TY - JOUR
T1 - An intervention to reduce stigma and improve management of depression, risk of suicide/self-harm and other significant emotional or medically unexplained complaints among adolescents living in urban slums
T2 - protocol for the ARTEMIS project
AU - Yatirajula, Sandhya Kanaka
AU - Kallakuri, Sudha
AU - Paslawar, Srilatha
AU - Mukherjee, Ankita
AU - Bhattacharya, Amritendu
AU - Chatterjee, Susmita
AU - Sagar, Rajesh
AU - Kumar, Ashok
AU - Lempp, Heidi
AU - Raman, Usha
AU - Singh, Renu
AU - Essue, Beverley
AU - Billot, Laurent
AU - Peiris, David
AU - Norton, Robyn
AU - Thornicroft, Graham
AU - Maulik, Pallab K.
N1 - Funding Information:
The George Institute has a part-owned social enterprise, George Health Enterprises, which has commercial relationships involving digital health innovations. PKM is partially supported by NHMRC/GACD grant APP1143911 - Systematic Medical Appraisal, Referral and Treatment for Common Mental Disorders in India – (SMART) Mental Health and ARTEMIS and MRC-UKRI grant (MR/S023224/1 – Adolescents’ Resilience and Treatment nEeds for Mental health in Indian Slums - ARTEMIS). SKY and SP are supported by ARTEMIS. SK and AM are supported by SMART Mental Health and ARTEMIS. DP is supported by fellowships from the National Health and Medical Research Council of Australia (1143904) and the Heart Foundation of Australia (101890). GT is supported by the National Institute for Health Research (NIHR) Applied Research Collaboration South London at King’s College London NHS Foundation Trust, and by the NIHR Asset Global Health Unit award. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. GT is also supported by the Guy’s and St Thomas’ Charity for the On Trac project (EFT151101), and by the MRC-UKRI in relation to the Emilia (MR/S001255/1) and Indigo Partnership (MR/R023697/1) awards. HL is supported by the Guy’s and St Thomas’ Charity for the On Trac project (EFT151101), by the MRC-UKRI in relation to the Emilia (MR/S001255/1) and Indigo Partnership (MR/R023697/1) awards, Mental Health and ARTEMIS and MRC-UKRI grant (MR/S023224/1 – Adolescents’ Resilience and Treatment nEeds for Mental health in Indian Slums - ARTEMIS), by the National Institute for Health Research Asset Global Health Unit award and the National Axial Spondyloarthritis Society (NASS).
Funding Information:
Funding support for this study is provided by UKRI/MRC grant (MR/S023224/1 - Adolescents’ Resilience and Treatment nEeds for Mental health in Indian Slums - ARTEMIS). PKM, SKY, SK, SP and AM are partially or wholly supported by the UKRI/MRC grant. There is no role of the funding body in the design of the study, and the conceptualisation and writing of the manuscript. The PI and number of other staff are employees of the sponsor institute.
Funding Information:
We acknowledge the contributions of the members of the Trial Steering Committee who commented on the protocol and helped refine it. The Trial Steering Committee comprises of: 1. Prof David Osrin (Independent Chairperson) - University College London, UK 2. Prof. Prabha Chandra – National Institute of Mental Health and Neurosciences, Bangalore, India 3. Asst. Prof Julian Eaton – London School of Hygiene and Tropical Medicine, UK 4. Dr Caroline Harris (Observer) - Medical Research Council - UK Research and Innovation (MRC-UKRI), UK
Publisher Copyright:
© 2022, The Author(s).
PY - 2022/7/29
Y1 - 2022/7/29
N2 - Background: There are around 250 million adolescents in India. Adolescents are vulnerable to common mental disorders with depression and self-harm accounting for a major share of the burden of death and disability in this age group. Around 20% of children and adolescents are diagnosed with/ or live with a disabling mental illness. A national survey has found that suicide is the third leading cause of death among adolescents in India. The authors hypothesise that an intervention involving an anti-stigma campaign co-created by adolescents themselves, and a mobile technology-based electronic decision support system will help reduce stigma, depression, and suicide risk and improve mental health for high-risk adolescents living in urban slums in India. Methods: The intervention will be implemented as a cluster randomised control trial in 30 slum clusters in each of the cities of Vijayawada and New Delhi in India. Adolescents aged 10 to 19 years will be screened for depression and suicide ideation using the Patient Health Questionnaire (PHQ-9). Two evaluation cohorts will be derived—a high-risk cohort with an elevated PHQ-9 score ≥ 10 and/or a positive response (score ≥ 2) to the suicide risk question on the PHQ-9, and a non-high-risk cohort comprising an equal number of adolescents not at elevated risk based on these scores. Discussion: The key elements that ARTEMIS will focus on are increasing awareness among adolescents and the slum community on these mental health conditions as well as strengthening the skills of existing primary healthcare workers and promoting task sharing. The findings from this study will provide evidence to governments about strategies with potential for addressing the gaps in providing care for adolescents living in urban slums and experiencing depression, other significant emotional or medically unexplained complaints or increased suicide risk/self-harm and should have relevance not only for India but also for other low- and middle-income countries. Trial status: Protocol version – V7, 20 Dec 2021 Recruitment start date: tentatively after 15th July 2022 Recruitment end date: tentatively 14th July 2023 (1 year after the trial start date) Trial registration: The trial has been registered in the Clinical Trial Registry India, which is included in the WHO list of Registries (https://www.who.int/clinical-trials-registry-platform/network/primary-registries) Reference No. CTRI/2022/02/040307. Registered on 18 February 2022. The tentative start date of participant recruitment for the trial will begin after 15th July 2022.
AB - Background: There are around 250 million adolescents in India. Adolescents are vulnerable to common mental disorders with depression and self-harm accounting for a major share of the burden of death and disability in this age group. Around 20% of children and adolescents are diagnosed with/ or live with a disabling mental illness. A national survey has found that suicide is the third leading cause of death among adolescents in India. The authors hypothesise that an intervention involving an anti-stigma campaign co-created by adolescents themselves, and a mobile technology-based electronic decision support system will help reduce stigma, depression, and suicide risk and improve mental health for high-risk adolescents living in urban slums in India. Methods: The intervention will be implemented as a cluster randomised control trial in 30 slum clusters in each of the cities of Vijayawada and New Delhi in India. Adolescents aged 10 to 19 years will be screened for depression and suicide ideation using the Patient Health Questionnaire (PHQ-9). Two evaluation cohorts will be derived—a high-risk cohort with an elevated PHQ-9 score ≥ 10 and/or a positive response (score ≥ 2) to the suicide risk question on the PHQ-9, and a non-high-risk cohort comprising an equal number of adolescents not at elevated risk based on these scores. Discussion: The key elements that ARTEMIS will focus on are increasing awareness among adolescents and the slum community on these mental health conditions as well as strengthening the skills of existing primary healthcare workers and promoting task sharing. The findings from this study will provide evidence to governments about strategies with potential for addressing the gaps in providing care for adolescents living in urban slums and experiencing depression, other significant emotional or medically unexplained complaints or increased suicide risk/self-harm and should have relevance not only for India but also for other low- and middle-income countries. Trial status: Protocol version – V7, 20 Dec 2021 Recruitment start date: tentatively after 15th July 2022 Recruitment end date: tentatively 14th July 2023 (1 year after the trial start date) Trial registration: The trial has been registered in the Clinical Trial Registry India, which is included in the WHO list of Registries (https://www.who.int/clinical-trials-registry-platform/network/primary-registries) Reference No. CTRI/2022/02/040307. Registered on 18 February 2022. The tentative start date of participant recruitment for the trial will begin after 15th July 2022.
KW - Adolescent mental health
KW - Anti-stigma campaign
KW - Depression and increased risk of self-harm/suicide
KW - Electronic decision support systems
KW - India
KW - Other significant emotional or medically unexplained complaints
KW - Primary healthcare worker
KW - Randomised control trial
KW - Slums
UR - http://www.scopus.com/inward/record.url?scp=85135159386&partnerID=8YFLogxK
U2 - 10.1186/s13063-022-06539-8
DO - 10.1186/s13063-022-06539-8
M3 - Article
C2 - 35906663
AN - SCOPUS:85135159386
SN - 1745-6215
VL - 23
JO - Trials
JF - Trials
IS - 1
M1 - 612
ER -
