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This Viewpoint describes ways in which artificial intelligence–powered large language models may be used to improve the delivery of mental health services worldwide.

IntroductionScalable psychological treatments to address depression among adolescents are urgently needed. This is particularly relevant to low-income and middle-income countries where 90% of the world’s adolescents live. While digital delivery of behavioural activation (BA) presents a promising solution, its feasibility, acceptability and effectiveness among adolescents in an African context remain to be shown.Methods and analysisThis study is a two-arm single-blind individual-level randomised controlled pilot trial to assess the feasibility, acceptability and initial efficacy of digitally delivered BA therapy among adolescents with depression. The intervention has been coproduced with adolescents at the study site. The study is based in the rural northeast of South Africa in the Bushbuckridge subdistrict of Mpumalanga province. A total of 200 adolescents with symptoms of mild to moderately severe depression on the Patient Health Questionnaire Adolescent Version will be recruited (1:1 allocation ratio). The treatment group will receive BA therapy via a smartphone application (the Kuamsha app) supported by trained peer mentors. The control group will receive an enhanced standard of care. The feasibility and acceptability of the intervention will be evaluated using a mixed methods design, and signals of the initial efficacy of the intervention in reducing symptoms of depression will be determined on an intention-to-treat basis. Secondary objectives are to pilot a range of cognitive, mental health, risky behaviour and socioeconomic measures; and to collect descriptive data on the feasibility of trial procedures to inform the development of a further larger trial.Ethics and disseminationThis study has been approved by the University of the Witwatersrand Human Research Ethics Committee (MED20-05-011) and the Oxford Tropical Research Ethics Committee (OxTREC 34-20). Study findings will be published in scientific open access peer-reviewed journals, presented at scientific conferences and communicated to participants, their caregivers, public sector officials and other relevant stakeholders.Trial registration numbersThis trial was registered on 19 November 2020 with the South African National Clinical Trials Registry (DOH-27-112020-5741) and the Pan African Clinical Trials Registry (PACTR202206574814636).

Using a novel panel survey of relatively poor urban Peruvian adolescents, we explore the link between educational aspirations and propensity to invest in the future. Aspirations comprise hope and agency. We find remarkably high educational aspirations, even among relatively poor individuals and adolescents who were exposed to negative shocks, suggesting high levels of resilience. We also find high occupational aspirations and aspirations to migrate. High-aspiration respondents were also more likely to invest in their education and avoid risky behaviors. These are associations as we do not have enough data to establish causality, although we were able to control for within-person traits. Aspirations are stable over time and positively associated with personality traits such as self-efficacy and life satisfaction, which help explain their persistence over time. Our findings complement those of other recent studies that highlight the role of personality traits in addition to cognitive skills in long-term educational, health, and socioeconomic outcomes.

Low-income and middle-income countries have increasingly relied on cash transfer programmes to expand social protection among the most poor and vulnerable people. Many of these cash transfer programmes have given cash directly to adolescents to incentivise behaviour that improve a range of health and social outcomes. The evidence for the effectiveness of these programmes has been mixed. Some studies show cash transfer to be effective in promoting desired behaviours among adolescentssuch as school participation and reducing sexually transmitted infections-whereas others find no evidence for an effect. One possible reason for these mixed results is that cash transfer programmes targeting adolescents have not taken into account the many biological, cognitive, and social changes that occur during this transitional period, thus failing to incorporate a developmental perspective in the design.

The transitional period of adolescence has long been associated with physical, social and behavioural change. During this time, adolescents start to develop their own selfidentity, make important life decisions and acquire the necessary skills to successfully transition to adulthood. More recently, advances in brain imaging technology have enabled increased understanding of structural and functional changes in the human brain during this developmental period, and how they relate to social, emotional, motivational and cognitive development. The ability to integrate these developing cognitive processes in increasingly complex social contexts is a key aspect of mature decisionmaking, which has implications for adolescent health, educational, economic and social outcomes. Insights from the field of developmental cognitive neuroscience could increase our understanding of this influential stage of life and thus inform potential interventions to promote adolescent health, a critical goal for global health research. Many social changes occur during adolescence and the social environment shapes both brain and cognitive development and the decisions adolescents make. Thus, it is important to study adolescent neurocognitive development in socio-cultural context. Yet, despite evidence from Western studies that socio-cultural and economic factors impact on adolescent neurocognitive development, existing studies of adolescent neurocognitive development in sub-Saharan Africa are relatively scarce. We summarise research findings from Western and sub-Saharan African contexts and highlight areas where research is lacking. Longitudinal studies from more diverse global samples will be needed to build a comprehensive model of adolescent development, that characterises both commonalities in developmental trajectories, as well as the way these can meaningfully differ between both individuals and contexts.

Introduction: Scalable psychological treatments to address depression amongst adolescents are urgently needed. This is particularly relevant to low- and middle-income countries where 90% of the world's adolescents live, socioeconomic adversities affecting mental ill-health are prevalent, and mental health service resources remain very limited. Whilst digital delivery of Behavioural Activation presents a promising solution, its feasibility, acceptability, and effectiveness remain to be shown. Methods and analysis: This study is a two-arm single-blind individual-level randomised controlled pilot trial to assess the feasibility, acceptability, and initial efficacy of digitally delivered Behavioural Activation (BA) therapy amongst adolescents with depression. The intervention has been co-produced with adolescents at the study site. The study is based in the rural north-east of South Africa in the Bushbuckridge sub-district of Mpumalanga Province. A total of 200 adolescents with symptoms of mild to moderately-severe depression on the Patient Health Questionnaire Adolescent Version (PHQ-A) will be recruited (1:1 allocation ratio). The treatment group will receive digitally delivered Behavioural Activation (the Kuamsha app programme) whilst the control group will receive an Enhanced Standard of Care. The feasibility and acceptability of the intervention will be evaluated using a mixed-methods design, and signals of initial efficacy of the intervention in reducing symptoms of depression will be determined on an intention-to-treat basis. Secondary objectives are to pilot a range of cognitive, mental health, risky behaviour, and socioeconomic measures; and to collect descriptive data on the feasibility of trial procedures to inform the development of a further larger trial. Ethics and dissemination: This study has been approved by the University of the Witwatersrand Human Research Ethics Committee (MED20-05-011) and the Oxford Tropical Research Ethics Committee (OxTREC 34-20). Study findings will be published in scientific open access peer-reviewed journals, presented at scientific conferences, and communicated to participants, their caregivers, public sector officials, and other relevant stakeholders. Trial registration: This trial was registered on 19 November 2020 with the South African National Clinical Trials Registry (DOH-27-112020-5741) and the Pan African Clinical Trials Registry (PACTR202206574814636).