基于文化敏感行为的学校干预减轻了青少年焦虑和抑郁的负担：乌干达的一项试点集群随机试验

IF 4.9 2区医学 Q1 CLINICAL NEUROLOGY

Journal of affective disorders Pub Date : 2025-04-23 DOI:10.1016/j.jad.2025.04.128

Davy Vancampfort , Philip B. Ward , Japheth Nkiriyehe Kwiringira , Tine Van Damme , Simon Rosenbaum , James Mugisha

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引用次数: 0

摘要

学校在应对心理健康挑战方面可以发挥关键作用，特别是在乌干达等低收入国家。然而，针对文化和背景因素的随机对照试验很少。本试验性集群随机试验考察了文化敏感的ACT -归属-承诺（ACT）干预措施，结合体育活动、睡眠卫生和压力管理措施对乌干达中学青少年焦虑和抑郁的影响。方法共2598例青少年(干预1295例；1303控制;男生1199人[46.1%]；平均年龄（16.3±1.0岁）的四所中学的学生被随机分为两组，一组接受为期12周、每周2小时的教师和同伴主导的ACT干预，另一组接受照旧治疗。在基线和干预后立即测量焦虑（GAD-7）和抑郁（PHQ-9-A）。儿童创伤（CTQ-SF）、自我报告的健康、财富和食品安全在基线时进行评估。采用线性混合模型评价干预效果。结果基线时，GAD-7评分为6.4±4.4分，PHQ-9-A评分为7.4±5.1分。干预组在心理健康方面表现出更大的改善，对焦虑的影响中等（Cohen’s d = 0.50, 95% CI = 0.42-0.57），对抑郁的影响较小（Cohen’s d = 0.44, 95% CI = 0.36-0.52）。适度分析基于预先指定的基线变量。结论该试点试验提供了初步证据，表明结合体育活动、睡眠卫生和压力管理措施的文化适应性ACT干预可能是一种有希望的全校方法来减少青少年的焦虑和抑郁。需要更多集群的进一步试验。

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A culturally sensitive act-belong-commit-based school intervention reduces the burden of anxiety and depression in adolescents: A pilot cluster-randomized trial from Uganda

Introduction

Schools can be pivotal in addressing mental health challenges, especially in low-income settings like Uganda. However, randomized controlled trials tailored to cultural and contextual factors are scarce. This pilot cluster-randomized trial examines the impact of a culturally sensitive Act-Belong-Commit (ACT) intervention, combined with physical activity, sleep hygiene and stress management measures on anxiety and depression among Ugandan adolescents attending secondary school.

Methods

A total of 2598 adolescents (1295 intervention; 1303 control; 1199 boys [46.1 %]; mean age 16.3 ± 1.0 years) from four secondary schools were randomized by school to either a 12-week, weekly two-hour teacher- and peer-led ACT intervention or a care-as-usual control. Anxiety (GAD-7) and depression (PHQ-9-A) were measured at baseline and immediately post-intervention. Childhood trauma (CTQ-SF), self-reported health, wealth, and food security were assessed at baseline. Linear mixed modeling was used to evaluate intervention effects.

Results

At baseline, the mean GAD-7 score was 6.4 ± 4.4 and PHQ-9-A was 7.4 ± 5.1. The intervention group showed greater improvements in mental health, with moderate effects on anxiety (Cohen's d = 0.50, 95 % CI = 0.42–0.57) and small effects on depression (Cohen's d = 0.44, 95 % CI = 0.36–0.52). Moderation analyses were based on pre-specified baseline variables.

Conclusion

This pilot trial provides preliminary evidence that a culturally adapted ACT intervention combined physical activity, sleep hygiene and stress management measures may be a promising whole-school approach to reduce anxiety and depression in adolescents. Further trials with more clusters are needed.

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来源期刊

Journal of affective disorders 医学-精神病学

CiteScore

10.90

自引率

6.10%

发文量

1319

审稿时长

9.3 weeks

期刊介绍： The Journal of Affective Disorders publishes papers concerned with affective disorders in the widest sense: depression, mania, mood spectrum, emotions and personality, anxiety and stress. It is interdisciplinary and aims to bring together different approaches for a diverse readership. Top quality papers will be accepted dealing with any aspect of affective disorders, including neuroimaging, cognitive neurosciences, genetics, molecular biology, experimental and clinical neurosciences, pharmacology, neuroimmunoendocrinology, intervention and treatment trials.