Innovation summary

The global population of young people exceeds one billion, with almost 90% residing in low to middle income countries. Depressive, anxiety and conduct disorders (the 'common mental disorders') account for over 75% of the burden of mental disorders in this age group. A considerable body of evidence suggests that psychological treatments are effective for treating mental disorders in adolescents -- however, the vast majority of young people do not receive these treatments (for reasons including availability of only non-specialized health workers, cultural explanations, and low demand for mental health care).1-11

The goal of PRIDE is to develop and evaluate a STEPPED CARE psychosocial intervention12 - consisting of a combination of self-care delivered through a digital app (STEP 1) and counselling  delivered by counsellors (STEP 2) - targeting common mental disorders in school-going adolescents in India. The development of the psychological intervention will follow a systematic methodology adopted from  an ongoing project, the Program for Effective Mental Health Interventions in Under-resourced settings (PREMIUM).13- 16 The intervention adopts a personalised transdiagnostic approach, incorporates strategies to address the contextual factors associated with the risk and maintenance of mental health problems, and uses information technology throughout the intervention from training to delivery. 

Impact summary

  • Access to ~800,000 school going adolescents in Delhi and Goa; recruitment aim of ~800 in control and intervention arms
  • Planned evaluation of effectiveness in reducing symptom severity and improving recovery rates in adolescents
  • Development of a digital manual on techniques to engage the adolescent (or parent) and delivery of specific strategies, using algorithms to devise a tailored intervention plan

Innovation details

The program will follow two broad phases of research, based on methodologies which have been developed by PREMIUM and other investigators to adapt psychological treatments for cross-cultural use.

Phase One: Intervention development

This phase is anticipated to require about 2.5 years. The objectives of the first phase are to define the theoretical framework for the intervention and to test the delivery of the intervention.

The development of the intervention will follow five guiding principles. The intervention will be:

  • Transdiagnostic, designed for a range of common mental health problems
  • Delivered in a personalized manner, using technology enabled self-care and decision support algorithms for counselors which guide the use of specific modules
  • Able to adapt to clinical problems in real time, tailored to address problems with engagement, comorbidity and rate of progress
  • Able to target mechanisms operating at multiple levels (notably individual psychological phenomena, peer and care-giver/parental relationships) consistent with evidence of the effectiveness of ecologically based interventions
  • Guided by both global evidence and contextually relevant practice

Phase Two: RCT

The second phase consists of a randomised controlled trial to evaluate the effectiveness and cost-effectiveness of the stepped care intervention delivered by combining self-care and face-to-face psychological treatment by trained counsellors to school-based adolescents compared with enhanced usual care.

 

Key drivers

Involvement of Local Governmental Agencies

The 2 project sites (Delhi and Goa) have initiated constant contact with the Ministries of Health and Education to ensure government are aware of project activities. Through their involvement, the project can look towards sustainability even after the funding period expires. Moreover, the research project is designed in line with the national RKSK program for adolescent health launched by the Ministry of Health, India in 2014.

Involvement of Sangath and PHFI

Sangath is the leading mental health research NGO headquartered in the state of Goa, while the Public Health Foundation of India (PHFI) is the leading public-private research/teaching institution headquartered in New Delhi. Both institutions were recently ranked as part of top public health research institutions in India. Both institutions will provide access to over 800,000 adolescents.

Continuation

The research project is designed, implemented and evaluated in such a manner to maximize scalability. It will serve as a model for future expansion of mental health interventions to young people all over India, and within similar settings elsewhere globally. Future plans are to replicate the project in other parts of India and many other similar locations in the world.

Partners

Funders

Key Partners 

Evaluation methods

The final phase of the intervention involves conducting a randomised controlled trial to evaluate the effectiveness and cost-effectiveness of this intervention compared with enhanced usual care. The evaluation of the trial will adopt a mixed methods evaluation strategy of mental health outcomes, intervention adherence and quality, intervention engagement and satisfaction, and trial indicators related to enrolment and attrition.

Cost of implementation

To be evaluated.

Impact details

To be evaluated.

References

1. Gore FM, Bloem PJ, Patton GC, Ferguson J, Joseph V, Coffey C, Sawyer SM, Mathers CD: Global burden of disease in young people aged 10-24 years: a systematic analysis. Lancet 2011, 377(9783):2093-2102.

2. Patel V, Flisher AJ, Hetrick S, McGorry P: Mental health of young people: a global public-health challenge. Lancet 2007, 369(9569):1302-1313.

3. Jones PB: Adult mental health disorders and their age at onset. The British journal of psychiatr Supplement 2013, 54:s5-10. [Anchor]

4. Chorpita BF D, E. L., Ebesutani, C., Young, J. Becker, K. D., Nakamura, B. J. Phillips, L., Hershberger, A., Stumpf, R., Trent, L., Smith, R. L., Okamura, K., Starace, N.: Evidence-based treatments for children and adolescents: An updated review of indicators of efficacy and effectiveness. . Clinical Psychology: Science and Practice 2011, 18:153-171.

5. Weisz JR, Kuppens S, Eckshtain D, Ugueto AM, Hawley KM, Jensen-Doss A: Performance of evidence-based youth psychotherapies compared with usual clinical care: a multilevel meta-analysis. JAMA psychiatry 2013, 70(7):750-761.

6. Ehrenreich-May J BE: The Development of a Transdiagnostic, Cognitive Behavioral Group Intervention for Childhood Anxiety Disorders and Co-Occurring Depression Symptoms Cognitive and Behavioral Practice 2012, 19:41-55.

7.  Green H MA, Meltzer H, Ford T, Goodman R: Mental health of children and young people. London: Palgrave MacMillan; 2005.

8. Chorpita BF, Daleiden EL: Mapping evidence-based treatments for children and adolescents: application of the distillation and matching model to 615 treatments from 322 randomized trials. Journal of consulting and clinical psychology 2009, 77(3):566-579.

9. Murray LK, Dorsey S, Haroz E, Lee C, Alsiary MM, Haydary A, Weiss WM, Bolton P: A Common Elements Treatment Approach for Adult Mental Health Problems in Low- and Middle-Income Countries. Cognitive and behavioral practice 2014, 21(2):111-123.

10. Weisz JR, Chorpita BF, Palinkas LA, Schoenwald SK, Miranda J, Bearman SK, Daleiden EL, Ugueto AM, Ho A, Martin J et al: Testing standard and modular designs for psychotherapy treating depression, anxiety, and conduct problems in youth: a randomized effectiveness trial. Archives of general psychiatry 2012, 69(3):274-282. [Anchor]

11. Patel V: The need for treatment evidence for common mental disorders in developing countries. Psychol Med 2000, 30(4):743-746.

12. Murray, L. K. and M. J. D. Jordans (2016). "Rethinking the service delivery system of psychological interventions in low and middle income countries." BMC Psychiatry 16(1): 1-6.

13. Patel V, Weobong B, Nadkarni A, Weiss HA, Anand A, Naik S, Bhat B, Pereira J, Araya R, Dimidjian S et al: The effectiveness and cost-effectiveness of lay counsellor-delivered psychological treatments for harmful and dependent drinking and moderate to severe depression in primary care in India: PREMIUM study protocol for randomized controlled trials. Trials 2014, 15(1):101.

14. Nadkarni A, Velleman R, Dabholkar H, Shinde S, Bhat B, McCambridge J, Murthy P, Wilson TWeobong B, Patel V: The Systematic Development and Pilot Randomized Evaluation of Counselling for Alcohol Problems, a Lay Counselor-Delivered Psychological Treatment for Harmful Drinking in Primary Care in India: The PREMIUM Study. Alcoholism, clinical and experimental research 2015, 39(3):522-531.

15. Chowdhary NA, A; Dimijian, S; Shinde, S; Weobong, B; Balaji, M; Rahman, A; Verdeli, H; Araya, R; King, M; Jordans, M; Fairburn, C; Kirkwood, B; Patel, V: The Healthy Activity Program lay counsellor delivered treatment for severe depression in India: systematic development and randomised evaluation. The British Journal of Psychiatry, Accepted 2015.

16. Vellakkal, S. and V. Patel (2015). "Designing Psychological Treatments for Scalability: The PREMIUM Approach." PLoS ONE 10(7): e0134189.

Research

Multimedia

Reports

Associates

Vikram Patel Project PI
Vikas Choudhry Project Director
Daniel Michelson Intervention Co-director
Pattie Gonsalves Project Coordinator, Public Engagement
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Country

India

Affiliated organizations

It’s Ok To Talk
Public Health Foundation of India
Sangath

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