Digital delivery of Behavioural Activation therapy to overcome depression and facilitate social and economic transitions of adolescents in South Africa
Date
2021-04-19
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Abstract
Adolescence is a critical period in life when young people negotiate independence and increased responsibility and make important decisions. The incidence of depression peaks during adolescence, coinciding with the development of multiple cognitive functions in the brain. Adolescent depression is a key public health concern, with high prevalence rates reported among rural and low resource communities in South Africa. Depression impacts young people’s ability to make decisions and manage stressful situations in life.2 It has also been linked to poor social, economic, and health outcomes including early pregnancy, HIV, lower educational attainment and poverty in adulthood. Evidence is urgently needed for cost-effective and scalable interventions targeting adolescent depression.
Behavioural activation (BA) is a psychological therapy which focuses on making links between mood and behaviour. It does this by identifying activities that are meaningful and positively reinforcing for the individual (activation), and addressing processes that inhibit activation (e.g. avoidance). BA has been shown to be effective in treating adolescent depression, and can be adapted to diverse sociocultural contexts. In addition to improving depressive symptoms, studies suggest that BA targets cognitive functions involved in depression, including executive function and social cognition. These functions develop substantially during adolescence and are associated with a range of future socioeconomic outcomes. Further, BA has been successfully delivered online and through trained peer mentors with limited specialist intervention, offering a scalable solution to overcome the lack of access to psychological therapies.
The proposed trial will be a pilot randomised controlled trial to evaluate digital delivery of Behavioural Activation therapy for adolescents with depression in rural South Africa (DoBAt study). Central to the study is an iterative process to co-design the Kuamsha app (meaning “activate” in Swahili) through extensive formative work with adolescents from the study site. We will assess the feasibility, acceptability and determine the preliminary effectiveness of the intervention (primary objective). As a secondary objective, we will locally adapt and pilot outcome measures of mental health, cognition, risky behaviours, socioeconomic measures, and collect descriptive data to inform the development of a further larger trial.
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DoBAT