Overview

PRIDE (PRemIum for aDolEscents) is an adolescent mental health research program that was conducted in India, a country that is home to the largest number of adolescents in the world. The aims were to develop and evaluate a suite of psychosocial interventions targeting emotional problems in school-based adolescents.  PRIDE was implemented from 2016-2022 in low-income schools in the state of Goa and the national capital of New Delhi as a collaboration between the London School of Hygiene and Tropical Medicine and Harvard Medical School with Sangath, the primary implementation partner in India. 

Rationale

Anxiety, depression, and disruptive behaviours impact youth globally, yet there is scarce research on the effectiveness of interventions outside of high-income countries. Evidence-based interventions tested in controlled research trials may also be difficult to scale due to resource constraints and a narrow focus on specific mental disorders, even though mental health problems commonly co-occur and may not fit rigid diagnostic categories. This award looked to address these challenges by developing and evaluating a community-based transdiagnostic stepped care model (i.e., relevant to a variety of common emotional and behavioural problems), which could be delivered by non-experts in low-resource global contexts.

Progress till date

PRIDE has generated 22 peer-reviewed papers (as of December 2023), including 19 led by early-career researchers. The key deliverables are set out below.

1.  A set of parsimonious evidence-based practice elements matched with common mental health presentations experienced by school-going adolescents and other contextual factors.

2. A whole-class ‘sensitisation’ intervention for delivery in a single session to enhance mental health literacy and help-seeking for mental health problems.

3. A resource-efficient stepped care architecture incorporated a transdiagnostic problem-solving intervention (‘Step 1’), followed by a higher-intensity second step (‘Step 2’) tailored to specific forms of psychopathology for non-responders. 

4. A demonstration of the sustained effectiveness of the delivery of the sensitisation and Step 1 interventions by lay counsellors in school settings. Modelling estimated the costs of scaling the intervention across 20 government-run schools in New Delhi at 4 USD per student, per academic year.

5. A scalable digital training platform with remote coach support and remotely delivered assessments of competencies, intended to expand the workforce capable of delivering the interventions nationally and globally 

6. A digitally delivered, self-guided, gamified version of Step 1 which can be deployed in school settings in an in-person format.

The PRIDE team worked across 32 schools in New Delhi and Goa and reached 176 students via co-design activities, 4000 students through pilot studies and RCTs, and 13,000+ students via classroom information sessions. Nearly 300 persons were trained to deliver the Step 1 intervention. Research capacity was developed through two embedded PhD projects led by Sangath staff. The team was also active in the psychosocial response to the Covid-19 pandemic, providing tele-counselling services based on PRIDE’s manualised interventions. These activities were recognised at the 2023 award ceremony of the Association for Child and Adolescent Mental Health (ACAMH), where PRIDE was highly commended in the inaugural category of ‘innovative research, training or practice in low- and middle-income countries'.

A parallel public engagement campaign, It’s Ok To Talk (http://www.itsoktotalk.in/), employed digital media, arts, community-based events, youth training, and leadership building to combat mental health stigma and promote youth-led mental health advocacy in India. It was recognised as one of the 10 most prominent international youth mental health campaigns by Facebook in 2019. The campaign delivered 112 community events and workshops for 8,500+ youth participants, involved 294 youth advisors, trained 73 youth advocates, and reached over 27 million users on social media. 

Implementation partnerships have extended to Karnataka, Haryana, and Rajasthan in India, as well as a growing number of international partnerships in Kenya, Bangladesh, Wales, and USA. 

Evidence from PRIDE has provided the foundation for METROPOLIS (2024-2028), a new Wellcome Trust-funded research program that will compare the effectiveness and mechanisms of two brief peer-delivered psychotherapies (problem-solving and behavioural activation) for university students with depression in New Delhi. 

Partner/s

• London School of Hygiene and Tropical Medicine, London, UK

• Harvard Medical School, Boston, USA