13 research outputs found
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Design, development and pilot evaluation of POD Adventures, a digital game-based intervention to improve adolescent mental health in schools in India
Mental disorders are a leading cause of disability among adolescents worldwide. Despite growing evidence for effectiveness psychosocial interventions, most adolescents do not receive appropriate mental health support, especially in low-and-middle-income countries (LMICs). Digital mental health interventions are increasingly being promoted as an important platform to deliver and scale up mental health care for adolescents with the potential to increase reach and reduce stigma and costs as compared with clinic-based service models, especially in lowresource settings. The present thesis incorporated three studies aimed at developing and evaluating âPOD Adventuresâ, a smartphone-delivered digital intervention for common adolescent mental health problems in India.
Study 1 comprised participatory qualitative research (N=118 adolescents; N=8 service providers) intended to co-design a game-based problem-solving intervention for school-going adolescents with or at risk of experiencing anxiety, depression and/or conduct difficulties. Results informed the specifications of âPOD Adventuresâ as an open-access, smartphone-enabled, low-intensity intervention for adolescents with a felt need for psychological support. Delivery was endorsed in a guided format, i.e., the POD Adventures app accompanied by brief lay counsellor guidance.
Study 2 used a mixed-methods pre-post cohort design (N=248) to evaluate the feasibility and acceptability of the POD Adventures intervention, and to explore the effects of the intervention on self-reported mental health symptoms, prioritised problems, stress, and well-being. Results showed high completion and satisfaction rates and that the intervention was associated with large improvements in problem severity and mental health symptom severity. Findings also showed 9 that POD Adventures was feasible to deliver with guidance from lay counsellors and that the participants were satisfied with the guidance provided.
Study 3 was originally planned as a full-scale randomised controlled trial (RCT) but was modified due to local COVID-19 school closures. The modified study comprised a pilot feasibility RCT of POD Adventures (N=11) when remotely delivered with telephone guidance from counsellors. The study aimed to assess whether the feasibility and acceptability of POD Adventures would be replicated when delivered online with remote telephone-based support. The study also aimed to generate preliminary effect size estimates for use in designing a full-scale trial. Despite modifications made to conduct the study online, this format of intervention delivery was not feasible in the study context. It was concluded that the biggest barriers may have included difficulties accessing the online research procedures, the remotely delivered intervention delivery or a combination of both, which may have been exacerbated by the ongoing COVID-19 pandemic conditions at the time.
Overall, results across the three studies illustrate the role and opportunity that context-specific digital interventions offer in providing early intervention support to school-going adolescents with a felt need for psychological support in low-resource settings
What are young Indians saying about mental health? A content analysis of blogs on the Itâs Ok To Talk website
Objectives: This study used thematic content analysis to examine submissions to a youth mental health website, www.itsoktotalk.in, in India.
Setting: We considered submissions made to the Itâs OK to Talk web platform during the first year of its operation (April 2017 - March 2018), focusing specifically on website users based in India.
Participants: We analysed 37 submissions by 33 authors aged 19-31 years (mean age 22 years) from 7 Indian cities (New Delhi, Lucknow, Bengaluru, Mumbai, Pune, Hyderabad and Haryana). Eligible submissions were English-language first-person accounts of self-identified mental health problems, submitted in any media format for online publication by authors aged 18 years or older and who were based in India. Eight study participants were additionally involved in a focus group that contributed to the coding process and preparation of the final manuscript.
Results: Four themes were identified:1) Living through difficulties; 2) Mental health in context; 3) Managing one's mental health; and 4) Breaking stigma and sharing hope. Overall, the participants expressed significant feelings of distress and hopelessness as a result of their mental health problems; many described the context of their difficulties as resulting from personal histories or wider societal factors; a general lack of understanding about mental health; and widespread stigma and other negative attitudes. Most participants expressed a desire to overcome mental health prejudice and discrimination.
Conclusions: Personal narratives offer a window into young peopleâs self-identified priorities and challenges related to mental health problems and recovery. Such insights can inform anti-stigma initiatives and other public awareness activities around youth mental health
Design and development of the âPOD Adventuresâ smartphone game: a blended problem-solving intervention for adolescent mental health in India
Introduction:
Digital technology platforms offer unparalleled opportunities to reach vulnerable adolescents at scale and overcome many barriers that exist around conventional service provision. This paper describes the design and development of POD Adventures, a blended problem-solving game-based intervention for adolescents with or at risk of anxiety, depression and conduct difficulties in India. This intervention was developed as part of the PRemIum for ADolEscents (PRIDE) research programme, which aims to establish a suite of transdiagnostic psychological interventions organised around a stepped care system in Indian secondary schools.
Methods and materials:
Intervention development followed a person-centered approach consisting of four iterative activities: (i) review of recent context-specific evidence on mental health needs and preferences for the target population of school-going Indian adolescents, including a multiple stakeholder analysis of school counselling priorities and pilot studies of a brief problem-solving intervention; (ii) new focus group discussions with N=46 student participants and N=8 service providers; (iii) co-design workshops with N=22 student participants and N=8 service providers; and (iv) user-testing with N=50 student participants. Participants were aged 12-17 years and recruited from local schools in New Delhi and Goa, including a subgroup with self-identified mental health needs (N=6).
Results:
Formative data from existing primary sources, new focus groups and co-design workshops supported a blended format for delivering a brief problem-solving intervention, with counsellors supporting use of a game-based app on âofflineâ smartphones. User-testing with prototypes identified a need for simplification of language, use of concrete examples of concepts and practice elements to enhance engagement. There were also indications that participants most valued relatability and interactivity within real-world stories with judicious support from an in-app guide. The final prototype comprised a set of interactive and gamified vignettes and a structured set of problem-solving questions to consolidate and generalise learning while encouraging real-world application.
Discussion:
Findings shaped the design of POD Adventures and its delivery as an open-access blended intervention for secondary school students with a felt need for psychological support, consistent with an early intervention paradigm. A randomised controlled trial is planned to evaluate processes and impacts of POD Adventures when delivered for help-seeking students in low-resource school settings
App-based guided problem-solving intervention for adolescent mental health: a pilot cohort study in Indian schools
Background
This paper describes the pilot evaluation of âPOD Adventuresâ, a lay counsellor-guided problem-solving intervention delivered via a smartphone app in Indian secondary schools.
Objective
To test the feasibility and acceptability of POD Adventures for adolescents with a felt need for psychological support, and to explore the interventionâs effects on self-reported mental health symptoms, prioritised problems, stress and well-being.
Methods
We used a mixed-methods pre-post cohort design. Participants were self-referred from grades 9â12 in two coeducational government-aided secondary schools in Goa, India. The intervention was delivered in two formats, âmixedâ (comprising individual and small group sessions) and âgroupâ (small group sessions only).
Findings
248 participants enrolled in the study and 230 (92.7%) completed the intervention. Outcomes at 4 weeks showed significant improvements on all measures that were maintained at 12 weeks. Large effects were observed on problem severity scores (4 weeks, d=1.47; 12 weeks, d=1.53) while small to moderate effects were seen on mental health symptoms, stress and well-being. 22 students completed qualitative interviews about their experience of the intervention. Participants found POD Adventures easy to use, engaging and helpful in solving their problems. They were satisfied with the guidance provided by the counsellor irrespective of delivery format.
Conclusions
POD Adventures was feasible to deliver with guidance from lay counsellors in Indian schools, acceptable to participants and associated with large improvements in problem severity and mental health symptom severity.
Clinical implications
POD Adventures has promise as an early intervention for adolescents with a felt need for psychological support in low-resource settings
A guided internet-based problem-solving intervention delivered through smartphones for secondary school pupils during the COVID-19 pandemic in India: protocol for a pilot randomized controlled trial
Background:
âPOD Adventuresâ is a gamified mental health intervention delivered via a smartphone app and supported by counsellors for a target population of secondary school students in India. This paper describes the protocol for a pilot randomized controlled trial of a remotely delivered version of the intervention in the context of COVID-19 restrictions.
Objective:
Our objectives are to assess the feasibility of research procedures and intervention delivery and to generate preliminary estimates of the effectiveness of the intervention to inform the sample size calculation of a full-scale trial.
Methods:
We will conduct a parallel, 2-arm, individually randomized pilot controlled trial in 11 secondary schools in Goa, India. This pilot trial aims to recruit 70 participants with a felt need for psychological support. Participants will receive either the POD Adventures intervention delivered over 4 weeks or usual care comprising information about local mental health services and national helplines. Outcomes will be assessed at two timepoints: baseline and 6 weeks post randomization.
Results:
The first participant was enrolled on January 28, 2021, and 6-week assessment completed on April 4, 2021. Owing to a second wave of the COVID-19 pandemic in India, schools in Goa were closed on April 22, 2021. Trial participants are currently receiving the intervention or completing follow-up assessments.
Conclusions:
This pilot trial will help understand the feasibility of implementing and evaluating a remotely delivered digital mental health intervention in a low-resource setting. Our findings will be used to design future trials that can address difficulties of accessing psychosocial support in-person and support wider efforts to scale up evidence-based mental health interventions for young people.
Trial Registration:
ClinicalTrials.gov NCT04672486; https://clinicaltrials.gov/ct2/show/NCT04672486
International Registered Report Identifier (IRRID):
DERR1-10.2196/3033
COVID-19 mental health impact and responses in low-income and middle-income countries: reimagining global mental health
Most of the global population live in low-income and middle-income countries (LMICs), which have historically received a small fraction of global resources for mental health. The COVID-19 pandemic has spread rapidly in many of these countries. This Review examines the mental health implications of the COVID-19 pandemic in LMICs in four parts. First, we review the emerging literature on the impact of the pandemic on mental health, which shows high rates of psychological distress and early warning signs of an increase in mental health disorders. Second, we assess the responses in different countries, noting the swift and diverse responses to address mental health in some countries, particularly through the development of national COVID-19 response plans for mental health services, implementation of WHO guidance, and deployment of digital platforms, signifying a welcome recognition of the salience of mental health. Third, we consider the opportunity that the pandemic presents to reimagine global mental health, especially through shifting the balance of power from high-income countries to LMICs and from narrow biomedical approaches to community-oriented psychosocial perspectives, in setting priorities for interventions and research. Finally, we present a vision for the concept of building back better the mental health systems in LMICs with a focus on key strategies; notably, fully integrating mental health in plans for universal health coverage, enhancing access to psychosocial interventions through task sharing, leveraging digital technologies for various mental health tasks, eliminating coercion in mental health care, and addressing the needs of neglected populations, such as children and people with substance use disorders. Our recommendations are relevant for the mental health of populations and functioning of health systems in not only LMICs but also high-income countries impacted by the COVID-19 pandemic, with wide disparities in quality of and access to mental health care
Suicide prevention: Putting the person at the center.
In September's Editorial, Vikram Patel and Pattie Gonsalves discuss suicide prevention, the focus of World Mental Health Day, 2019
A systematic review and lived experience synthesis of self-disclosure as an active ingredient in interventions for youth anxiety and depression
Background: Self-disclosure, referring to the ability to communicate and share intimate personal feelings, has strong face validity for many young people as a way of improving anxiety and depression outcomes. The current review aimed to generate the first comprehensive evidence synthesis of self-disclosure interventions involving young people aged 14-24 years who are either disclosers or recipients of personal information about living with anxiety and/or depression.
Methods: A systematic review of quantitative and qualitative data was combined with new insights from a youth lived-experience panel (n=7) with the intention to combine rigorous systematic review methods and experiential knowledge.
Results: Six studies of variable quality were included in this review, five were quantitative and one was qualitative. Findings suggest that self-disclosure may be effective at reducing symptoms for youth with established depression; effects were not apparent when delivered as early prevention. No evidence for impacts on anxiety was found. The potential for negative effects like bullying or harassment was identified.
Limitations: Findings were limited by a small number of studies; low representation of peer-reviewed studies from low-or middle-income countries; and varied interventions in terms of format, participants' context, and nature of delivery.
Conclusions: Self-disclosure may be of value in the context of interventions intended explicitly to reduce depression for those already showing symptoms. Delivery by non-specialists (such as peers and teachers) in addition to mental health professionals can help build capacity in community health systems. Self-disclosure may also be helpful at reducing stigma and stimulating help-seeking at earlier stages of mental health problems
A systematic review and lived experience synthesis of self-disclosure as an active ingredient in interventions for adolescents and young adults with anxiety and depression
Background: Self-disclosure, referring to the ability to communicate and share intimate personal feelings, has strong face validity for many young people as a way of improving anxiety and depression outcomes. The current review aimed to generate the first comprehensive evidence synthesis of self-disclosure interventions involving young people aged 14-24 years who are either disclosers or recipients of personal information about living with anxiety and/or depression.
Methods: A systematic review of quantitative and qualitative data was combined with new insights from an adolescents and young adults lived-experience panel (n=7) with the intention to combine rigorous systematic review methods and experiential knowledge.
Results: Six studies of variable quality were included in this review, five were quantitative and one was qualitative. Findings suggest that self-disclosure may be effective at reducing symptoms for adolescents and young adults with established depression; effects were not apparent when delivered as early prevention. No evidence for impacts on anxiety was found. The potential for negative effects like bullying or harassment was identified.
Limitations: Findings were limited by a small number of studies; low representation of peerreviewed studies from low-or middle-income countries; and varied interventions in terms of format, participants' context, and nature of delivery.
Conclusions: Self-disclosure may be of value in the context of interventions intended explicitly to reduce depression for those already showing symptoms. Delivery by nonspecialists (such as peers and teachers) in addition to mental health professionals can help build capacity in community health systems. Self-disclosure may also be helpful at reducing stigma and stimulating help-seeking at earlier stages of mental health problems
Digital Innovations for Global Mental Health: Opportunities for Data Science, Task Sharing, and Early Intervention
Purpose
Globally, individuals living with mental disorders are more likely to have access to a mobile phone than mental health care. In this commentary, we highlight opportunities for expanding access to and use of digital technologies to advance research and intervention in mental health, with emphasis on the potential impact in lower resource settings.
Recent findings
Drawing from empirical evidence, largely from higher income settings, we considered three emerging areas where digital technology will potentially play a prominent role: supporting methods in data science to further our understanding of mental health and inform interventions, task sharing for building workforce capacity by training and supervising non-specialist health workers, and facilitating new opportunities for early intervention for young people in lower resource settings. Challenges were identified related to inequities in access, threats of bias in big data analyses, risks to users, and need for user involvement to support engagement and sustained use of digital interventions.
Summary
For digital technology to achieve its potential to transform the ways we detect, treat, and prevent mental disorders, there is a clear need for continued research involving multiple stakeholders, and rigorous studies showing that these technologies can successfully drive measurable improvements in mental health outcomes