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Can we develop cost-effective interventions for youth mental health? Lessons from Kenya

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Abstract Developing cost-effective interventions for youth mental health in low- and middle-income countries (LMICs) is an urgent public health priority. Over the past years, our multicultural team has developed and tested interventions for adolescent depression and anxiety symptoms. Our intervention development approach was informed by the belief that youth mental health interventions in low-resource communities may benefit from including empirically supported elements, using stigma-free content, and using trained lay-providers. We developed Shamiri—a 4-week, lay-provider-delivered group intervention that teaches growth mindset, gratitude, and value affirmation—for adolescent depression and anxiety. The content is delivered by recent high school graduates (ages 18 – 22) trained as lay-providers. Participants meet in school once-a-week in groups of 9-12 youths (average group size 10). In a 2018 pilot RCT (N = 51), we found that compared to an active control, Shamiri produced greater reductions in adolescent depression symptoms (p = .038; d = .32) and anxiety symptoms (p = .039; d = .54) from baseline to four-week follow-up, and greater improvements in academic performance (p = .034; d = .32) from the school-term before versus after the intervention. This was the first report that a brief, lay-provider delivered, community-based intervention may reduce internalizing symptoms and improve academic outcomes in high-symptom adolescents in Sub-Saharan Africa. In a 2019 high-powered pre-registered and gold-standard RCT (N = 413), Shamiri showed greater reductions in depressive symptoms at post-treatment (Cohen d=0.35 [95%CI 0.09-0.60]), 2-weeks (Cohen d =0.28 [95%CI 0.04-0.54]), and 7-months (Cohen d=0.45 [95%CI 0.19-0.71]), and greater reductions in anxiety symptoms at post-treatment (Cohen d=0.37, [95%CI 0.11-0.63]), 2-weeks (Cohen d=0.26 [95%CI -0.01-0.53]), and 7-months (Cohen d=0.44 [95%CI 0.18-0.71]). These findings confirmed that this kind of intervention may prove useful in other global settings where limited resources, mental illness stigma, or a shortage of professionals limit access to mental health care. Overall, our work in Kenya has shown that simple psychological interventions that focus on positive human attributes rather than psychopathology, are delivered by lay-providers, and are developed through multicultural collaboration may reduce depression and anxiety symptoms and should be considered for use in low-resource settings.

Biography Tom Osborn is the founder and Executive Director of Shamiri Institute, a data-driven public benefit organization that combines social science research with a deep contextual knowledge of local communities to develop and scale mental health care to young people across Sub-Saharan Africa and especially Kenya, where 45 percent of young people report clinical depression. Shamiri Institute currently provides mental healthcare to 7,5000 Kenyan youths. Born and raised in poverty — receiving >$300,000 in academic scholarships — Tom has developed a reputation as a community mobilizer, entrepreneur, and global mental health researcher. At 18, he co-founded GreenChar, a social enterprise that provided homes and institutions in rural Kenya and urban slums with clean energy. For his work and leadership at GreenChar, he was the youngest recipient of Echoing Green Fellowship – an award for the world’s best social entrepreneurs. At 19, he was named on the Forbes’ 30 under 30 list in Social Entrepreneurship, the second youngest person to receive the honor. He has also been awarded the Women Deliver Social Entrepreneur Award in 2016, the Anzisha Prize Energy Award and many other awards. Salt Magazine has also listed him as 30 under 30 social entrepreneur. Tom is a 2021TED Fellow—given to doers who have shown unusual accomplishment, exceptional courage, and are creating positive change around the world—and an Acumen Fellow. Tom graduated from Harvard College with a Bachelor’s in Psychology (High Honors). For more information about Tom Osborn, please visit https://www.shamiri.institute/co-founders/tom-osborn

This talk is part of the Department of Psychiatry & CPFT Thursday Lunchtime Seminar Series series.

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