Abstract summary 

Mental health problems are prevalent among African adolescents, but professional treatment capacity is limited. Shamiri, an efficient lay-provider-delivered intervention, has significantly reduced depression and anxiety symptoms in previous RCTs. We investigated effects of the full Shamiri intervention and its components (growth-only, gratitude-only, and values-only), against a study-skills control.In a five-group RCT with adolescents from Kenyan high-schools, anxiety, depression, and wellbeing were self-reported through eight-month follow-up. The RCT occurred immediately after an unanticipated government-mandated COVID shutdown forced three years of schoolwork into two, escalating academic pressures.Participants (N=1,252; 48.72% female) were allocated to: growth (n=249), gratitude (n=237), values (n=265), Shamiri (n=250), and study-skills (n=251). Longitudinal multilevel models showed that, across all conditions, anxiety scores significantly improved at midpoint (B=-0.847), endpoint (B=-2.948), one-month (B=-1.587), three-month (B=-2.374), and eight-month (B=-1.917) follow-ups. Depression scores also improved significantly at midpoint (B=-0.796), endpoint (B=-3.126), one-month (B=-2.382), three-month (B=-2.521), and eight-month (B=-2.237) follow-ups. Wellbeing scores improved significantly at midpoint (B=1.73), endpoint (B=3.44), one-month (B=2.21), three-month (B=1.78), and eight-month (B=1.59) follow-ups. Symptom-reduction with Shamiri matched that of pre-COVID trials, but symptom-reduction with study-skills far outpaced that of trials before the COVID-related school shutdown (31% greater anxiety reduction and 60% greater depression reduction). Thus, in contrast to previous RCTs, this COVID-era trial showed no significant differences between outcomes in any intervention and active control groups.Our RCT conducted during a post-COVID period of heightened academic pressure produced unexpected results. Improvements in youth-reported anxiety and depression were consistent with previous trials for Shamiri, but markedly larger than in previous trials for study-skills. "Control interventions" teaching life-skills may produce mental health benefits when they convey skills of particular contextual relevance.

Authors & Co-authors:  Venturo-Conerly Katherine E KE Osborn Tom L TL Rusch Thomas T Ochuku Brenda Kemuma BK Johnson Natalie E NE van der Markt Afra A Wasanga Christine M CM Weisz John R JR

Study Outcome 

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