Identifying Depression Early in Adolescence (IDEA) King's-Brazil-Nepal-Nigeria network

Depression is a common mental disorder that will affect up to one out of five people around the world during their lifetimes and tends to start in adolescence. Depression is an especially debilitating mental illness because it often begins early in life and has a chronic course with many depressive episodes occurring throughout one's lifetime. Many people lack access to depression care and this is especially true in the world's poorest countries. Our proposed collaboration aims to bring a high-income country's expertise in research, where most of the scientific knowledge about depression and other mental health problems has been produced, to developing countries, where 9 out of 10 children and adolescents live. This collaboration between King's College London in the UK and researchers from Brazil, Nepal and Nigeria intends to find new ways to identify which adolescents are at risk of depression, what protects young people from developing depression, and are these factors the same or different in these contrasting contexts. Such information is crucial to help us understand how to intervene early in a range of settings to prevent a lifetime of suffering.

In order to achieve this, we propose to do the following: First, we will bring together researchers with different types of expertise from high (UK), middle (Brazil and Nigeria) and low (Nepal) income countries to reach a consensus about how to measure risk and protective factors for depression in comparable ways among adolescents in these different countries. We will then draw upon existing datasets of youth who have participated in research at multiple time points during their childhood and adolescence to run initial tests to see whether similar or different factors predict the development of depression in each country. This collaborative network will then apply for funding to conduct a new research project to assess much larger numbers of adolescents in each country with the consensus measures to identify the biological, social, psychological, and environmental factors that predict which adolescents will develop depression and which will not in each of these settings. Finally, we will scope out potential gaps in equipment, expertise, and policies in each country so that we know what needs to be put in place before such a large-scale research project can be successfully conducted. In order to begin the process of rectifying these gaps, we will deliver online training and offer hands-on apprenticeships to increase the skills of researchers in Brazil, Nepal and Nigeria to enable them to effectively conduct the research themselves.

Ultimately, this research will generate new knowledge on how to identify and prevent depression among youth, which would substantially decrease the personal, social and economic costs associated with the disorder in these countries and around the globe.

Depression is a leading contributor to the global burden of disease and, for most individuals, depression has its onset in adolescence and young adulthood. Youth in low- and middle-income countries (LMICs), who comprise 90% of the world's child and adolescent populations, bear the greatest burden of depression. Moreover, one out of every three suicides each year are among adolescents and young adults in LMICs, accounting for ~300,000 deaths each year. To combat this global public health challenge, more research is needed to identify risk and resiliency factors to detect and prevent depression during adolescence, especially within the LMIC context.

The key aims of King's College London's proposal are: to consolidate a recently formed multidisciplinary UK-Brazil-Nepal-Nigeria network of early and mid-career researchers, and build capacity within LMICs to pave the way to apply for more substantive grants to increase understanding of biopsychosocial risk and resiliency factors for depression in adolescence. This would greatly improve early detection of depression across the globe, and ultimately lead to the development of context-specific treatments and preventive interventions. This will be achieved through:

(1) Two in-person networking meetings of early- and mid-career researchers and clinicians from King's, universities in Brazil and Nigeria, and an NGO in Nepal, will be held to discuss harmonisation of measures across existing cohorts, reach consensus on a uniform set of assessments for future large-scale research in these settings, and develop a substantive grant application.

(2) Undertaking pilot analyses of replicability of a Brazilian depression risk score in adolescents from cohorts in the UK, Nepal and Nigeria.

(3) Conducting scoping exercises to ascertain the viability of conducting large-scale neurobiological psychiatric research in the 3 LMICs.

(4) Building capacity by providing virtual training and apprenticeships to researchers in each LMIC

LMIC populations: The consolidation of the Identifying Depression in Early Adolescence (IDEA) network, a partnership between King's College London in the UK and organisations in Brazil, Nepal and Nigeria, will enable promotion and dissemination of technical knowledge and build research skills in these low- and middle-income countries (LMICs) with the potential to enhance their national scientific production capacity. These countries represent the full range of countries on the DAC list (Brazil is at the higher end of the MICs, Nigeria is at the lower end of the MICs, and Nepal is one of the least developed countries) and thus the knowledge gained during this award is likely to be relevant to the full LMIC spectrum.

The knowledge obtained from the scoping exercises, building of LMIC research capacity, and production of preliminary data, during the activities proposed in this application, together with consolidation of the IDEA multidisciplinary network, would put the network in the ideal position to apply for more substantive grants to investigate neurobiological and psychosocial risk and resiliency factors for adolescent depression across the three LMIC settings. Ultimately, this research would contribute to the development of tools for early identification of depression in adolescents across a range of LMICs, and in the longer term has the potential to improve prevention and reduce the onset of depression in adolescents. This in turn would decrease the personal, social, and economic costs associated with this disorder in these countries and around the globe. This is particularly relevant to LMICs where restricted mental health budgets demand wise allocation of resources and better-informed policymaking. The enhanced research capacity within the LMICs would facilitate the nimble development and implementation of numerous studies into other aspects of global mental health. Moreover, it would strengthen King's links with these LMICs, opening up a wealth of further research and training opportunities.

Academic beneficiaries: This project would provide an invaluable opportunity for researchers at the Institute of Psychiatry, Psychology, & Neuroscience at King's College London, to extend their biosocial mental health expertise into the global health arena through working closely with partners in Brazil, Nepal and Nigeria to address the mental health challenge of adolescent depression within these LMICs. None of these King's early- or mid-career researchers has previously worked outside of the high-income country context. This would enhance not only their scientific skillset but also open up a wide range of opportunities in terms of future training, cross-cultural replications of findings, the breadth of research questions they could investigate, and expand the number of relevant grant calls they could apply to in order to build more extensive programmes of research and facilitate their transition to senior investigators. Moreover, leading this interdisciplinary network will further extend the Principal Investigator's leadership skills and ensure she is in the ideal position to lead large global mental health research projects. The proposed training would promote the development of early-career researchers across the LMIC partners and they would be supported to apply for their own fellowships/grants, thus hopefully contributing to their career advancement. Finally, collaborating on the development of a large grant application will provide the mid-career researchers in the UK and LMICs with the incredibly valuable experience of producing large-scale programme grants on global mental health, which will benefit their long-term careers in academia.