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Hamdani SU, Huma ZE, Malik A, Nizami AT, Baneen UU, Suleman N, Javed H, Wang D, van Ommeren M, Mazhar S, Khan SA, Minhas FA, Rahman A. Improving psychosocial distress for young adolescents in rural schools of Pakistan: study protocol of a cluster randomised controlled trial. BMJ Open 2022; 12:e063607. [PMID: 36153028 PMCID: PMC9511576 DOI: 10.1136/bmjopen-2022-063607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION Emotional problems are leading contributors to health burden among adolescents worldwide. There is an urgent need for evidence-based psychological interventions for young people. This study aims to evaluate the effectiveness of a school-based, group psychological intervention, Early Adolescent Skills for Emotions (EASE) developed by the WHO to improve psychosocial distress in Pakistani adolescents. METHOD AND ANALYSIS A two-arm, single-blinded, cluster randomised controlled trial, with a wait-list control arm is being conducted in school settings of rural Pakistan. Forty eligible public-school clusters have been randomised (stratified by gender) on a 1:1 allocation ratio into intervention (n=20) and control arm (n=20). Following informed consent, 564 adolescents with psychosocial distress (Youth-reported Paediatric Symptoms Checklist, cut-off ≥28) from 40 schools have been enrolled into the trial (14±3 average cluster size) between 2 November 2021 and 30th November 2021. Participants in the intervention arm will receive EASE in 7-weekly adolescents and 3-biweekly caregivers group sessions in schools. The adolescent sessions involve the components of psychoeducation, stress management, behavioural activation, problem-solving and relapse prevention. Caregivers will receive training to learn and implement active listening; spending quality time and using praise as a strategy to help their children. The primary outcome is reduction in psychosocial distress at 3 months postintervention. Secondary outcomes include symptoms of depression and anxiety, caregiver-adolescent relationship and caregivers' well-being. Outcomes will be assessed at baseline, immediate 1 week and 3-months postintervention. Qualitative process evaluation will explore barriers and facilitators to programme implementation in low-resource school settings. ETHICS Ethics approval has been obtained from Central Ethics Committee of University of Liverpool, UK, Ethics Review Committee of WHO Geneva and from the Institutional Review Board of Human Development Research Foundation (HDRF), Pakistan. DISSEMINATION The findings of the study will be disseminated by WHO and through peer-reviewed publications. TRIAL REGISTRATION NUMBER ISRCTN17755448.
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Affiliation(s)
- Syed Usman Hamdani
- Global Institute of Human Development, Shifa Tameer-e-Millat University, Islamabad, Pakistan
- Department of Primary Care and Mental Health, University of Liverpool Faculty of Health and Life Sciences, Liverpool, UK
- Child and Adolescent Mental Health, Human Development Research Foundation, Islamabad, Pakistan
| | - Zill-E- Huma
- Global Institute of Human Development, Shifa Tameer-e-Millat University, Islamabad, Pakistan
- Department of Primary Care and Mental Health, University of Liverpool Faculty of Health and Life Sciences, Liverpool, UK
- Child and Adolescent Mental Health, Human Development Research Foundation, Islamabad, Pakistan
| | - Aiysha Malik
- Department of Mental Health and Substance Use, World Health Organization, Geneve, Switzerland
| | | | - Um Ul Baneen
- Global Institute of Human Development, Shifa Tameer-e-Millat University, Islamabad, Pakistan
- Child and Adolescent Mental Health, Human Development Research Foundation, Islamabad, Pakistan
| | - Nadia Suleman
- Global Institute of Human Development, Shifa Tameer-e-Millat University, Islamabad, Pakistan
- Child and Adolescent Mental Health, Human Development Research Foundation, Islamabad, Pakistan
| | - Hashim Javed
- Global Institute of Human Development, Shifa Tameer-e-Millat University, Islamabad, Pakistan
- Child and Adolescent Mental Health, Human Development Research Foundation, Islamabad, Pakistan
| | - Duolao Wang
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Mark van Ommeren
- Department of Mental Health and Substance Use, World Health Organization, Geneve, Switzerland
| | - Samra Mazhar
- Noncommunicable Diseases and Mental Health Department, Pakistan Ministry of National Health Services Regulations and Coordination, Islamabad, Pakistan
| | - Shahzad Alam Khan
- Noncommunicable Diseases and Mental Health Department, World Health Organization, Islamabad, Pakistan
| | - Fareed Aslam Minhas
- Global Institute of Human Development, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | - Atif Rahman
- Department of Primary Care and Mental Health, University of Liverpool Faculty of Health and Life Sciences, Liverpool, UK
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Hamdani SU, Warraitch A, Suleman N, Muzzafar N, Minhas FA, Nizami AT, Sikander S, Pringle B, Hamoda HM, Wang D, Rahman A, Wissow LS. Technology-Assisted Teachers' Training to Promote Socioemotional Well-Being of Children in Public Schools in Rural Pakistan. Psychiatr Serv 2021; 72:69-76. [PMID: 32838678 PMCID: PMC7775896 DOI: 10.1176/appi.ps.202000005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND The World Health Organization's (WHO) Eastern Mediterranean Regional Office (EMRO) developed a school mental health program (SMHP) to help reduce the burden of youth mental health problems. Designed in collaboration with international consultants, the SMHP draws on evidence-based interventions to train personnel to identify students in need, respond therapeutically, and engage families in seeking care. METHODS Teams from Pakistan, Egypt, Iran, and Jordan collaborated with the WHO EMRO and British and U.S. universities to form the School Health Implementation Network: Eastern Mediterranean Region (SHINE), a National Institute of Mental Health-funded global mental health hub. SHINE partners used a "theory of change" process to adapt the SMHP to be more readily adopted by school personnel and replicated with fidelity. The adapted SMHP more directly addresses teachers' priorities and uses technology to facilitate training. RESULTS A cluster-randomized implementation effectiveness trial enrolling 960 children ages 8-13 in 80 Pakistani schools will test the adapted SMHP against the original. Children who screen positive on first the teacher and subsequently the parent Strengths and Difficulties Questionnaires (SDQs) will be enrolled and tracked for 9 months. The primary trial outcome is reduction in parent-rated SDQ total difficulties scores. Secondary outcomes include children's well-being, academic performance, absenteeism, and perceived stigma; parent-teacher interaction; teachers' self-efficacy and subjective well-being; and school environment. Implementation outcomes include change in teachers' behavior and sense of program acceptability, cultural appropriateness, feasibility, penetration, and sustainability. NEXT STEPS The trial began in October 2019, and the expected completion date is March 2021. Outcomes will inform dissemination of the SMHP in Pakistan and elsewhere.
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Affiliation(s)
- Syed Usman Hamdani
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, United Kingdom (Hamdani, Huma, Rahman); Institute of Psychiatry, World Health Organization Collaborating Centre for Mental Health Research and Training, Rawalpindi, Pakistan (Hamdani, Minhas, Nizami); Human Development Research Foundation, Islamabad, Pakistan (Hamdani, Huma, Warraitch, Suleman, Muzzafar, Sikander); National Institute of Mental Health, Bethesda, Maryland (Pringle); Department of Psychiatry, Boston Children's Hospital and Harvard Medical School, Boston (Hamoda); Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom (Wang); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Wissow)
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- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, United Kingdom (Hamdani, Huma, Rahman); Institute of Psychiatry, World Health Organization Collaborating Centre for Mental Health Research and Training, Rawalpindi, Pakistan (Hamdani, Minhas, Nizami); Human Development Research Foundation, Islamabad, Pakistan (Hamdani, Huma, Warraitch, Suleman, Muzzafar, Sikander); National Institute of Mental Health, Bethesda, Maryland (Pringle); Department of Psychiatry, Boston Children's Hospital and Harvard Medical School, Boston (Hamoda); Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom (Wang); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Wissow)
| | - Azza Warraitch
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, United Kingdom (Hamdani, Huma, Rahman); Institute of Psychiatry, World Health Organization Collaborating Centre for Mental Health Research and Training, Rawalpindi, Pakistan (Hamdani, Minhas, Nizami); Human Development Research Foundation, Islamabad, Pakistan (Hamdani, Huma, Warraitch, Suleman, Muzzafar, Sikander); National Institute of Mental Health, Bethesda, Maryland (Pringle); Department of Psychiatry, Boston Children's Hospital and Harvard Medical School, Boston (Hamoda); Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom (Wang); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Wissow)
| | - Nadia Suleman
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, United Kingdom (Hamdani, Huma, Rahman); Institute of Psychiatry, World Health Organization Collaborating Centre for Mental Health Research and Training, Rawalpindi, Pakistan (Hamdani, Minhas, Nizami); Human Development Research Foundation, Islamabad, Pakistan (Hamdani, Huma, Warraitch, Suleman, Muzzafar, Sikander); National Institute of Mental Health, Bethesda, Maryland (Pringle); Department of Psychiatry, Boston Children's Hospital and Harvard Medical School, Boston (Hamoda); Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom (Wang); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Wissow)
| | - Naila Muzzafar
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, United Kingdom (Hamdani, Huma, Rahman); Institute of Psychiatry, World Health Organization Collaborating Centre for Mental Health Research and Training, Rawalpindi, Pakistan (Hamdani, Minhas, Nizami); Human Development Research Foundation, Islamabad, Pakistan (Hamdani, Huma, Warraitch, Suleman, Muzzafar, Sikander); National Institute of Mental Health, Bethesda, Maryland (Pringle); Department of Psychiatry, Boston Children's Hospital and Harvard Medical School, Boston (Hamoda); Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom (Wang); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Wissow)
| | - Fareed Aslam Minhas
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, United Kingdom (Hamdani, Huma, Rahman); Institute of Psychiatry, World Health Organization Collaborating Centre for Mental Health Research and Training, Rawalpindi, Pakistan (Hamdani, Minhas, Nizami); Human Development Research Foundation, Islamabad, Pakistan (Hamdani, Huma, Warraitch, Suleman, Muzzafar, Sikander); National Institute of Mental Health, Bethesda, Maryland (Pringle); Department of Psychiatry, Boston Children's Hospital and Harvard Medical School, Boston (Hamoda); Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom (Wang); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Wissow)
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- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, United Kingdom (Hamdani, Huma, Rahman); Institute of Psychiatry, World Health Organization Collaborating Centre for Mental Health Research and Training, Rawalpindi, Pakistan (Hamdani, Minhas, Nizami); Human Development Research Foundation, Islamabad, Pakistan (Hamdani, Huma, Warraitch, Suleman, Muzzafar, Sikander); National Institute of Mental Health, Bethesda, Maryland (Pringle); Department of Psychiatry, Boston Children's Hospital and Harvard Medical School, Boston (Hamoda); Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom (Wang); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Wissow)
| | - Asad Tameezuddin Nizami
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, United Kingdom (Hamdani, Huma, Rahman); Institute of Psychiatry, World Health Organization Collaborating Centre for Mental Health Research and Training, Rawalpindi, Pakistan (Hamdani, Minhas, Nizami); Human Development Research Foundation, Islamabad, Pakistan (Hamdani, Huma, Warraitch, Suleman, Muzzafar, Sikander); National Institute of Mental Health, Bethesda, Maryland (Pringle); Department of Psychiatry, Boston Children's Hospital and Harvard Medical School, Boston (Hamoda); Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom (Wang); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Wissow)
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- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, United Kingdom (Hamdani, Huma, Rahman); Institute of Psychiatry, World Health Organization Collaborating Centre for Mental Health Research and Training, Rawalpindi, Pakistan (Hamdani, Minhas, Nizami); Human Development Research Foundation, Islamabad, Pakistan (Hamdani, Huma, Warraitch, Suleman, Muzzafar, Sikander); National Institute of Mental Health, Bethesda, Maryland (Pringle); Department of Psychiatry, Boston Children's Hospital and Harvard Medical School, Boston (Hamoda); Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom (Wang); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Wissow)
| | - Siham Sikander
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, United Kingdom (Hamdani, Huma, Rahman); Institute of Psychiatry, World Health Organization Collaborating Centre for Mental Health Research and Training, Rawalpindi, Pakistan (Hamdani, Minhas, Nizami); Human Development Research Foundation, Islamabad, Pakistan (Hamdani, Huma, Warraitch, Suleman, Muzzafar, Sikander); National Institute of Mental Health, Bethesda, Maryland (Pringle); Department of Psychiatry, Boston Children's Hospital and Harvard Medical School, Boston (Hamoda); Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom (Wang); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Wissow)
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- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, United Kingdom (Hamdani, Huma, Rahman); Institute of Psychiatry, World Health Organization Collaborating Centre for Mental Health Research and Training, Rawalpindi, Pakistan (Hamdani, Minhas, Nizami); Human Development Research Foundation, Islamabad, Pakistan (Hamdani, Huma, Warraitch, Suleman, Muzzafar, Sikander); National Institute of Mental Health, Bethesda, Maryland (Pringle); Department of Psychiatry, Boston Children's Hospital and Harvard Medical School, Boston (Hamoda); Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom (Wang); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Wissow)
| | - Beverly Pringle
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, United Kingdom (Hamdani, Huma, Rahman); Institute of Psychiatry, World Health Organization Collaborating Centre for Mental Health Research and Training, Rawalpindi, Pakistan (Hamdani, Minhas, Nizami); Human Development Research Foundation, Islamabad, Pakistan (Hamdani, Huma, Warraitch, Suleman, Muzzafar, Sikander); National Institute of Mental Health, Bethesda, Maryland (Pringle); Department of Psychiatry, Boston Children's Hospital and Harvard Medical School, Boston (Hamoda); Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom (Wang); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Wissow)
| | - Hesham M Hamoda
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, United Kingdom (Hamdani, Huma, Rahman); Institute of Psychiatry, World Health Organization Collaborating Centre for Mental Health Research and Training, Rawalpindi, Pakistan (Hamdani, Minhas, Nizami); Human Development Research Foundation, Islamabad, Pakistan (Hamdani, Huma, Warraitch, Suleman, Muzzafar, Sikander); National Institute of Mental Health, Bethesda, Maryland (Pringle); Department of Psychiatry, Boston Children's Hospital and Harvard Medical School, Boston (Hamoda); Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom (Wang); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Wissow)
| | - Duolao Wang
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, United Kingdom (Hamdani, Huma, Rahman); Institute of Psychiatry, World Health Organization Collaborating Centre for Mental Health Research and Training, Rawalpindi, Pakistan (Hamdani, Minhas, Nizami); Human Development Research Foundation, Islamabad, Pakistan (Hamdani, Huma, Warraitch, Suleman, Muzzafar, Sikander); National Institute of Mental Health, Bethesda, Maryland (Pringle); Department of Psychiatry, Boston Children's Hospital and Harvard Medical School, Boston (Hamoda); Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom (Wang); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Wissow)
| | - Atif Rahman
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, United Kingdom (Hamdani, Huma, Rahman); Institute of Psychiatry, World Health Organization Collaborating Centre for Mental Health Research and Training, Rawalpindi, Pakistan (Hamdani, Minhas, Nizami); Human Development Research Foundation, Islamabad, Pakistan (Hamdani, Huma, Warraitch, Suleman, Muzzafar, Sikander); National Institute of Mental Health, Bethesda, Maryland (Pringle); Department of Psychiatry, Boston Children's Hospital and Harvard Medical School, Boston (Hamoda); Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom (Wang); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Wissow)
| | - Lawrence S Wissow
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, United Kingdom (Hamdani, Huma, Rahman); Institute of Psychiatry, World Health Organization Collaborating Centre for Mental Health Research and Training, Rawalpindi, Pakistan (Hamdani, Minhas, Nizami); Human Development Research Foundation, Islamabad, Pakistan (Hamdani, Huma, Warraitch, Suleman, Muzzafar, Sikander); National Institute of Mental Health, Bethesda, Maryland (Pringle); Department of Psychiatry, Boston Children's Hospital and Harvard Medical School, Boston (Hamoda); Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom (Wang); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Wissow)
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