trials were included for systematic review and more than half (57.14%) were from Kenya and Nigeria. Common school-based psychological interventions were cognitive behavioral therapy and Shamiri interventions (an intervention that focuses on youths to cultivate a growth mindset, practice gratitude and take the value). More than half (57.14%) of the interventions were delivered by non-specialists like teachers, lay providers and community health workers. Nearly one-fifth of the interventions were used individual modality. School-based psychological interventions provided by non-specialists also produced a greater reduction in adolescents' depressive, anxiety, and post-traumatic stress symptoms compared to the control groups.
CONCLUSION
Cognitive behavioral therapy and Shamiri interventions were the common treatment delivered in school settings. The range of interventions could be effectively delivered by non- professionals that promote task-shifting of psychological interventions from very scarce mental health specialists in these countries.
TRIAL REGISTRATION
Trial Registration: Prospero CRD42022378372. https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022378372.
背景
青少年精神障碍负担沉重，且发病早。它们会损害青少年的身心健康、生存和未来潜力。另一方面，撒哈拉以南非洲的年轻人无法充分获得基本的卫生服务。我们旨在综述以学校为基础的心理干预措施、内容、实施方式和治疗 10-24 岁青少年和青年抑郁、焦虑或创伤后应激症状的有效性证据。
方法
我们在以下数据库中检索文章：PubMed、Scopus、Embase 和 Science Direct，检索时间为 2022 年 10 月 17 日至 12 月 30 日。此外，还从高级谷歌学术、谷歌搜索和确定的参考文献列表中搜索了相关研究。我们使用 MeSH 浏览器输入关键词：心理干预、抑郁、焦虑、创伤后应激障碍和撒哈拉以南非洲国家列表。我们使用标准布尔运算符（OR、AND）组合词。使用 Cochrane 协作风险偏倚工具评估研究质量，并以叙述性综述呈现结果，因为干预措施非常多样化。
结果
有 14 项随机对照试验被纳入系统评价，其中一半以上（57.14%）来自肯尼亚和尼日利亚。常见的以学校为基础的心理干预措施包括认知行为疗法和 Shamiri 干预（一种侧重于培养青少年成长心态、实践感恩和采取价值观的干预措施）。超过一半（57.14%）的干预措施由非专业人员（如教师、社区卫生工作者）实施。近五分之一的干预措施采用个体模式。与对照组相比，由非专业人员提供的以学校为基础的心理干预措施也能更有效地减轻青少年的抑郁、焦虑和创伤后应激症状。
结论
认知行为疗法和 Shamiri 干预是在学校环境中进行的常见治疗方法。这些干预措施的范围可以由非专业人员有效地实施，从而促进将心理干预措施从这些国家非常稀缺的心理健康专家手中转移出去。
试验注册
Trial Registration：Prospéro CRD42022378372. https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022378372.
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