PRIDE is a Wellcome Trust-funded programme (2016-22) that aims to develop and test a suite of scalable, evidence-based interventions addressing the major share of the adolescent mental health burden (i.e., anxiety, depression and conduct difficulties) in India. The country is home to the largest concentration of adolescents in the world, comprising 20% of the total global population of 10-19-year-olds. Previous research has shown that as many as 23.3% of secondary school students experience significant mental health morbidity, and suicide is the leading cause of mortality in Indian adolescents (Roy et al., 2019).
Designed initially for urban, low-income secondary schools in New Delhi and Goa, the PRIDE intervention model incorporates three design innovations. First, the content is built around a core set of active ingredients that were systematically identified by matching evidence-based practices to common adolescent problems found in the local context. These building blocks are combined within a structured transdiagnostic protocol from which a ‘menu’ of behavioural modules are selected, titrated and sequenced according to clinical presentations. The parsimonious use of a single intervention framework for multiple problems is intended to improve both efficiency and utility, especially in “real-world” service settings where psychosocial complexity and comorbidity are commonplace. Second, PRIDE employs non-specialist (“lay”) counsellors as the primary delivery agents, in line with evidence for the cost-effectiveness of task-sharing for mental health care in diverse low-resourced settings. A low-cost digital training package has been developed to enable capacity building at scale. Third, a stepped care architecture allows for further resource efficiency. A broad-based problem-solving intervention (“Step 1”) is delivered as a brief first-line intervention, followed by a more tailored, higher-intensity second step (“Step 2”) for non-responders.
The conceptual development of the PRIDE stepped care model has been detailed in a series of linked publications (Boustani et al., 2020; Chorpita et al., 2020; Michelson et al., 2020a). Subsequently, Step 1 has been trialled as a standalone intervention (Michelson et al., 2020b) using a brief (3-week) face-to-face counselling format, and compared against problem-solving booklets alone. The counselling format had a significant effect on self-reported psychosocial problem severity at 6 and 12 weeks, with the effect sustained over 12 months (Malik et al., in submission). Other PRIDE studies have included a stepped-wedge, cluster-randomised controlled trial of a classroom-based sensitisation intervention designed to generate demand for the Step 1 problem-solving intervention (Parikh et al., 2021), as well as a pilot evaluation of the complete stepped care protocol (Malik et al., in submission). A digital version of the problem-solving intervention has also been developed (Gonsalves et al., 2021), with a trial planned for 2022. A further trial will evaluate the learning outcomes of online training provided for prospective PRIDE counsellors without prior experience in psychological therapies.
PRIDE aimed to develop and evaluate a suite of transdiagnostic interventions targeting common mental health problems among school-going students.
TRIAL PAPERS
INTERVENTION DEVELOPMENT PAPERS
FORMATIVE PAPERS
do_shortcode(‘
‘)