津巴布韦青少年精神障碍干预措施的整群随机试验。

A cluster-randomized trial of interventions for adolescent mental disorders in Zimbabwe.

作者信息

Beji-Chauke Rhulani, Simms Victoria, Abas Melanie, Muzariri Kelly, Mavhu Webster, Mangenah Collin, Verhey Ruth, Chiriseri Ephraim, Dambi Jermaine M, Araya Ricardo, Weiss Helen A, Cowan Frances M, Chibanda Dixon

机构信息

Friendship Bench Zimbabwe, 4 Weale Rd, Milton Park, Harare, Email, Zimbabwe.

MRC International Statistics and Epidemiology Group, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.

出版信息

BMC Psychiatry. 2025 Jul 2;25(1):673. doi: 10.1186/s12888-025-06755-x.

DOI:10.1186/s12888-025-06755-x

PMID:40604530

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12220635/

Abstract

PURPOSE

Young people have low uptake of mental health. We compared two task-shifted mental health care models, i.e., adult Friendship Bench (FB) delivered by community health workers and Youth Friendship Bench (YouFB) delivered by trained university students in Harare, Zimbabwe. We hypothesised that the peer-delivered YouFB would have greater uptake and effectiveness in managing common mental disorders (CMDs) in 16-19-year-olds compared to the standard FB model. We also aimed to evaluate the reach, fidelity, acceptability and cost of the YouFB compared to standard FB.

METHODS

We conducted an open-label cluster-randomised, hybrid type-2 implementation trial with cost analysis in 26 primary care clinics and their surrounding communities. Facilities were randomised 1:1 to FB or YouFB. The primary implementation outcome was uptake, defined as the proportion of adolescents aged 16-19 offered FB sessions for treatment of CMD who completed at least one FB session. Secondary implementation outcomes included reach, fidelity, and acceptability. The main clinical outcome was the clinical effectiveness of YouFB vs. FB at six months, assessed by changes in Shona Symptom Questionnaire (SSQ-14) scores. We also carried out a cost analysis from a societal perspective. Acceptability was evaluated qualitatively using in-depth interviews. Reach was calculated as the number of adolescents receiving FB sessions per clinic day.

RESULTS

Uptake in the FB and YouFB arms was 86.6% (187/216) and 95.6% (220/230), respectively (primary outcome). The number of completed FB sessions (feasibility) was higher in the YouFB arm than the FB arm (cluster-level mean prevalence 96.7% vs. 85.8%, prevalence ratio = 1.13; 95% CI:0.98-1.30). Among 528 trial participants, adjusting for baseline score, gender, education, marital status, employment and HIV status, the proportion of participants with SSQ-14 score ≥ 8 was similar by arm after six months, adjusted odds ratio = 0.65 (95% CI: 0.36-1.17). Total program costs were higher in the YouFB arm. Process evaluation found the YouFB to be highly acceptable.

CONCLUSIONS

A youth-focused Friendship Bench intervention is feasible and acceptable. Recipients highly valued the ability to connect with a same-age peer and its easy accessibility. However, further intervention optimisation is needed to improve its clinical and cost-effectiveness.

TRIAL REGISTRATION

This trial was prospectively registered on 21/08/2018 with the Pan African Clinical Trial Registry database. Registration no PACTR201808181810124.

摘要

目的

年轻人对心理健康服务的利用率较低。我们比较了两种任务转移型心理健康护理模式，即由社区卫生工作者提供的成人友谊长椅（FB）模式和由津巴布韦哈拉雷受过培训的大学生提供的青年友谊长椅（YouFB）模式。我们假设，与标准FB模式相比，由同龄人提供的YouFB模式在管理16至19岁青少年的常见精神障碍（CMD）方面将具有更高的利用率和有效性。我们还旨在评估YouFB模式与标准FB模式相比的覆盖范围、保真度、可接受性和成本。

方法

我们在26家初级保健诊所及其周边社区进行了一项开放标签的整群随机、混合型2实施试验，并进行了成本分析。医疗机构被随机分为1:1的FB组或YouFB组。主要实施结果是利用率，定义为16至19岁被提供FB治疗CMD的青少年中完成至少一次FB治疗的比例。次要实施结果包括覆盖范围、保真度和可接受性。主要临床结果是六个月时YouFB与FB的临床有效性，通过绍纳症状问卷（SSQ - 14）评分的变化进行评估。我们还从社会角度进行了成本分析。使用深入访谈对可接受性进行定性评估。覆盖范围计算为每个诊所日接受FB治疗的青少年人数。

结果

FB组和YouFB组的利用率分别为86.6%（187/216）和95.6%（220/230）（主要结果）。YouFB组完成的FB治疗次数（可行性）高于FB组（整群水平平均患病率96.7%对85.8%，患病率比 = 1.13；95% CI：0.98 - 1.30）。在528名试验参与者中，在调整基线评分、性别、教育程度、婚姻状况、就业和艾滋病毒感染状况后，六个月后两组中SSQ - 14评分≥8的参与者比例相似，调整后的优势比 = 0.65（95% CI：0.36 - 1.17）。YouFB组的总项目成本更高。过程评估发现YouFB模式非常可接受。