Effectiveness and costs associated with a lay counselor–delivered, brief problem-solving mental health intervention for adolescents in urban, low-income schools in India

Autor: Rooplata Sahu, Kanika Malik, E J James, Sonal Mathur, Helen A. Weiss, Giulia Greco, Aoife M. Doyle, Pim Cuijpers, Bruce F. Chorpita, Paulomi M. Sudhir, Daniel Michelson, Michael King, Vikram Patel, Christopher G. Fairburn
Přispěvatelé: Clinical Psychology, World Health Organization (WHO) Collaborating Center, APH - Global Health, APH - Mental Health
Jazyk: angličtina
Rok vydání: 2021
Předmět:
Counseling
Male
Urban Population
Psychological intervention
Social Sciences
Adolescents
law.invention
Geographical Locations
Families
0302 clinical medicine
Randomized controlled trial
Sociology
law
Medicine and Health Sciences
Medicine
Psychology
030212 general & internal medicine
Children
Problem Solving
Schools
Mental Disorders
General Medicine
Strengths and Difficulties Questionnaire
3. Good health
Distress
Clinical Psychology
Outcome and Process Assessment
Health Care
Caregivers
Costs and Cost Analysis
Female
Psychosocial
Research Article
medicine.medical_specialty
Asia
Adolescent
Psychological Stress
India
Education
03 medical and health sciences
Intervention (counseling)
Mental Health and Psychiatry
Humans
Poverty
Psychological and Psychosocial Issues
business.industry
Cognitive Psychology
Repeated measures design
Biology and Life Sciences
Mental health
030227 psychiatry
Health Care
Age Groups
People and Places
Physical therapy
Cognitive Science
Population Groupings
business
Neuroscience
Follow-Up Studies
Zdroj: PLoS Medicine
Malik, K, Michelson, D, Doyle, A M, Weiss, H A, Greco, G, Sahu, R, James, E J, Mathur, S, Sudhir, P, King, M, Cuijpers, P, Chorpita, B, Fairburn, C G & Patel, V 2021, ' Effectiveness and costs associated with a lay counselor–delivered, brief problem-solving mental health intervention for adolescents in urban, low-income schools in India : 12-month outcomes of a randomized controlled trial ', PLoS Medicine, vol. 18, no. 9, e1003778, pp. 1-19 . https://doi.org/10.1371/journal.pmed.1003778
PLoS Medicine, 18(9):e1003778, 1-19. Nature Publishing Group
PLoS Medicine, Vol 18, Iss 9, p e1003778 (2021)
ISSN: 1549-1676
1549-1277
0363-0471
Popis: Background Psychosocial interventions for adolescent mental health problems are effective, but evidence on their longer-term outcomes is scarce, especially in low-resource settings. We report on the 12-month sustained effectiveness and costs of scaling up a lay counselor–delivered, transdiagnostic problem-solving intervention for common adolescent mental health problems in low-income schools in New Delhi, India. Methods and findings Participants in the original trial were 250 school-going adolescents (mean [M] age = 15.61 years, standard deviation [SD] = 1.68), including 174 (69.6%) who identified as male. Participants were recruited from 6 government schools over a period of 4 months (August 20 to December 14, 2018) and were selected on the basis of elevated mental health symptoms and distress/functional impairment. A 2-arm, randomized controlled trial design was used to examine the effectiveness of a lay counselor–delivered, problem-solving intervention (4 to 5 sessions over 3 weeks) with supporting printed booklets (intervention arm) in comparison with problem solving delivered via printed booklets alone (control arm), at the original endpoints of 6 and 12 weeks. The protocol was modified, as per the recommendation of the Trial Steering Committee, to include a post hoc extension of the follow-up period to 12 months. Primary outcomes were adolescent-reported psychosocial problems (Youth Top Problems [YTP]) and mental health symptoms (Strengths and Difficulties Questionnaire [SDQ] Total Difficulties scale). Other self-reported outcomes included SDQ subscales, perceived stress, well-being, and remission. The sustained effects of the intervention were estimated at the 12-month endpoint and over 12 months (the latter assumed a constant effect across 3 follow-up points) using a linear mixed model for repeated measures and involving complete case analysis. Sensitivity analyses examined the effect of missing data using multiple imputations. Costs were estimated for delivering the intervention during the trial and from modeling a scale-up scenario, using a retrospective ingredients approach. Out of the 250 original trial participants, 176 (70.4%) adolescents participated in the 12-month follow-up assessment. One adverse event was identified during follow-up and deemed unrelated to the intervention. Evidence was found for intervention effects on both SDQ Total Difficulties and YTP at 12 months (YTP: adjusted mean difference [AMD] = −0.75, 95% confidence interval [CI] = −1.47, −0.03, p = 0.04; SDQ Total Difficulties: AMD = −1.73, 95% CI = −3.47, 0.02, p = 0.05), with stronger effects over 12 months (YTP: AMD = −0.98, 95% CI = −1.51, −0.45, p < 0.001; SDQ Total Difficulties: AMD = −1.23, 95% CI = −2.37, −0.09; p = 0.03). There was also evidence for intervention effects on internalizing symptoms, impairment, perceived stress, and well-being over 12 months. The intervention effect was stable for most outcomes on sensitivity analyses adjusting for missing data; however, for SDQ Total Difficulties and impairment, the effect was slightly attenuated. The per-student cost of delivering the intervention during the trial was $3 United States dollars (USD; or $158 USD per case) and for scaling up the intervention in the modeled scenario was $4 USD (or $23 USD per case). The scaling up cost accounted for 0.4% of the per-student school budget in New Delhi. The main limitations of the study’s methodology were the lack of sample size calculations powered for 12-month follow-up and the absence of cost-effectiveness analyses using the primary outcomes. Conclusions In this study, we observed that a lay counselor–delivered, brief transdiagnostic problem-solving intervention had sustained effects on psychosocial problems and mental health symptoms over the 12-month follow-up period. Scaling up this resource-efficient intervention is an affordable policy goal for improving adolescents’ access to mental health care in low-resource settings. The findings need to be interpreted with caution, as this study was a post hoc extension, and thus, the sample size calculations did not take into account the relatively high attrition rate observed during the long-term follow-up. Trial registration ClinicalTrials.gov NCT03630471.
Kanika Malik, Daniel Michelson, and colleagues study the sustained effectiveness of a lay counsellor-delivered problem solving intervention to mental health of adolescents enrolled in low-income schools in New Delhi, India.
Author summary Why was this study done? The PRemIum for aDolEscents (PRIDE) is a research program that aims to develop a transdiagnostic, stepped care intervention model to address common adolescent mental health problems (anxiety, depression, and conduct difficulties) in low-resource settings. The intervention model comprises a brief problem-solving intervention (“Step 1”), followed by a higher-intensity personalized psychological treatment (“Step 2”) for adolescents with persistent problems. We previously reported on short-term outcomes from a randomized controlled trial of the first-line problem-solving intervention delivered by lay counselors in secondary schools serving low-income communities in New Delhi, India. The current study examined the sustained effectiveness and costs of scaling up the counselor-led problem-solving intervention compared to printed problem-solving materials without counselor input. What did the researchers do and find? We followed up the original trial participants at 12 months after randomization and collected adolescent-reported outcomes, as well as data on intervention costs using a retrospective ingredients approach. The primary analysis showed sustained intervention effects on both psychosocial problems and mental health symptoms. The economic analysis showed that the counselor-led problem-solving intervention can be scaled up at a small percentage of the per-student budgetary allocation in government-run schools in New Delhi, India. What do these findings mean? Despite its brevity and delivery by lay counselors, the problem-solving intervention showed sustained effectiveness. Scaling up this low-cost intervention represents an affordable policy goal for improving access to school-based mental health care for adolescents in India and, potentially, in other low-resource settings.
Databáze: OpenAIRE
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