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Increasing demand for school counselling through a lay counsellor-delivered classroom sensitisation intervention: a stepped-wedge cluster randomised controlled trial in New Delhi, India

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Version 2 2023-06-12, 09:55
Version 1 2023-06-10, 00:16
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posted on 2023-06-12, 09:55 authored by Rachana Parikh, Adriaan Hoogendoorn, Daniel Michelson, Jeroen Ruwaard, Rhea Sharma, Bhargav Bhat, Kanika Malik, Rooplata Sahu, Pim Cuijpers, Vikram Patel
Introduction: We evaluated a classroom-based sensitisation intervention that was designed to reduce demand-side barriers affecting referrals to a school counselling programme. The sensitisation intervention was offered in the context of a host trial evaluating a low-intensity problem-solving treatment for common adolescent mental health problems. Methods: We conducted a stepped-wedge, cluster randomized controlled trial with 70 classes in six secondary schools serving low-income communities in New Delhi, India.The classes were randomized to receive a classroom sensitisation session involving a brief video presentation and group discussion, delivered by a lay counsellor over one class period (intervention condition, IC), in two steps of 4 weeks each. The control condition (CC) was whole-school sensitisation (teacher-meetings and whole-school activities such as poster displays). The primary outcome was the proportion of students referred into the host trial. Secondary outcomes were the proportion of students who met mental health caseness criteria and the proportion of self-referred adolescents. Results: Between 20th August 2018 and 9th December 2018, 835 students (23.3% of all students) were referred into the host trial. The referred sample included 591 boys (70.8%), and had a mean age of 15.8 years, SD=0.06; 194 students (31.8% of 610 with complete data) met mental health caseness criteria. Referral rates were substantially higher in the IC (IC=21.7%,CC=1.5%, OR=111.36, 95%CI=35.56-348.77,p<0.001). The proportion of self-referred participants was also higher in the IC (IC=98.1%,CC=89.1%, Pearson chi2(1)=16.92,p<0.001). Although the proportion of referred students meeting caseness criteria was similar in both conditions (IC=32.0% vs CC=28.1%), the proportion weighted for the total student population was substantially higher in the IC (IC=5.2%,CC=0.3%, OR=52.39, 95%CI=12.49-219.66,p<0.001), indicating that significantly more cases were referred in the IC. Conclusion: A single, lay counsellor-delivered, classroom sensitisation session increased psychological help-seeking for common mental health problems among secondary school pupils from urban, low-income communities in India.

History

Publication status

  • Published

File Version

  • Published version

Journal

BMJ Global Health

ISSN

2059-7908

Publisher

BMJ Publishing Group

Issue

6

Volume

6

Page range

1-11

Department affiliated with

  • Psychology Publications

Full text available

  • Yes

Peer reviewed?

  • Yes

Legacy Posted Date

2021-07-02

First Open Access (FOA) Date

2021-07-02

First Compliant Deposit (FCD) Date

2021-07-01

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