Layperson-delivered psychological intervention may improve adolescent depression, anxiety

A layperson-delivered psychological intervention that focused on positive human attributes rather than psychopathology reduced depression and anxiety in adolescents, according to results of a randomized clinical trial conducted in Kenya.

“This intervention, Shamiri (Kiswahili for thrive), is designed for implementation with adolescents meeting in groups led by trained laypersons,” Tom L. Osborn, AB, of the Shamiri Institute and department of psychology at Harvard University, and colleagues wrote in JAMA Psychiatry. “A preliminary proof-of-concept trial tested Shamiri with 51 Kenyan youths (aged 14 to 17 years) who showed elevated anxiety and/or depression symptoms. Youths randomly assigned to Shamiri (n = 28) showed significantly greater reductions in depression and anxiety symptoms than youths randomized to a study skills control (n = 23).”

However, small sample size and limited follow-up weakened that study, according to Osborn and colleagues. In the current study, they aimed to determine whether Shamiri, a 4-week layperson-delivered intervention incorporating elements of growth mindset, gratitude and value affirmation, improved depression and anxiety symptoms among symptomatic Kenyan adolescents aged 13 to 18 years. They included outcomes evaluated at baseline, posttreatment and 2-week and 7-month follow-up from four secondary schools in two counties in Kenya and used intent-to-treat analyses to analyze effects.

Osborn and colleagues randomly assigned participants to the Shamiri intervention (n = 205) or to a study skills control group (n = 208), and those in both conditions met in groups with a mean size of 9 participants for 60 minutes per week for 4 weeks. A total of 307 adolescents completed the 4-week intervention. Participants had a mean age of 15.5 years and 65.21% were female. Depression symptoms assessed via the Patient Health Questionnaire-8 item and anxiety symptoms assessed via the Generalized Anxiety Disorder-7 item served as primary outcomes. The researchers hypothesized analyses of imputed data to reveal significant reductions in symptoms of depression and anxiety for participants assigned to Shamiri vs. those assigned to the study skills group.

Results showed participants rated both Shamiri and study skills as highly useful and that both reduced symptoms of depression and anxiety; however, according to analyses with imputed data, those who received Shamiri exhibited greater reductions in depressive symptoms at posttreatment, 2-week follow-up and 7-month follow-up, as well as greater reductions in anxiety symptoms at posttreatment, 2-week follow-up and 7-month follow-up.

“Shamiri was created, and the study designed and implemented, by a multicultural team with combined expertise in intervention science and the relevant cultural context — an approach that may have value for global mental health research,” Osborn and colleagues wrote. “The positive findings suggest the testable possibility that interventions that are simple in design, low in cost, focused on positive human attributes and character strengths and delivered by laypersons may contribute usefully to global mental health.”