Controlled clinical trial of teacher-delivered Cognitive Behavioural Therapy (CBT) for adolescents with clinically diagnosed depressive disorder in Nigeria

Abstract

Most depressed adolescents in Low and Middle Income Countries (LMICs) like Nigeria have no access to psychological intervention due to lack of trained mental health professionals. This huge treatment gap could be bridged by using non-mental health professionals such as teachers to deliver the interventions. This study evaluated a teacher-delivered Cognitive Behavioral Therapy (CBT) programme for depressed adolescents in Nigeria. Forty adolescents (aged 13-18 years) with clinically diagnosed depressive disorder were recruited from two schools (20 from each school). One school was balloted as intervention and the other as control. The intervention group received five sessions of manualised group-based CBT delivered by two teachers who were trained and supervised by a psychiatrist. Primary outcome was BDI score at week 6. Controlling for baseline BDI score, the intervention group had significantly lower post-intervention depressive symptoms fMeans 4.60 vs 17.05; t ¼ 4.13; p ¼ 0.0001, F(1, 39) ¼ 16.76, p ¼ 0.0001, Effect Size (Cohen's d) ¼ 1.3g. Eighty-percent of the intervention group achieved remission compared with only 15.8% of the controls (p < 0.0001). To our knowledge, this is the first study of a teacher-delivered CBT programme for clinically depressed adolescents in a LMIC. The intervention was feasible, well received and showed promising efficacy.

Educational and Training Interventions Aimed at Healthcare Workers in the Detection and Management of People With Mental Health Conditions in South and South-East Asia: A Systematic Review

“…Our review findings are consistent with task sharing research published in other LMICs (83)(84)(85)(86) that suggest that community health workers, who have limited or no prior training in the mental health, can effectively deliver psychological interventions. Scaling up these training programmes has potential to strengthen the wider health system as effective, yet the least resource intensive treatment, can be delivered to patients first; only "stepping up" to intensive/specialist services as clinically required (38,87,88).…”

A controlled trial of Cognitive Behavioural Therapy-based strategies for insomnia among in-school adolescents in southern Nigeria

“…However, even with these measures aimed at improving access, only 28% of participants attended all 5 sessions which suggests that offering the intervention at a separate location requiring additional travelling might not have been viable. We adopted a simple cognitive strategy (count your blessings), which had shown acceptance and benefit in previous CBT-based interventions in the country [ 18 , 19 ]. We nuanced and contextualised aspects of typical CBT-I such as stimulus control that did not fit the socio-ecology of the setting.…”

“…This figure was increased to 25 in each group to account for potential attrition. Previous pilot intervention studies in this region have shown that similar sized samples were adequate to identify the level of difference hypothesised in this study [ 18 , 19 ]. In addition to lack of consent, students were to be excluded if they had a history of psychiatric disorder or their teachers identified them as having learning difficulties.…”

“…The intervention was delivered by the first author who holds a degree in Counselling Psychology, but no prior specific certification in CBT-I. The other authors who are experienced in CBT-based interventions in the setting [ 18 , 19 , 24 ] provided weekly supervision. The intervention consisted of weekly sessions of 45 min over 5 weeks delivered in two groups of 12 or 13 students in their own schools.…”

A postgraduate training programme in child and adolescent mental health in a lower-middle-income country: a partnership model from Nigeria

“…This involves delegating tasks to existing or new cadres of health workers or lay persons trained to deliver CAMH interventions. 4 However, the success of task sharing requires the availability of CAMH-trained professionals to develop policy and to provide leadership, advocacy, training and supervision for the non-CAMH professionals. 5 A systematic review 6 found only one short (3 days) CAMH training programme from Nigeria and none from other West African countries.…”