Katherine E. Venturo-Conerly MA , Tom L. Osborn BA , Thomas Rusch PhD , Brenda Kemuma Ochuku MA , Natalie E. Johnson MPH , Afra van der Markt MD, PhD , Christine M. Wasanga PhD , John R. Weisz PhD
{"title":"在 COVID-19 大流行期间对肯尼亚青少年进行 Shamiri 干预措施及其组成部分的测试：五臂随机对照试验的结果。","authors":"Katherine E. Venturo-Conerly MA , Tom L. Osborn BA , Thomas Rusch PhD , Brenda Kemuma Ochuku MA , Natalie E. Johnson MPH , Afra van der Markt MD, PhD , Christine M. Wasanga PhD , John R. Weisz PhD","doi":"10.1016/j.jaac.2024.04.015","DOIUrl":null,"url":null,"abstract":"<div><h3>Objective</h3><div>Mental health problems are prevalent among African adolescents, but professional treatment capacity is limited. Shamiri, an efficient lay provider–delivered intervention, has significantly reduced depression and anxiety symptoms in previous randomized controlled trials (RCTs). This trial investigated effects of the full Shamiri intervention and its components (growth-only, gratitude-only, and values-only) against a study skills control.</div></div><div><h3>Method</h3><div>In a 5-group RCT with adolescents from Kenyan high schools, anxiety, depression, and well-being were self-reported through 8-month follow-up. The RCT occurred immediately after an unanticipated government-mandated COVID-19 shutdown forced 3 years of schoolwork into 2 years, escalating academic pressures.</div></div><div><h3>Results</h3><div>Participants (N = 1,252; 48.72% female) were allocated to: growth (n = 249), gratitude (n = 237), values (n = 265), Shamiri (n = 250), and study skills (n = 251) conditions. Longitudinal multilevel models showed that, across all conditions, anxiety scores significantly improved at midpoint (<em>B</em> = −0.847), end point (<em>B</em> = −2.948), 1-month (<em>B</em> = −1.587), 3-month (<em>B</em> = −2.374), and 8-month (<em>B</em> = −1.917) follow-ups. Depression scores also improved significantly at midpoint (<em>B</em> = −0.796), end point (<em>B</em> = −3.126), 1-month (<em>B</em> = −2.382), 3-month (<em>B</em> = −2.521), and 8-month (<em>B</em> = −2.237) follow-ups. Well-being scores improved significantly at midpoint (<em>B</em> = 1.73), end point (<em>B</em> = 3.44), 1-month (<em>B</em> = 2.21), 3-month (<em>B</em> = 1.78), and 8-month (<em>B</em> = 1.59) follow-ups. Symptom reduction with Shamiri matched that of pre–COVID-19 trials, but symptom reduction with study skills far outpaced that of trials before the COVID-19–related school shutdown (31% greater anxiety reduction and 60% greater depression reduction). Thus, in contrast to previous RCTs, this COVID-19–era trial showed no significant differences between outcomes in any intervention and active control groups.</div></div><div><h3>Conclusion</h3><div>Our RCT conducted during a post–COVID-19 period of heightened academic pressure produced unexpected results. Improvements in youth-reported anxiety and depression were consistent with previous trials for Shamiri, but markedly larger than in previous trials for study skills. Control interventions teaching life skills may produce mental health benefits when they convey skills of particular contextual relevance.</div></div><div><h3>Plain language summary</h3><div>In this large 5-group randomized controlled trial involving 1,252 Kenyan adolescents, the authors compared the Shamiri intervention to its component interventions (growth mindset, gratitude, and values affirmation) and a study-skills control. This study was conducted right after an unanticipated government-mandated COVID-19 shutdown forced 3 years of schoolwork into 2 years. Benchmarking analyses against previous trials showed approximately equal effects of Shamiri over time, but a 31% greater anxiety reduction and 60% greater depression reduction for the study-skills condition. These findings highlight the potential of teaching highly relevant study-skills for improving mental health when youth are under considerable academic pressure.</div></div><div><h3>Clinical trial registration</h3><div>Five-Arm Shamiri Trial; <span><span>https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=14677</span><svg><path></path></svg></span></div></div>","PeriodicalId":17186,"journal":{"name":"Journal of the American Academy of Child and Adolescent Psychiatry","volume":"64 7","pages":"Pages 786-798"},"PeriodicalIF":9.5000,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Testing the Shamiri Intervention and Its Components With Kenyan Adolescents During the COVID-19 Pandemic: Outcomes of a Universal, 5-Arm Randomized Controlled Trial\",\"authors\":\"Katherine E. Venturo-Conerly MA , Tom L. Osborn BA , Thomas Rusch PhD , Brenda Kemuma Ochuku MA , Natalie E. Johnson MPH , Afra van der Markt MD, PhD , Christine M. Wasanga PhD , John R. Weisz PhD\",\"doi\":\"10.1016/j.jaac.2024.04.015\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Objective</h3><div>Mental health problems are prevalent among African adolescents, but professional treatment capacity is limited. Shamiri, an efficient lay provider–delivered intervention, has significantly reduced depression and anxiety symptoms in previous randomized controlled trials (RCTs). This trial investigated effects of the full Shamiri intervention and its components (growth-only, gratitude-only, and values-only) against a study skills control.</div></div><div><h3>Method</h3><div>In a 5-group RCT with adolescents from Kenyan high schools, anxiety, depression, and well-being were self-reported through 8-month follow-up. The RCT occurred immediately after an unanticipated government-mandated COVID-19 shutdown forced 3 years of schoolwork into 2 years, escalating academic pressures.</div></div><div><h3>Results</h3><div>Participants (N = 1,252; 48.72% female) were allocated to: growth (n = 249), gratitude (n = 237), values (n = 265), Shamiri (n = 250), and study skills (n = 251) conditions. Longitudinal multilevel models showed that, across all conditions, anxiety scores significantly improved at midpoint (<em>B</em> = −0.847), end point (<em>B</em> = −2.948), 1-month (<em>B</em> = −1.587), 3-month (<em>B</em> = −2.374), and 8-month (<em>B</em> = −1.917) follow-ups. Depression scores also improved significantly at midpoint (<em>B</em> = −0.796), end point (<em>B</em> = −3.126), 1-month (<em>B</em> = −2.382), 3-month (<em>B</em> = −2.521), and 8-month (<em>B</em> = −2.237) follow-ups. Well-being scores improved significantly at midpoint (<em>B</em> = 1.73), end point (<em>B</em> = 3.44), 1-month (<em>B</em> = 2.21), 3-month (<em>B</em> = 1.78), and 8-month (<em>B</em> = 1.59) follow-ups. Symptom reduction with Shamiri matched that of pre–COVID-19 trials, but symptom reduction with study skills far outpaced that of trials before the COVID-19–related school shutdown (31% greater anxiety reduction and 60% greater depression reduction). Thus, in contrast to previous RCTs, this COVID-19–era trial showed no significant differences between outcomes in any intervention and active control groups.</div></div><div><h3>Conclusion</h3><div>Our RCT conducted during a post–COVID-19 period of heightened academic pressure produced unexpected results. Improvements in youth-reported anxiety and depression were consistent with previous trials for Shamiri, but markedly larger than in previous trials for study skills. Control interventions teaching life skills may produce mental health benefits when they convey skills of particular contextual relevance.</div></div><div><h3>Plain language summary</h3><div>In this large 5-group randomized controlled trial involving 1,252 Kenyan adolescents, the authors compared the Shamiri intervention to its component interventions (growth mindset, gratitude, and values affirmation) and a study-skills control. This study was conducted right after an unanticipated government-mandated COVID-19 shutdown forced 3 years of schoolwork into 2 years. Benchmarking analyses against previous trials showed approximately equal effects of Shamiri over time, but a 31% greater anxiety reduction and 60% greater depression reduction for the study-skills condition. These findings highlight the potential of teaching highly relevant study-skills for improving mental health when youth are under considerable academic pressure.</div></div><div><h3>Clinical trial registration</h3><div>Five-Arm Shamiri Trial; <span><span>https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=14677</span><svg><path></path></svg></span></div></div>\",\"PeriodicalId\":17186,\"journal\":{\"name\":\"Journal of the American Academy of Child and Adolescent Psychiatry\",\"volume\":\"64 7\",\"pages\":\"Pages 786-798\"},\"PeriodicalIF\":9.5000,\"publicationDate\":\"2025-07-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of the American Academy of Child and Adolescent Psychiatry\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0890856724003095\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/6/6 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q1\",\"JCRName\":\"PEDIATRICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of the American Academy of Child and Adolescent Psychiatry","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0890856724003095","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/6/6 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"PEDIATRICS","Score":null,"Total":0}
Testing the Shamiri Intervention and Its Components With Kenyan Adolescents During the COVID-19 Pandemic: Outcomes of a Universal, 5-Arm Randomized Controlled Trial
Objective
Mental health problems are prevalent among African adolescents, but professional treatment capacity is limited. Shamiri, an efficient lay provider–delivered intervention, has significantly reduced depression and anxiety symptoms in previous randomized controlled trials (RCTs). This trial investigated effects of the full Shamiri intervention and its components (growth-only, gratitude-only, and values-only) against a study skills control.
Method
In a 5-group RCT with adolescents from Kenyan high schools, anxiety, depression, and well-being were self-reported through 8-month follow-up. The RCT occurred immediately after an unanticipated government-mandated COVID-19 shutdown forced 3 years of schoolwork into 2 years, escalating academic pressures.
Results
Participants (N = 1,252; 48.72% female) were allocated to: growth (n = 249), gratitude (n = 237), values (n = 265), Shamiri (n = 250), and study skills (n = 251) conditions. Longitudinal multilevel models showed that, across all conditions, anxiety scores significantly improved at midpoint (B = −0.847), end point (B = −2.948), 1-month (B = −1.587), 3-month (B = −2.374), and 8-month (B = −1.917) follow-ups. Depression scores also improved significantly at midpoint (B = −0.796), end point (B = −3.126), 1-month (B = −2.382), 3-month (B = −2.521), and 8-month (B = −2.237) follow-ups. Well-being scores improved significantly at midpoint (B = 1.73), end point (B = 3.44), 1-month (B = 2.21), 3-month (B = 1.78), and 8-month (B = 1.59) follow-ups. Symptom reduction with Shamiri matched that of pre–COVID-19 trials, but symptom reduction with study skills far outpaced that of trials before the COVID-19–related school shutdown (31% greater anxiety reduction and 60% greater depression reduction). Thus, in contrast to previous RCTs, this COVID-19–era trial showed no significant differences between outcomes in any intervention and active control groups.
Conclusion
Our RCT conducted during a post–COVID-19 period of heightened academic pressure produced unexpected results. Improvements in youth-reported anxiety and depression were consistent with previous trials for Shamiri, but markedly larger than in previous trials for study skills. Control interventions teaching life skills may produce mental health benefits when they convey skills of particular contextual relevance.
Plain language summary
In this large 5-group randomized controlled trial involving 1,252 Kenyan adolescents, the authors compared the Shamiri intervention to its component interventions (growth mindset, gratitude, and values affirmation) and a study-skills control. This study was conducted right after an unanticipated government-mandated COVID-19 shutdown forced 3 years of schoolwork into 2 years. Benchmarking analyses against previous trials showed approximately equal effects of Shamiri over time, but a 31% greater anxiety reduction and 60% greater depression reduction for the study-skills condition. These findings highlight the potential of teaching highly relevant study-skills for improving mental health when youth are under considerable academic pressure.
期刊介绍：
The Journal of the American Academy of Child & Adolescent Psychiatry (JAACAP) is dedicated to advancing the field of child and adolescent psychiatry through the publication of original research and papers of theoretical, scientific, and clinical significance. Our primary focus is on the mental health of children, adolescents, and families.
We welcome unpublished manuscripts that explore various perspectives, ranging from genetic, epidemiological, neurobiological, and psychopathological research, to cognitive, behavioral, psychodynamic, and other psychotherapeutic investigations. We also encourage submissions that delve into parent-child, interpersonal, and family research, as well as clinical and empirical studies conducted in inpatient, outpatient, consultation-liaison, and school-based settings.
In addition to publishing research, we aim to promote the well-being of children and families by featuring scholarly papers on topics such as health policy, legislation, advocacy, culture, society, and service provision in relation to mental health.
At JAACAP, we strive to foster collaboration and dialogue among researchers, clinicians, and policy-makers in order to enhance our understanding and approach to child and adolescent mental health.
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