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 ‘POD Adventures’, 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 ‘POD Adventures’ 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 It’s 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 It’s 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 people’s 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

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

Ten simple rules for open human health research

International audienc