Effect of Shamiri Layperson-Provided Intervention vs Study Skills Control Intervention for Depression and Anxiety Symptoms in Adolescents in Kenya

Abstract

IMPORTANCE Low-cost interventions for adolescent depression and anxiety are needed in low-resource countries such as those in Sub-Saharan Africa.OBJECTIVE To assess whether Shamiri, a 4-week layperson-delivered group intervention that teaches growth mindset, gratitude, and value affirmation, can alleviate depression and anxiety symptoms in symptomatic Kenyan adolescents. DESIGN, SETTING, AND PARTICIPANTSThis school-based randomized clinical trial included outcomes assessed at baseline, posttreatment, and 2-week and 7-month follow-up from 4 secondary schools in Nairobi and Kiambu County, Kenya. Adolescents aged 13 to 18 years with elevated symptoms on standardized depression or anxiety measures were eligible. Intent-to-treat analyses were used to analyze effects. Recruitment took place in June 2019; follow-up data were collected in August 2019 and February 2020.INTERVENTION Adolescents were randomized to the Shamiri intervention or to a study skills control. All adolescents in both conditions met in groups (mean group size, 9) for 60 minutes per week for 4 weeks. MAIN OUTCOMES AND MEASURES Primary outcomes were depression (Patient HealthQuestionnaire-8 item) and anxiety (Generalized Anxiety Disorder-7 item) symptoms. Analyses of imputed data were hypothesized to reveal significant reductions in depression and anxiety symptoms for adolescents assigned to Shamiri compared with those in the study skills group. RESULTSOf 413 adolescents, 205 (49.6%) were randomized to Shamiri and 208 (50.4%) to study skills. The mean (SD) age was 15.5 (1.2) years, and 268 (65.21%) were female. A total of 307 youths completed the 4-week intervention. Both Shamiri and study skills were rated highly useful (4.8/5.0) and reduced symptoms of depression and anxiety, but analyses with imputed data revealed that youths receiving Shamiri showed greater reductions in depressive symptoms at posttreatment (Cohen d = 0.35 [95% CI, 0.09-0.60]), 2-week follow-up (Cohen d = 0.28 [95% CI, 0.04-0.54]), and 7-month follow-up (Cohen d = 0.45 [95% CI, 0.19-0.71]) and greater reductions in anxiety symptoms at posttreatment (Cohen d = 0.37 [95% CI, 0.11-0.63]), 2-week follow-up (Cohen d = 0.26 [95% CI, −0.01 to 0.53]), and 7-month follow-up (Cohen d = 0.44 [95% CI, 0.18-0.71]).CONCLUSIONS AND RELEVANCE Both the Shamiri intervention and a study skills control group reduced depression and anxiety symptoms; the low-cost Shamiri intervention had a greater effect, with effects lasting at least 7 months. If attrition is reduced and the clinical significance of outcome differences is established, this kind of intervention may prove useful in other global settings where there are limited resources, mental illness stigma, or a shortage of professionals and limited access to mental health care.

Digitales Leben in der vernetzten Welt: Chancen und Risiken für die Psychiatrie

“…Dem korrespondiert eine große Anzahl von Studien, die das supportive soziale Netzwerk als eine der zentralen Determinanten somatischer und psychischer Gesundheit zeigen [ 7 ]. In der hier vorgestellten, jüngst in JAMA Psychiatry erschienen Studie [ 3 ] benutzten wir Smartphones, um Probanden während des Alltags zu fragen, ob und wie sie sozial interagierten, und setzten dies in Beziehung zu ihrem Wohlbefinden. Wie zu erwarten war, ergab sich eine deutliche positive Beziehung zwischen Wohlbefinden und sozialen Interaktionen.…”

Long-term health outcomes of adolescent character strength interventions: 3- to 4-year outcomes of three randomized controlled trials of the Shamiri program

“…All participants who have taken part in three previous RCTs [ 15 , 20 , 21 ] of the in-person, group-based, 4-week Shamiri intervention, and had elevated symptoms of depression or anxiety at baseline of the previous RCTs (defined as scores of 10 or over on the Generalized Anxiety Disorder-7 (GAD) and 15 or over on the Patient Health Questionnaire-8 (PHQ-8)) are eligible for enrolment in this long-term follow-up study. Participant consent or assent, and in the case of minors, guardian consent, will also be required for participation.…”

“…Participants will not participate in the intervention or control condition again as part of this study but instead will complete follow-up measures to assess the long-term effects of these interventions. These interventions are further detailed in the intervention descriptions of our previous three RCTs [ 15 , 20 , 21 ]. Each condition consisted of an equal dose of total intervention time: four 1-h weekly sessions that focused on teaching and reinforcing the knowledge and application of the active ingredient of the condition.…”

“…Previous research on Shamiri in Kenya has shown promising improvements in youth mental health, psychosocial, and academic outcomes at post-intervention and seven-months follow-up [ 17 , 20 ]. In a randomized controlled trial (RCT) of Shamiri with 51 Kenyan adolescents with clinically elevated depression and/or anxiety symptoms, we found improvements in depression and anxiety symptoms, academic performance, and perceived social support from friends when compared to an active study skills control group immediately post-intervention [ 15 ].…”

“…In a well-powered ( N = 413), preregistered replication of this study [ 16 ], youths in the Shamiri intervention exhibited improvements in depression and anxiety symptoms over time, and when compared to the active study skills control group. These improvements were maintained at 7 months post-intervention [ 20 ]. This study also indicated that Shamiri is feasible and acceptable to Kenyan youths.…”