The Shamiri group intervention for adolescent anxiety and depression: study protocol for a randomized controlled trial of a lay-provider-delivered, school-based intervention in Kenya

Abstract

Background Developing low-cost, socio-culturally appropriate, and scalable interventions for youth depression and anxiety symptoms in low-income regions such as countries in sub-Saharan Africa is a global mental health priority. We developed and intend to evaluate one such intervention for adolescent depression and anxiety in Kenya. The intervention, named Shamiri (a Swahili word for “thrive”), draws upon evidence-based components of brief interventions that involve nonclinical principles rather than treatment of psychopathology (e.g., growth mindset, gratitude, and virtues). Methods Four hundred twenty Kenyan adolescents (ages 13–18) with clinically elevated depression and/or anxiety symptoms will be randomized to either the 4-week Shamiri group intervention or a group study-skills control intervention of equal duration and dosage. Participating adolescents will meet in groups of 8–15, led by a high-school graduate trained to deliver Shamiri as a lay-provider. Adolescents will self-report primary outcome measures (depression—measured by the PHQ-8, and anxiety symptoms—measured by the GAD-7) and secondary outcome measures (perceived social support, perceived academic control, self-reported optimism and happiness, loneliness, and academic grades) at the 2-week intervention midpoint, 4-week post-intervention endpoint, and 2-week post-intervention follow-up. We predict that adolescents in the Shamiri group, when compared to the study-skills control group, will show greater improvements in primary outcomes and secondary outcomes. Discussion Results may suggest that a brief, lay-provider delivered, school-based intervention may reduce depression and anxiety symptoms, improving academic outcomes and other psychosocial outcomes in adolescents with clinically-elevated symptoms in sub-Saharan Africa. Trial registration Pan African Clinical Trials Registry PACTR201906525818462. Registered on 12 June 2019.

Adolescent psychopathology and psychological wellbeing: a network analysis approach

“…While these findings are insufficient to draw claims about interventions, they may suggest why positive psychological interventions that target psychological wellbeing elements rather than psychopathology—such as the Shamiri (“thrive”) intervention [ 30 ]—have been successful in treating depression and anxiety symptoms with Kenyan youths. For example, research on trait gratitude suggests that having a lot of things to be grateful for is associated with exhibiting positive states and outcomes that may buffer against depression and anxiety [ 68 ].…”

“…Participants were 2192 Kenyan adolescents recruited from four secondary schools in Nairobi and Kiambu Counties, as part of a large-scale clinical trial (called Shamiri [ 30 , 31 ];). The trial was registered in the Pan African Clinical Trials Registry ( PACTR201906525818462 ).…”

Testing the effects of the Shamiri Intervention and its components on anxiety, depression, wellbeing, and academic functioning in Kenyan adolescents: study protocol for a five-arm randomized controlled trial

“…The GQ-6 has been shown to have strong psychometric properties among North American youths. It has also been used in past RCTs with Kenyan adolescents [ 3 , 21 ].…”

“…We tested the Shamiri intervention in a randomized controlled trial (RCT) with 51 Kenyan adolescents with clinically elevated depression and/or anxiety symptoms; youths assigned to Shamiri reported significant improvements in depression and anxiety symptoms, academic performance, and perceived social support from friends when compared to youths in an active study skills control group of equal duration [ 16 ]. In a well-powered replication ( N = 413) [ 21 ], we found that youths assigned to the Shamiri intervention reported significantly greater improvement in depression and anxiety symptoms than youth in the control group. Effects lasted until the 7-month follow-up period [ 33 ].…”

“…The Shamiri intervention includes three empirically supported brief character strength interventions: growth mindset [ 23 – 27 ], gratitude [ 28 – 30 ], and value affirmation [ 31 , 32 ], which were iteratively adapted through co-design with and feedback from local stakeholders [ 20 , 33 ] to be appropriate for use in Kenyan high schools. Shamiri is a group-based intervention delivered in naturalistic school settings by lay providers who are recent high school graduates without formal training in mental health [ 20 , 21 ]. We tested the Shamiri intervention in a randomized controlled trial (RCT) with 51 Kenyan adolescents with clinically elevated depression and/or anxiety symptoms; youths assigned to Shamiri reported significant improvements in depression and anxiety symptoms, academic performance, and perceived social support from friends when compared to youths in an active study skills control group of equal duration [ 16 ].…”