Background Educational settings are ideal for promoting mental well-being and resilience in children. The challenges of the COVID-19 pandemic made evident the important role that teachers and school counselors play in the mental health of their students. Therefore, it is imperative to develop and implement cost-effective interventions that allow them to identify and address mental health problems early, especially in post–armed conflict areas, to reduce the burden of mental disorders in this population. Objective This study aimed to adapt an existing patient-focused digital intervention called DIALOG+ from an adult clinical setting to an adolescent educational setting and to assess the feasibility, acceptability, and estimated effect of implementing this intervention as a tool for promoting quality of life, mental well-being, and resilience. Methods We conducted an exploratory mixed methods study in 2 public schools in postconflict areas in Tolima, Colombia. This study was conducted in 3 phases. In the adaptation phase, focus groups were conducted with students and teachers to identify changes required in DIALOG+ for it to be used in the school setting. The exploration phase consisted of an exploratory cluster randomized controlled trial. A total of 14 clusters, each with 1 teacher and 5 students, were randomly allocated to either the experimental (DIALOG+S) group or to an active control group (counseling as usual). Teachers in both groups delivered the intervention once a month for 6 months. Through screening scales, information was collected on mental health symptoms, quality of life, self-esteem, resilience, and family functionality before and after the intervention. Finally, the consolidation phase explored the experiences of teachers and students with DIALOG+S using focus group discussions. Results The changes suggested by participants in the adaptation phase highlighted the central importance of the school setting in the mental health of adolescents. In the exploratory phase, 70 participants with a mean age of 14.69 (SD 2.13) years were included. Changes observed in the screening scale scores of the intervention group suggest that the DIALOG+S intervention has the potential to improve aspects of mental health, especially quality of life, resilience, and emotional symptoms. The consolidation phase showed that stakeholders felt that using this intervention in the school setting was feasible, acceptable, and an enriching experience that generated changes in the perceived mental health and behavior of participants. Conclusions Our results are encouraging and show that the DIALOG+S intervention is feasible and acceptable as a promising opportunity to promote well-being and prevent and identify mental health problems in the school context in a postconflict area in Colombia. Larger, fully powered studies are warranted to properly assess the efficacy and potential impact of the intervention and to refine implementation plans. Trial Registration International Standard Randomised Controlled Trial Number (ISRCTN) registry ISRCTN14396374; https://www.isrctn.com/ISRCTN14396374 International Registered Report Identifier (IRRID) RR2-10.2196/40286

Background Colombia has a long history of an armed conflict that has severely affected communities with forced internal displacement and violence. Victims of violence and armed conflicts have higher rates of mental health disorders, and children and adolescents are particularly affected. However, the mental health needs of this population are often overlooked, especially in low- and middle-Income countries, where scarcity of resources exacerbates the problem that has been further compounded by the global COVID-19 pandemic. Thus, special attention should be paid to the development of interventions that target this population. Objective Our research aims to adapt an existing patient-centered digital intervention called DIALOG+ from a clinical setting to an educational setting using stakeholders’ (teachers’ and students’) perspectives. We aim to evaluate the feasibility, acceptability, and estimated effect of implementing this intervention as a tool for the identification and mobilization of personal and social resources to mitigate the impact of social difficulties and to promote mental well-being. Methods We will conduct an exploratory mixed methods study in public schools of postconflict areas in Tolima, Colombia. The study consists of 3 phases: adaptation, exploration, and consolidation of the DIALOG+ tool. The adaptation phase will identify possible changes that the intervention requires on the basis of data from focus groups with teachers and students. The exploration phase will be an exploratory cluster randomized trial with teachers and school counselors to assess the acceptability, feasibility, and estimated effect of DIALOG+ for adolescents in school settings. Adolescents’ data about mental health symptoms and wellness will be collected before and after DIALOG+ implementation. During this phase, teachers or counselors who were part of the intervention group will share their opinions through the think-aloud method. Lastly, the consolidation phase will consist of 2 focus groups with teachers and students to discuss their experiences and to understand acceptability. Results Study recruitment was completed in March 2022, and follow-up is anticipated to last through November 2022. Conclusions This exploratory study will evaluate the acceptability, feasibility, and estimated effect of DIALOG+ for adolescents in postconflict school settings in Colombia. The use of this technology-supported tool aims to support interactions between teachers or counselors and students and to provide an effective student-centered communication guide. This is an innovative approach in both the school and the postconflict contexts that could help improve the mental health and wellness of adolescents in vulnerable zones in Colombia. Subsequent studies will be needed to evaluate the effectiveness of DIALOG+ in an educational context as a viable option to reduce the gap and inequities of mental health care access. Trial Registration ISRCTN Registry ISRCTN14396374; https://www.isrctn.com/ISRCTN14396374?q=ISRCTN14396374 International Registered Report Identifier (IRRID) DERR1-10.2196/40286

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BACKGROUND Colombia has a long history of an armed conflict that has severely affected communities with forced internal displacement and violence. Victims of violence and armed conflicts have higher rates of mental health disorders, and children and adolescents are particularly affected. However, the mental health needs of this population are often overlooked, especially in Low- and Middle-Income countries (LMICs), where scarcity of resources exacerbates the problem that has been further compounded by the COVID-19 global pandemic. Thus, special attention should be placed on the development of interventions that target this population. OBJECTIVE Our research aims to adapt an existing patient-centred digital intervention called DIALOG+ from a clinical to an educational setting utilising stakeholders (teachers and students) perspectives. We aim to evaluate the feasibility and acceptability of implementing this intervention as a tool for the identification and mobilisation of personal and social resources to mitigate the impact of social difficulties and to promote mental wellbeing. METHODS We will conduct an exploratory mixed-methods study in public schools of post-conflict areas in Tolima, Colombia. The study consists of three phases: adaptation, exploration, and consolidation of the DIALOG+ tool. The adaptation phase will identify possible changes that the intervention requires based on data from focus groups with teachers and students. The exploration phase will be an exploratory cluster randomised trial with teachers and school counsellors to assess the acceptability and feasibility of DIALOG+ for adolescents in school settings. Adolescents´ data about mental health symptoms and wellness will be collected before and after the DIALOG+ implementation. As part of this phase, teachers or counsellors who were part of the intervention group will share their opinions through the “think aloud” methodology. Lastly, the consolidation phase consists of two focus groups with teachers and students to discuss their experiences and to understand acceptability. RESULTS Study recruitment was completed in March 2022 and follow up is anticipated to last through November 2022. CONCLUSIONS This feasibility study will evaluate the acceptability and feasibility of DIALOG+ for adolescents in post-conflict school settings in Colombia. The use of this technology supported tool aims to support interactions between teachers or counsellors and students and to provide an effective student-centred communication guide. This is an innovative approach in both the school and the post-conflict contexts that could help to improve the mental health and wellness of adolescents in vulnerable zones from Colombia. Subsequent studies will be needed to evaluate the effectiveness of DIALOG+ in an educational context as a viable option to reduce the gap and inequities of mental health care access. CLINICALTRIAL The study has been prospectively registered on ISRCTN, ISRCTN14396374 https://doi.org/10.1186/ISRCTN14396374

The impact of COVID-19 pandemic on mental health of adolescents are emerging and require particular attention in settings where challenges like armed conflict, poverty and internal displacement have previously affected their mental wellbeing. This study aimed to determine the prevalence of mental health problems and symptoms of anxiety and depression, probable post-traumatic stress disorder, and resilience capacity in adolescents in a post-armed conflict area in Colombia during the COVID-19 pandemic. A cross-sectional study was conducted with 657 school attending adolescents aged 12 to 18 years old. Mental health information was obtained through screening scales for anxiety (GAD-7), depression (PHQ-8), probable post-traumatic stress disorder (PCL-5) and resilience capacity (CD-RISC-25). The prevalence observed for moderate to severe depression symptoms was 30.0% (CI95%=26.5–33.7) and for moderate to severe anxiety symptoms was 18.9% (CI95%=16.0-22.1). A prevalence of probable post-traumatic stress disorder (PTSD) of 22.3% (CI95%=18.1–27.2) was found. The CD-RISC-25 results for resilience had a median score of 54 [IQR:30]. Our results are in line with emerging evidence that suggests multiple domains of adolescents’ mental wellbeing were negatively impacted by the pandemic, and agree with other studies of regions affected by the armed conflict that show an increase in the prevalence of mental health disorders in young populations. In contrast, our data show lower resilience than other studies of adolescents. These findings call for multidisciplinary actions necessary to respond effectively to the impact of the pandemic on the mental health of adolescents, as well as to guarantee a successful educational recovery, being schools key places in which prompt intervention might reduce the burden of mental distress in adolescents.

Esta segunda edición de Comunicarnos sin daño parte de las inquietudes de los autores de incorporar nuevos elementos de reflexión acerca de cómo promover formas de comunicación que alienten la reconciliación nacional y favorezcan la salud mental de los colombianos y las colombianas. Desaprender y desnaturalizar las formas violentas de comunicación que han permeado la vida en sociedad con el fin de aprender a comunicarnos para una convivencia pacífica y saludable no es una tarea fácil, pues no solo demanda esfuerzo, creatividad y compromiso, sino también apertura y suficiente disposición para hacer lo que las dinámicas de violencia nos han impedido hacer: escucharnos y comprendernos mutuamente para avanzar en la búsqueda de consensos que permitan mejorar nuestra calidad de vida. Siguiendo ese propósito, todos como ciudadanos debemos pensar en el poder de la información, el lenguaje y la palabra en la salud mental, en la resolución pacífica de los conflictos y en la reconciliación. En ese sentido, Comunicarnos sin daño es un llamado a entender la comunicación como un fertilizante que puede abonar el terreno social para que la convivencia pacífica y el bienestar germinen con suficiente vigor, respaldo y legitimidad. Este es un libro de reflexiones y recomendaciones prácticas en el que los lectores encuentran una ruta para comunicarse en pro de la sana convivencia y la reconciliación.

The consequences that the COVID-19 pandemic had on the mental health of adolescents are emerging and require particular attention in settings where challenges like armed conflict, poverty and internal displacement have previously burdened their mental wellbeing. We conducted a cross-sectional study with 657 school attending adolescents in a post-armed conflict area in Colombia during the COVID-19 pandemic. Mental health information was obtained though screening scales. The prevalence observed for moderate to severe depression symptoms was 30.0% (CI95%=26.5-33.7) and for moderate to severe anxiety symptoms was 18.9% (CI95%=16.0-22.1). A prevalence of probable Post-Traumatic Stress Disorder of 22.3% (CI95%=18.1-27.2) was found. The CD-RISC-25 results for resilience had a median score of 54 [IQR:30]. These findings highlight the need to strengthen mental health care systems, with schools being key places in which prompt intervention might reduce the burden of mental distress in adolescents.

The impact of COVID-19 pandemic on mental health of adolescents are emerging and require particular attention in settings where challenges like armed conflict, poverty and internal displacement have previously affected their mental wellbeing. This study aimed to determine the prevalence of anxiety symptoms, depressive symptomatology, probable post-traumatic stress disorder and resilience in school-attending adolescents in a post-conflict area of Tolima, Colombia during the COVID-19. A cross-sectional study was carried out with 657 adolescents from 12 to 18 years old, recruited by convenience sampling in 8 public schools in the south of Tolima, Colombia, who completed a self-administered questionnaire. Mental health information was obtained through screening scales for anxiety symptoms (GAD-7), depressive symptomatology (PHQ-8), probable post-traumatic stress disorder (PCL-5) and resilience (CD-RISC-25). The prevalence observed for moderate to severe anxiety symptoms was 18.9% (95% CI 16.0–22.1) and for moderate to severe depressive symptomatology was 30.0% (95% CI 26.5–33.7). A prevalence of probable post-traumatic stress disorder (PTSD) of 22.3% (95% CI 18.1–27.2) was found. The CD-RISC-25 results for resilience had a median score of 54 [IQR 30]. These results suggest that approximately two-thirds of school-attending adolescents in this post-conflict area experienced at least one mental health problem such as anxiety symptoms, depressive symptomatology or probable PTSD during the COVID-19 pandemic. Future studies are of interest to establish the causal relationship between these findings and the impact of the pandemic. These findings highlight the challenge that schools have after pandemic to address the mental health of their students in order to promoting adequate coping strategies and implement prompt multidisciplinary interventions to reduce the burden of mental health problems in adolescents.