# **1 Introduction**

Mental disorders are a major contributor to years lived with disability worldwide, with major depressive and anxiety disorders among the leading specific causes (GBD 2019 Mental Disorders Collaborators, 2022). Adolescents and young women are especially at risk, with depressive disorders the leading cause of years lost to disability among 15-19 year old females globally (Guthold et al., 2021). Beyond the immediate welfare losses, mental health disorders developed during adolescence can also have long-term consequences, both because they are associated with lower human capital accumulation and because most mental disorders that persist into adult life first manifest between the ages of 12 to 24 (Patel et al., 2007).<sup>1</sup> Recognizing the growing body of evidence suggesting a negative feedback loop between poverty and mental illness, the Lancet Commission on global mental health and sustainable development has called for urgent action to prioritize mental health interventions as a means to promote sustainable development, uphold human rights, and foster social inclusion (Patel et al., 2018). It is therefore highly pertinent to identify efficacious and scalable interventions tackling adolescent mental health, especially in low- and middle-income countries (LMICs) (Patel and Kleinman, 2003; Ridley et al., 2020).

One such intervention that has received considerable attention and has shown promise is — manual-based “talk therapy” most often based on cognitive behavioral therapy (CBT) — and/or interpersonal therapy (IPT) which can be delivered in groups and by trained non-specialist providers (Singla et al., 2017; Van Ginneken et al., 2013; Ridley et al., 2020). This approach is motivated, in large part but not exclusively, by resource constraints and the limited availability of specialist providers in most LMIC settings, especially in rural and remote areas (Saxena et al., 2007; Chisholm et al., 2016). A growing literature has found that such therapy interventions can result in sizable improvements in mental health and economic outcomes, at least in the short-run (Singla et al., 2017; Lund et al., 2011, 2022). However, the longer-term and at-scale impacts are less clear, and a number of recent trials have failed to find sustained effects beyond the 12-month post-intervention period (Lund et al., 2022; Ridley et al., 2020; Haushofer et al., 2023a). Furthermore, there is little evidence on the — impact of mental health interventions on broader well-being e.g., outcomes related to human capital accumulation (Ridley et al., 2020).

We contribute to this body of work by evaluating a pilot program, jointly conducted by StrongMinds and BRAC Uganda. StrongMinds is an International Non-Governmental

> 1Mental health disorders in adolescence are associated with increased risky decision-making (DiClemente et al., 2001; Fishbein et al., 2006); future mental and physical health problems (Evans et al., 2007; Hardaway and Smalls, 2009); lower educational achievement (Currie and Stabile, 2006; Eisenberg et al., 2009; Fletcher, 2008; Kessler et al., 1995; Stein and Kean, 2000); and low self-esteem and self-efficacy (Sowislo and Orth, 2013).

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