Title: NIHR Global Health Research Group on Interventions for Youth with Depression and Anxiety Disorders in African Countries
Funder: Department of Health and Social Care

Abstract: Our multidisciplinary group of African and UK researchers will work with youth in Ghana and Zimbabwe to adapt and evaluate a stepped care intervention for youth aged 15 to 24 with depression or anxiety, which is suitable to be delivered through task-shifting to non-specialists. We will build research capacity by involving early and mid-career African researchers in this project, training them, and strengthening their institutions. Malawi is added for capacity building but not primary research._x000D_ Depression and anxiety are common in youth, often beginning at age 15-24. They cause functional impairment and are key risk factors for self-harm. Cost-effective treatments exist but are rarely available in low and middle income countries (LMIC). We have shown the acceptability and effectiveness of a stepped-care intervention called the Friendship Bench for working age adults in Zimbabwe. This comprises brief psychological therapy, with the option of adding an antidepressant for those who do not recover. We now wish to adapt this for youth. In Zimbabwe and Ghana there have been calls to develop youth mental health treatments, especially since the COVID-19 pandemic but also before. Our planned research responds to, and will align with, stated priorities and planned pilot activities being led by Ministries of Health and/or well-established non-governmental organisations (NGO) in each country. For instance, in Zimbabwe, this includes Ministry of Health policy to integrate mental health care into existing health and community services, to scale up the Friendship Bench at least for working age adults, and to a planned government pilot, called “Catch Them Young”, of screening and psychological first aid in schools. The Ghana Mental Health Authority is scaling up basic WHO mental health care training, and the NGO, BasicNeeds, is piloting mental health literacy training in nine schools. A Ghana government policy report has assigned “top priority” to training youth sector practitioners in mental health. Context-specific research in African countries is needed to inform practice and policy to address an estimated 95% unmet need for youth mental health treatment. _x000D_ In the Formative Phase we will apply a theory-informed participatory approach to adapt the intervention, and develop implementation strategies in Zimbabwe and Ghana. Based on country priorities and context, we will tailor the intervention in Ghana for those aged 15-18 enrolled in Ghana’s free senior high school system and in Zimbabwe for youth aged 15-24 in schools, colleges and community health settings including sexual health services. In the Implementation Phase, in Zimbabwe, we will run a single-arm study to test feasibility of implementing through community, health and education systems, and assess preliminary outcomes. In Ghana we will run a fully powered RCT in senior high schools in Navrongo, to test the effectiveness, cost-effectiveness and implementation of our intervention compared to control. _x000D_ Within 4 years, our pioneering ambitious new group will have adapted a stepped care intervention, tailored to the needs of communities in Ghana and Zimbabwe, suitable for delivery by non-specialists, for government and NGOs to use. We will disseminate through our Community Engagement and Involvement, program providing youth and family-friendly materials, and through webinars and publications. Our robust clinical trial evidence will support generalisation to other LMIC.

Lay abstract: Our multidisciplinary group of African and UK researchers will work with youth in Ghana, and Zimbabwe to adapt and evaluate an intervention suitable for youth aged 15 to 24 with depression or anxiety. We will build research capacity by involving early career African researchers from Ghana and Zimbabwe in this project, mentoring mid-career researchers, and strengthening their institutions. Capacity building will also take place in Malawi. We will set up a Community Engagement and Involvement program including Young People’s and Family Advisory Groups. _x000D_ Depression and anxiety are common in youth, often beginning at age 15-24. They cause functional impairment, preventing youth from productivity and innovation, and increase risk for self-harm. Treatments exist but are rarely available in low and middle income countries (LMIC) . We have shown the acceptability and effectiveness of a stepped-care intervention called the Friendship Bench for working age adults in Zimbabwe. We now wish to adapt this for youth. Our planned research responds to, and will align with, stated priorities and planned pilot activities being led by Ministries of Health and/or well-established non-governmental organisations (NGO) in each country. For instance, in Zimbabwe, this includes Ministry of Health policy to integrate mental health care into existing health and community services, to scale up the Friendship Bench at least for working age adults, and to a planned government pilot, called “Catch Them Young”, of screening and psychological first aid in schools. The Ghana Mental Health Authority is scaling up basic WHO mental health care training, and the NGO, BasicNeeds, is piloting mental health literacy training in nine schools. A Ghana situation analysis has urged mental health specialists to train practitioners in youth sectors as a ‘top priority’. Context-specific research in African countries is needed to inform practice and policy to address an estimated 95% unmet need for youth mental health treatment._x000D_ In the Formative Phase we will apply adapt the intervention, and develop implementation strategies in Zimbabwe and Ghana, involving youth, families and health workers in the research. We will tailor the intervention in Ghana for those aged 15-18 enrolled in Ghana’s free senior high school system and in Zimbabwe for youth aged 15-24 in schools, colleges and community health settings including sexual health services. In the Implementation Phase, in Zimbabwe, we will test feasibility of implementing the intervention through community, health and education systems, and assess preliminary outcomes. In Ghana we will run a clinical trial in senior schools in Navrongo, to test the effectiveness, cost-effectiveness and implementation of our intervention compared to control. _x000D_ Within 4 years, our pioneering ambitious new group will have adapted a stepped care intervention, tailored to the need of communities in Ghana and Zimbabwe, suitable for delivery by non-specialists, for government and NGOs to use. We will disseminate through our CEI program, providing youth and family-friendly materials, and through webinars and publications. The evidence we produce will help guide policy in other LMIC

Research activity codes: 6.6 PSYCHOLOGICAL AND BEHAVIOURAL
Health categories: MENTAL HEALTH