School based stepped care TrEatment for adolescent depression in Pakistan- a Sequential Multiple Assignment Randomized Trial (SMART-STEP)

巴基斯坦青少年抑郁症的学校阶梯护理治疗——序贯多重分配随机试验 (SMART-STEP)

• 批准号: 10526449
• 负责人: Siham Sikander
• 金额: $ 50.4万
• 依托单位: SHIFA TAMEER-E-MILLAT UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-14 至 2027-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10526449
• 关键词: Address; Adolescent; Adopted; Advisory Committees; Anxiety; Behavioral; COVID-19 pandemic; Caring; Cognitive Therapy; Communities; Computers; Consult; Counseling; Country; Data; Decision Trees; Development; Development Plans; Early identification; Economics; Effectiveness; Effectiveness of Interventions; Emotional; Ensure; Guidelines; Health; Health Policy; Heterogeneity; Human; Income; Intervention; Knowledge; Life; Low income; Measures; Mediator of activation protein; Mediterranean Region; Mental Depression; Mental Health; Mental Health Services; Mental disorders; National Institute of Mental Health; Pakistan; Parents; Patient Self-Report; Patients; Performance; Personal Satisfaction; Persons; Phase; Prevalence; Problem Solving; Program Sustainability; Psyche structure; Psychosocial Assessment and Care; Questionnaires; Reporting; Research; Research Personnel; Resources; Schools; Sequential Multiple Assignment Randomized Trial; Site; Specialist; Stress; Subgroup; Symptoms; System; Teacher Professional Development; Technology; Therapeutic; Thinking; Time; To specify; Training Programs; Treatment outcome; Well in self; Work; World Health Organization; Youth; aged; anxiety management; base; behavior test; career development; chatbot; child depression; clinical outcome measures; cognitive testing; common symptom; cost effective; cost effectiveness; cost-effectiveness evaluation; depressive symptoms; design; disorder later incidence prevention; dosage; effective intervention; effectiveness evaluation; effectiveness testing; evidence base; experience; feasibility testing; health literacy; improved; optimal treatments; programs; psychoeducation; psychologic; psychological distress; recruit; reduce symptoms; response; scale up; school health; self help; skills; stress management; success; symptom treatment; symptomatic improvement; teacher; treatment as usual; treatment optimization; trial design

Project summary Depression and anxiety (common mental disorders, CMD’s) are the leading contributors to health burden in adolescents worldwide and are associated with adverse outcomes1,2. In Pakistan, the reported prevalence estimates of emotional problems in school going adolescents range between 25%- 35%3,4. Schools have been identified as a scalable platform to bridge the treatment gap for adolescent mental health5,6. However, in Pakistan, no formal system for school-based programs to promote youth mental health exists. To address this unmet need, a President’s Program to Promote Mental Health of Pakistanis, an ambitious plan to scale-up the school based mental health programs to the entire country, was initiated7,8. Under the umbrella of the President’s program and through our NIMH U19 Global Mental Health Research Hub, SHINE (School Health Implementation Network: Eastern Mediterranean Region), we 1) adapted and feasibility tested the WHO School Mental Health Program (SMHP)9 into an online teachers’ training program (Enhanced School Mental Health Program [eSMHP], www.learnwithshine.org) and 2) supported the development and feasibility testing of the Cognitive Behavioral Therapy (CBT) based, WHO STARS (Sustainable Technology for Adolescent to Reduce Stress) self-help chat- bot to address the symptoms of CMDs in adolescents studying in low resource public schools of Pakistan10. Pilot implementation of eSMHP and STARS has identified a need to integrate these interventions into a stepped care package and to determine their optimal delivery sequence to address heterogeneity in the presentation and progression of CMDs’ symptoms over time, and to ensure cost-effective implementation at-scale. Therefore, the aim of the ‘SMART-STEP study’ is to investigate the effectiveness of eSMHP (low intensity and least resource intensive treatment) (vs. Treatment as Usual-TAU) as a front-line treatment to improve the symptoms of depression in adolescents, and STARS self-help chat-bot as an augmentation tactic (second-line treatment) to address early signs of non-response to the eSMHP and TAU. By using Sequential Multiple Assignment Randomized Trial (SMART) design to compare the timing and dosage of these intervention strategies, we will answer ‘what works, for whom, under what conditions and why for adolescent depression’ in public schools of Pakistan. We hypothesize that adolescents who receive the eSMHP will show improved symptoms of depression compared to TAU, and among non-responding adolescents, augmenting eSMHP with the STARS self-help chat- bot (vs. continue with the initial intervention) will improve symptoms of depression from baseline to 9-months. We will begin our work by establishing an External Advisory Committee, consulting stakeholders and engaging young people to guide project implementation. Next, the SMART-STEP trial will investigate the (cost) effectiveness of stepped care package. These research aims are aligned with my research career development plans to become a global mental health expert in optimizing interventions for adolescents with CMDs in low- income communities and are supported by a highly experienced team of co-investigators and consultants.

项目摘要 抑郁和动画（常见的精神疾病，CMD）是伯恩健康的主要贡献者 全世界的青少年，与不良结果相关。1,2。在巴基斯坦，报告的患病率 学校前进的青少年情绪问题的估计范围在25％-35％3,4之间。学校已经 被确定为弥合青少年心理健康治疗差距的可扩展平台5,6。但是，在 巴基斯坦，没有针对促进青年心理健康的学校计划的正式系统。解决这个问题 尚未满足的总统计划促进巴基斯坦人的心理健康计划，这是一项雄心勃勃的计划，旨在扩大规模 启动了基于学校的心理健康计划。7,8。在总统的伞下 计划以及通过NIMH U19全球心理健康研究中心，Shine（学校健康实施） 网络：东地中海地区），我们1）适应性和可行性测试了WHO学校的心理健康 计划（SMHP）9进入在线教师培训计划（增强学校心理健康计划[ESMHP]， www.learnwithshine.org）和2）支持认知行为的发展和可行性测试 基于治疗（CBT），明星（青少年可持续技术减轻压力）自助聊天 - 在巴基斯坦低资源公立学校学习的青少年研究中CMD的症状的机器人。 ESMHP和Stars的飞行员实施已经确定需要将这些干预措施整合到阶梯中 护理包并确定其最佳交付顺序，以解决演示文稿中的异质性和 随着时间的推移，CMDS症状的进展，并确保实施成本效益。因此， “智能步骤研究”的目的是研究ESMHP的有效性（低强度和最少的资源） 强化治疗）（与往常一样治疗）作为一线治疗，以改善 青少年的抑郁症和明星自助聊天机作为增强策略（二线治疗） 地址ESMHP和TAU的早期迹象。通过使用顺序多重分配 随机试验（智能）设计以比较这些干预策略的时间和剂量，我们将 在公立学校 巴基斯坦。我们假设接受ESMHP的青少年将显示出改善的抑郁症状 与tau和无反应的青少年相比，与星星自助聊天一起增强ESMHP 机器人（vs.继续进行初始干预）将改善从基线到9个月的抑郁症状。 我们将通过成立外部咨询委员会，咨询利益相关者并参与的外部咨询委员会开始我们的工作 指导项目实施的年轻人。接下来，智能步骤试验将调查（成本） 阶梯护理包的有效性。这些研究目标与我的研究职业发展保持一致 计划成为全球心理健康专家，以优化低 - 中CMD的青少年干预措施 收入社区，并得到经验丰富的共同投资者和顾问团队的支持。