Syed Usman Hamdani PhD , Zill-e Huma PhD , Aiysha Malik DPhil DClinPsych , Asad Tamizuddin-Nizami FCPS , Hashim Javed MSc , Prof Fareed Aslam Minhas FRCPsych , Prof Mark J D Jordans PhD , Prof Marit Sijbrandij PhD , Nadia Suleman MPhil , Um-ul Baneen MPhil , Prof Richard Allan Bryant PhD , Mark van Ommeren PhD , Prof Atif Rahman PhD , Prof Duolao Wang PhD
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引用次数: 0
摘要
背景生活在中低收入国家（LMICs）的青少年的情绪问题在很大程度上仍未得到解决；主要原因包括缺乏训练有素的心理健康专业人员，以及缺乏循证、可扩展的心理干预措施。我们的目的是评估非专业人员提供的集体心理干预措施对减轻巴基斯坦在校青少年心理压力的效果。方法在一项双臂、单盲、分组随机对照试验中，巴基斯坦拉瓦尔品第古贾尔汗（Gujar Khan）一个农村分区符合条件的公立学校分组采用包络区组随机法（1:1，按性别分层）被随机分为干预组（20 人）和等待对照组（20 人）。使用青少年报告的儿科症状检查表（PSC；心理社会困扰总分 0 至 70 分）对提供知情同意和照顾者同意的 13-15 岁青少年进行心理社会困扰筛查，得分在 28 分或以上的青少年及其照顾者被纳入试验。干预组的青少年每周接受七节小组课程，而他们的照顾者则每两周在学校环境中接受三次由受过培训的非专业人员提供的小组课程。主要结果是干预后 3 个月时 PSC 总分与基线相比的变化。该试验在国际标准随机对照试验编号登记处（ISRCTN17755448）进行了前瞻性登记。研究结果在2021年11月2日至11月30日期间，40个学校集群共招募了282名干预组青少年和284名等待名单对照组青少年。3个月后，干预组青少年的PSC平均总分明显低于对照组青少年（与基线相比的平均差异为3-48 [95% CI 1-66-5-29]，p=0-0002，效应大小为0-38 [95% CI 0-18-0-57]；调整后的平均差异为3-26 (95% CI 1-46-5-06]，p=0-0004，效应大小为0-35 (0-16-0-55)）。两组均无不良事件报告。释义小组心理干预很可能是在学校环境中为有心理社会困扰的青少年提供的一种可行而有效的选择。
Effectiveness of a group psychological intervention to reduce psychosocial distress in adolescents in Pakistan: a single-blind, cluster randomised controlled trial
Background
Emotional problems in adolescents living in low-income and middle-income countries (LMICs) remain largely unaddressed; key reasons include a scarcity of trained mental health professionals and unavailability of evidence-based, scalable psychological interventions. We aimed to evaluate the effectiveness of a non-specialist-delivered, group psychological intervention to reduce psychosocial distress in school-going adolescents in Pakistan.
Methods
In a two-arm, single-blind, cluster randomised controlled trial, eligible public school clusters from a rural subdistrict of Gujar Khan, Rawalpindi, Pakistan, were randomised (1:1, stratified by sex) using permuted block randomisation into intervention (n=20) and wait-list control (n=20) groups. Adolescents aged 13–15 years who provided informed assent and caregivers’ consent were screened for psychosocial distress using the youth-reported Pediatric Symptoms Checklist (PSC; total psychosocial distress scores from 0 to 70), and those scoring 28 or more and their caregivers were enrolled into the trial. Adolescents in the intervention group received seven weekly group sessions and their caregivers received three biweekly group sessions in school settings from trained non-specialists. The primary outcome was change from baseline in the total PSC scores at 3 months post-intervention. The trial was registered prospectively with the International Standard Randomised Controlled Trial Number registry, ISRCTN17755448.
Findings
From the 40 school clusters that were included, 282 adolescents in the intervention group and 284 adolescents in the wait-list control group were enrolled between Nov 2 and Nov 30, 2021. At 3 months, adolescents in the intervention group had significantly lower mean total score on the PSC compared with adolescents in the control group (mean difference in change from baseline 3·48 [95% CI 1·66–5·29], p=0·0002, effect size 0·38 [95% CI 0·18–0·57]; adjusted mean difference 3·26 (95% CI 1·46–5·06], p=0·0004, effect size 0·35 (0·16–0·55). No adverse events were reported in either group.
Interpretation
The group psychological intervention most likely represents a feasible and effective option for adolescents with psychosocial distress in school settings.
Funding
UK Medical Research Council, Foreign Commonwealth and Development Office, Department of Health and Social Care.
Translation
For the Urdu translation of the abstract see Supplementary Materials section.
期刊介绍：
The Lancet Child & Adolescent Health, an independent journal with a global perspective and strong clinical focus, presents influential original research, authoritative reviews, and insightful opinion pieces to promote the health of children from fetal development through young adulthood.
This journal invite submissions that will directly impact clinical practice or child health across the disciplines of general paediatrics, adolescent medicine, or child development, and across all paediatric subspecialties including (but not limited to) allergy and immunology, cardiology, critical care, endocrinology, fetal and neonatal medicine, gastroenterology, haematology, hepatology and nutrition, infectious diseases, neurology, oncology, psychiatry, respiratory medicine, and surgery.
Content includes articles, reviews, viewpoints, clinical pictures, comments, and correspondence, along with series and commissions aimed at driving positive change in clinical practice and health policy in child and adolescent health.
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