Osborn Tom L, Ndetei David M, Sacco Pier Luigi, Mutiso Victoria, Sommer Doris
Shamiri Institute, Nairobi, Kenya.
Africa Mental Health Research and Training Foundation, Nairobi, Kenya.
EClinicalMedicine. 2023 Nov 15;66:102288. doi: 10.1016/j.eclinm.2023.102288. eCollection 2023 Dec.
Mental health problems are prevalent among youth in low-resource countries and are further compounded by stigma and limited access to traditional treatments. The need for scalable, accessible, and stigma-free mental health interventions is urgent. We developed and tested Pre-Texts, an arts-literacy intervention that targets adolescent depression and anxiety, in Kenya.
We conducted a universal RCT (Randomized Controlled Trial). Students from Kenyan high schools (N = 235, ages 13-19, 53.19% female) were randomized to either Pre-Texts or a study skills control intervention. Pre-Texts involves the use of a text-such an excerpt from a novel, a physics lesson, or a technical manual-to inspire art-making that is followed by collective reflection on the process of interpretation through artmaking. Participants met daily for a week in groups of 6-12 youths for 1-h sessions. Groups were facilitated by high school graduates trained as lay-providers. This study was pre-registered at the Pan African Clinical Trials Registry (PACTR; registration number: PACTR202111497122432). The trial took place between August 11th 2021 and December 18th 2021.
Pre-Texts produced a greater reduction in depression (d = 0.52, 95% CI [0.19, 0.84]) and anxiety (d = 0.51, 95% CI [0.20, 0.81]) symptoms from baseline to 1-month follow-up compared to the control group. Similarly, in a sub-sample of participants with elevated depression and anxiety symptoms, Pre-Texts produced a greater reduction in depression (d = 1.10, 95% CI [0.46, 1.75]) and anxiety (d = 0.54, 95% CI [-0.07, 1.45]) symptoms.
Our findings suggest that a brief arts-literacy intervention with challenging school material in a group setting, implemented as an afterschool program, can reduce depression and anxiety symptoms in adolescents in Sub-Saharan Africa. Future replication trials with larger sample sizes with extended follow-ups will help assess the strength and sustainability of these effects.
The study was funded by grants from the Mind, Brain, and Behaviour (MBB) Initiative at Harvard University and the Center for African Studies at Harvard University.
心理健康问题在资源匮乏国家的青少年中普遍存在，而耻辱感和传统治疗手段的有限可及性使情况更加复杂。迫切需要可扩展、可及且无耻辱感的心理健康干预措施。我们在肯尼亚开发并测试了“预文本”，这是一种针对青少年抑郁和焦虑的艺术素养干预措施。
我们进行了一项整群随机对照试验。来自肯尼亚高中的学生（N = 235，年龄13 - 19岁，53.19%为女性）被随机分为接受“预文本”干预组或学习技能对照组。“预文本”干预措施包括使用一篇文本，如小说节选、物理课内容或技术手册，来激发艺术创作，随后通过艺术创作对解读过程进行集体反思。参与者以6 - 12名青少年为一组，每天见面一次，每次1小时，共持续一周。小组活动由接受过培训的高中毕业生担任外展服务提供者进行协助。本研究已在泛非临床试验注册中心（PACTR；注册号：PACTR202111497122432）进行了预注册。试验于2021年8月11日至2021年12月18日进行。
与对照组相比，从基线到1个月随访期，“预文本”干预措施使抑郁症状（d = 0.52，95%置信区间[0.19, 0.84]）和焦虑症状（d = 0.51，95%置信区间[0.20, 0.81]）有更大程度的减轻。同样，在抑郁和焦虑症状较高的参与者子样本中，“预文本”干预措施使抑郁症状（d = 1.10，95%置信区间[0.46, 1.75]）和焦虑症状（d = 0.54，95%置信区间[-0.07, 1.45]）有更大程度的减轻。
我们的研究结果表明，作为课后项目实施的、在小组环境中使用具有挑战性的学校材料进行的简短艺术素养干预，可以减轻撒哈拉以南非洲青少年的抑郁和焦虑症状。未来进行更大样本量和更长随访期的重复试验，将有助于评估这些效果的强度和可持续性。
本研究由哈佛大学心智、大脑与行为（MBB）倡议以及哈佛大学非洲研究中心提供的资助。
