Sustained mental health outcomes from the youth readiness intervention: A four‐year effectiveness follow‐up of a hybrid type II trial in Sierra Leone

Abstract

Background Strategies to expand access to care and sustain evidence‐based mental health interventions (EBIs) must be tested within novel delivery platforms to extend the reach of services in fragile and conflict‐affected settings. Integration into broader development programs may help maintain long‐term effects. This study presents a four‐year follow‐up of a previously conducted Hybrid Type II implementation‐effectiveness cluster‐randomized trial (CRT) of the Youth Readiness Intervention (YRI)—an EBI drawing on cognitive‐behavioral, interpersonal, and mindfulness‐based approaches—delivered within a youth entrepreneurship program in Sierra Leone (2018–2019). Methods Long‐term mental health outcomes (emotion regulation, psychological distress, and interpersonal functioning) were examined among a randomly selected subgroup of 584 participants across three study arms: a control group, a group that only received entrepreneurship training (‘ENTR’), and a group that received both YRI and ENTR (‘YRI + ENTR’). Linear mixed‐effect models accounted for the nested structure of the data. Impact of the COVID‐19 pandemic was also assessed through economic and relationship stressors using structural equation modeling. Results Four years postintervention, YRI + ENTR‐youth maintained improvements in depression ( β = −.057; 95% CI −0.09 to −0.02; [effect size] d = −.111) and combined depression/anxiety symptoms ( β = −.047; 95% CI −0.08 to −0.01; [effect size] d = −.096) though no sustained effects were observed for daily functioning or emotion regulation. No differences were found for ENTR‐only participants versus controls and YRI + ENTR. COVID‐19‐related economic stressors mediated the relationship between study arm and mental health, revealing small but significant effects. Conclusions In low‐income settings like Sierra Leone, where formal mental health services are scarce, sustainable community‐based interventions such as the combined YRI + ENTR intervention offer a critical approach to reducing psychological distress. Sustained long‐term benefits suggest that participants developed coping strategies that supported resilience during challenges like the COVID‐19 pandemic. These gains may also foster broader community resilience, enhancing both individual well‐being and collective capacity to withstand future adversity.