BACKGROUND Emotional problems in adolescents living in low-income and middle-income countries (LMICs) remain largely unaddressed; key reasons include a scarcity of trained mental health professionals and unavailability of evidence-based, scalable psychological interventions. We aimed to evaluate the effectiveness of a non-specialist-delivered, group psychological intervention to reduce psychosocial distress in school-going adolescents in Pakistan. METHODS In a two-arm, single-blind, cluster randomised controlled trial, eligible public school clusters from a rural subdistrict of Gujar Khan, Rawalpindi, Pakistan, were randomised (1:1, stratified by sex) using permuted block randomisation into intervention (n=20) and wait-list control (n=20) groups. Adolescents aged 13-15 years who provided informed assent and caregivers' consent were screened for psychosocial distress using the youth-reported Pediatric Symptoms Checklist (PSC; total psychosocial distress scores from 0 to 70), and those scoring 28 or more and their caregivers were enrolled into the trial. Adolescents in the intervention group received seven weekly group sessions and their caregivers received three biweekly group sessions in school settings from trained non-specialists. The primary outcome was change from baseline in the total PSC scores at 3 months post-intervention. The trial was registered prospectively with the International Standard Randomised Controlled Trial Number registry, ISRCTN17755448. FINDINGS From the 40 school clusters that were included, 282 adolescents in the intervention group and 284 adolescents in the wait-list control group were enrolled between Nov 2 and Nov 30, 2021. At 3 months, adolescents in the intervention group had significantly lower mean total score on the PSC compared with adolescents in the control group (mean difference in change from baseline 3·48 [95% CI 1·66-5·29], p=0·0002, effect size 0·38 [95% CI 0·18-0·57]; adjusted mean difference 3·26 (95% CI 1·46-5·06], p=0·0004, effect size 0·35 (0·16-0·55). No adverse events were reported in either group. INTERPRETATION The group psychological intervention most likely represents a feasible and effective option for adolescents with psychosocial distress in school settings. FUNDING UK Medical Research Council, Foreign Commonwealth and Development Office, Department of Health and Social Care. TRANSLATION For the Urdu translation of the abstract see Supplementary Materials section.

中文翻译：

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团体心理干预减少巴基斯坦青少年心理社会困扰的有效性：一项单盲、整群随机对照试验。


背景 生活在低收入和中等收入国家（LMIC）的青少年的情绪问题在很大程度上仍未得到解决；主要原因包括缺乏训练有素的心理健康专业人员以及缺乏循证的、可扩展的心理干预措施。我们的目的是评估非专家提供的团体心理干预的有效性，以减少巴基斯坦在校青少年的社会心理困扰。方法 在一项双组、单盲、整群随机对照试验中，使用置换区组随机化对来自巴基斯坦拉瓦尔品第古贾尔汗农村分区的合格公立学校集群进行随机化（1:1，按性别分层）。 n=20）和等待名单控制（n=20）组。使用青少年报告的儿科症状检查表（PSC；心理社会困扰总分从 0 到 70）对提供知情同意和照顾者同意的 13-15 岁青少年进行心理社会困扰筛查，得分 28 或以上的青少年及其照顾者参加试验。干预组中的青少年每周接受七次小组会议，他们的照顾者在学校环境中接受由经过培训的非专家参加的每两周一次的三次小组会议。主要结果是干预后 3 个月时 PSC 总评分相对于基线的变化。该试验前瞻性地在国际标准随机对照试验编号注册处注册，ISRCTN17755448。结果 2021 年 11 月 2 日至 11 月 30 日期间，在纳入的 40 个学校集群中，干预组有 282 名青少年和候补名单对照组有 284 名青少年入学。 3 个月时，与对照组青少年相比，干预组青少年的 PSC 平均总分显着较低（与基线相比变化的平均差异为 3·48 [95% CI 1·66-5·29]，p= 0·0002，效应大小 0·38 [95% CI 0·18-0·57]；调整后的平均差 3·26 (95% CI 1·46-5·06]，p=0·0004，效应大小 0 ·35 (0·16-0·55) 两组均未报告不良事件。 解释 对于学校环境中存在心理社会困扰的青少年来说，团体心理干预很可能是一种可行且有效的选择。联邦与发展办公室，健康与社会关怀部 翻译 有关摘要的乌尔都语翻译，请参阅补充材料部分。