Five-arm RCT of Shamiri and components during COVID-19

Objective: Mental health problems are prevalent among African adolescents, but professional treatment capacity is limited. Shamiri, an efficient lay provider-delivered intervention, has significantly reduced depression and anxiety symptoms in previous randomized controlled trials (RCTs). This trial investigated effects of the full Shamiri intervention and its components (growth-only, gratitude-only, and values-only) against a study skills control.

Method: In a 5-group RCT with adolescents from Kenyan high schools, anxiety, depression, and well-being were self-reported through 8-month follow-up. The RCT occurred immediately after an unanticipated government-mandated COVID-19 shutdown forced 3 years of schoolwork into 2 years, escalating academic pressures.

Results: Participants (N = 1,252; 48.72% female) were allocated to: growth (n = 249), gratitude (n = 237), values (n = 265), Shamiri (n = 250), and study skills (n = 251) conditions. Across all conditions, anxiety, depression, and well-being scores significantly improved at all timepoints. Symptom reduction with study skills outpaced that of pre-COVID trials (31% greater anxiety reduction and 60% greater depression reduction). In contrast to previous RCTs, this COVID-19-era trial showed no significant differences between outcomes in any intervention and active control groups.

Conclusion: Control interventions teaching life skills may produce mental health benefits when they convey skills of particular contextual relevance.