Adapting mental health interventions through employment in Sierra Leone

A total of 80 youth were enrolled in the trial. Overall, the treatment and control groups were equivalent at baseline. There were an equal number of males and females, by design, who were approximately 16 years of age, had similar levels of education, and none were married at the time of the baseline survey.

None of the psychosocial variables tested showed a significant difference between the YRI group and the control group. However, there were a number of trajectories detected across the entire sample, and gender differences in those trajectories. The 25-item Hopkins Symptom Checklist (HSCL) was examined, and showed a tendency for symptoms to decrease over the time of study. However, this effect was more than offset for females, whose scores increased slightly over time. This may be, in part, attributable to participants learning more about emotion identification and feeling more comfortable over time sharing those feelings in the interview.

Several outcomes were measured using the Oxford Measure of Psychological Adjustment (OMPA) scales. The OMPA total problems score increased significantly over time for females. The OMPA internalizing scale showed an increase over time for females, with no statistically significant effect for males. The OMPA externalizing scale also showed an increase in symptoms over time for females without a significant offsetting trend for males, although the magnitude is close to half the trend for females. There were no significant trends over time for the OMPA prosocial or confidence scales. As with the HSCL this may be attributable to participants being able to assess, identify, and speak about their behaviors and emotions. This will need to be examined more fully in our powered trials, as the study is ultimately underpowered; thus small variations in scores have the ability to skew data in a direction that may be misleading. Emotion regulation showed an increase over the period, which is nearly exactly offset for females. Irritability showed an average monthly decrease. The WHODAS manifested a monthly decrease, but with a perfectly offsetting effect for females, who manifested no average monthly change.

The major finding of the qualitative interviews was the need increased levels of support and psychosocial interventions that target vulnerable youth, particularly within the employment sector. Specifically, youth reported that they struggled interacting with others. Facilitators, NGO, multilateral, and government stakeholders reported that youth often struggled to successfully complete programming, but that the intervention resulted in a major change in the youth overall. While we did cultivate strong buy in, stakeholders did not fully understand the nature of evidence based psychosocial interventions prior to the intervention. Data suggests that this intervention was effective and well received by all stakeholders. Many commented that the intervention was a missing link for employment program effectiveness. At the programmatic level, youth and facilitator interviews focused on intervention expectations, experiences, and impact. At the stakeholder level, interviews with individuals within government, multilateral, and non-governmental organizations focused on overall employment program needs and effectiveness, efficacy of targeting, and the addition and integration of psychosocial services into employment programming.

Facilitators and youth both spoke of the impact of the intervention. Facilitators cited specific examples where they saw noticeable change and recounted stories the youth had told them as part of their homework and about their lives. Youth reported being able to achieve or make significant progress towards their goals that often included mending strained or broken relationships and their image in the community, and improving interactions with others.