Abstract

Most depressed adolescents in Low and Middle Income Countries (LMICs) like Nigeria have no access to psychological intervention due to lack of trained mental health professionals. This huge treatment gap could be bridged by using non-mental health professionals such as teachers to deliver the interventions. This study evaluated a teacher-delivered Cognitive Behavioral Therapy (CBT) programme for depressed adolescents in Nigeria. Forty adolescents (aged 13–18 years) with clinically diagnosed depressive disorder were recruited from two schools (20 from each school). One school was balloted as intervention and the other as control. The intervention group received five sessions of manualised group-based CBT delivered by two teachers who were trained and supervised by a psychiatrist. Primary outcome was BDI score at week 6. Controlling for baseline BDI score, the intervention group had significantly lower post-intervention depressive symptoms {Means 4.60 vs 17.05; t = 4.13; p = 0.0001, F(1, 39) = 16.76, p = 0.0001, Effect Size (Cohen’s d) = 1.3}. Eighty-percent of the intervention group achieved remission compared with only 15.8% of the controls (p < 0.0001). To our knowledge, this is the first study of a teacher-delivered CBT programme for clinically depressed adolescents in a LMIC. The intervention was feasible, well received and showed promising efficacy.

摘要

由于缺乏训练有素的心理健康专业人员，尼日利亚等中低收入国家 (LMIC) 的大多数抑郁青少年无法获得心理干预。这种巨大的治疗差距可以通过使用教师等非心理健康专业人员来提供干预措施来弥补。本研究评估了针对尼日利亚抑郁青少年的教师提供的认知行为疗法 (CBT) 计划。从两所学校（每所学校 20 名）招募了 40 名临床诊断为抑郁症的青少年（13-18 岁）。一所学校被选为干预，另一所学校被选为控制。干预组接受了五次手工化的基于小组的 CBT，由两名接受过精神科医生培训和监督的教师提供。主要结果是第 6 周时的 BDI 评分。控制基线 BDI 评分，干预组的干预后抑郁症状显着降低 {平均值 4.60 vs 17.05; t = 4.13；p  = 0.0001，F(1, 39) = 16.76，p  = 0.0001，效应大小 (Cohen's d) = 1.3}。80% 的干预组达到缓解，而对照组只有 15.8% ( p  < 0.0001)。据我们所知，这是针对 LMIC 临床抑郁青少年的教师授课 CBT 项目的首次研究。该干预是可行的，受到好评并显示出良好的疗效。