Pilot cluster randomised controlled trial of Stepping Stones and Creating Futures Plus to reduce emotional dysregulation among young men in rural areas and urban informal settlements in KwaZulu-Natal Province, South Africa.

Aim: Emotional dysregulation (ED) - the difficulty to control emotional responses to stressors - is a potential driver of intimate partner violence (IPV) perpetration among young men in HIV endemic resource-limited settings. This two-armed pilot cluster randomised controlled trial investigated the effectiveness of Stepping Stones and Creating Futures Plus (SSCF+), a participatory gender transformative and livelihood strengthening intervention, on the emotional dysregulation (ED) among young men in South Africa (SA).

Methods: A total of 163 young men ages 18 to 30 years were recruited in 30 clusters (friendship groups) in urban informal settlements and rural areas in KwaZulu-Natal, SA. Clusters were randomly allocated (1:1) to either the experimental SSCF+ or control arm, stratified urban/rural and participants were followed-up at 5 months. Intention-to-treat analysis based on generalised estimating equations (GEE) were fitted to quantify the impact of SSCF+ on the men's ED using the culturally tested short version of the Difficulties in Emotion Regulation Scale with 16 items (DERS-16).

Results: At 5 months SSCF+ did not significantly reduce ED in the overall sample. However, SSCF+ had a significant impact on ED among the men at risk of depression at baseline (adjusted odds ratio = 0.12, 95% CI [0.03, 0.46], p = .002).

Conclusion: SSCF+, a gender transformative and livelihoods strengthening intervention designed to address poverty and other socio-economic challenges, reduced ED among youth with depression challenges in KwaZulu-Natal Province, South Africa.