ADOLESCENT TALKING THERAPIES FOR LOW-RESOURCE SETTINGS: ASKING WHAT WORKS FOR WHOM, HOW, AND IN WHAT CIRCUMSTANCES

Lead Research Organisation: King's College London
Department Name: Social Science, Health and Medicine

Abstract

Worldwide, depression is common among adolescents and can have detrimental effects on their health and development. In high-income countries adolescents with depression can be treated with evidence-based interventions including talking therapies such as cognitive behaviour therapy and interpersonal therapy (IPT). These therapies are generally unavailable in low- and middle-income countries (LMICs) where 90% of the world's adolescents live. Researchers have tried with varying success to take therapies developed in high-income countries and adapt them for LMICs. A major barrier to implementing therapies in different settings is that we do not know much about how they work, who they work for, where they work best and over what time frame. Answering these questions is key to advancing the field of global mental health and is therefore the focus of my FLF.

I will test IPT, a talking therapy with the potential to improve adolescent depression in LMICs. To do this I will conduct a realist randomised controlled trial (RCT). This is an innovative approach that combines testing intervention mechanisms and modifying effects of contextual factors with an evaluation of the overall intervention impact. I will also address the lack of longitudinal research on depression in LMICs through a longer term follow-up of trial participants. Through a personalised training programme and international placements, I aim to develop as an intervention scientist, impact champion and mental health advocate, whilst also working to build the capacity of early career researchers involved in the project through training and mentorship.

I will test IPT in Nepal, a low-income country where I have strong collaborations and in 2018-20 led a UKRI-funded study that adapted and showed the feasibility of school-based group IPT for depressed adolescents aged 13-18. I will use my work in Nepal as a springboard for the fellowship and later broaden my focus to other LMICs.

The first phase of my FLF (Years 1-5 of a 5[+3 year] FLF model adjusted for part-time working) involves:
i) Development of an IPT logic model to map all the potential inputs and outcomes of IPT, mechanisms of change, and contextual factors that modify the mechanisms and effects of the intervention. I will do this through stakeholder consultation (adolescents, Nepali and international mental health specialists), consolidating psychological and social theory on IPT through a desk review, and integrating findings from my earlier IPT adaptation and feasibility study.
ii) Testing short and medium-term effects of IPT by conducting a realist RCT in Nepal. This will involve collecting qualitative and quantitative data from adolescent participants aged 13-18 and key stakeholders. I will use the data to assess IPT's impact and cost-effectiveness, and to refine and test hypotheses informed by the IPT logic model about intervention mechanisms and outcomes and how they vary by context (rural/urban, school environment) and participant characteristics (caste/ethnicity, age, gender). In preparation for the RCT I will develop and test procedures for data collection and control and intervention conditions through a small pilot trial.

In the second phase (Years 6-8) I will explore longer term effects of IPT and adolescent depression through a mixed methods follow-up study of RCT participants. I will assess participants 18 and 30 months after the intervention to examine whether outcomes are maintained and knock-on consequences for health, education, employment, and relationships. Data will also help to answer broader, elusive questions including: what are the mechanisms of relapse and remission in adolescent depression?; how does depression in early adolescence influence health and socio-economic trajectories in later adolescence and young adulthood? I will collaborate with the Identifying Depression Early in Adolescence (IDEA) Research Consortium to synthesise data from Nepal and cohorts in other LMICs.

Publications

10 25 50
 
Description Established a cadre of interpersonal therapists in Nepal
Geographic Reach National 
Policy Influence Type Influenced training of practitioners or researchers
Impact Interpersonal therapists have developed the requisite skills needed to competently deliver the therapy. This is evidenced in several ways: satisfactory adherence to the therapy manual; passing a knowledge test; demonstration of interpersonal competencies; positive feedback from adolescents who received the therapy and a trend towards improved depression. The two original interpersonal trainers are being supported to receive international certification by the International Society of Interpersonal Therapy.
 
Description Fee waiver for Nepali PhD student
Amount £79,920 (GBP)
Organisation King's College London 
Sector Academic/University
Country United Kingdom
Start 06/2023 
End 01/2026
 
Description London Interdisciplinary Social Science Doctoral Training Partnership
Amount £72,852 (GBP)
Organisation Economic and Social Research Council 
Sector Public
Country United Kingdom
Start 10/2023 
End 09/2026
 
Description Establishment of the Women in Global Mental Health Research Group 
Organisation Addis Ababa University
Country Ethiopia 
Sector Academic/University 
PI Contribution Dr Kelly Rose-Clarke, along with colleagues from TPO Nepal (Prasansa Subba, Dristy Gurung), King's College London (Doerte Bemme, Charlotte Hanlon) and University College London (Joanna Morrison) established the Women in Global Mental Health Research Group. The group aims to promote gender equity in global mental health research by raising awareness about the issues women researchers face, identifying possible solutions, and building a network of women to facilitate peer support, research collaboration and mentorship. Members of the group are from the Global South and North including Ethiopia, Malawi, South Africa, Nepal, India, Bangladesh, Denmark, UK, Australia and the US.
Collaborator Contribution Members of the group met in person in London and filled out questionnaires online about key challenges for women researchers in global mental health. We have drafted a commentary for Transcultural Psychiatry to be published later this year.
Impact The group is multidisciplinary including anthropologists, epidemiologists, psychiatrists, psychologists, public health researchers, and global mental health researchers. So far, outputs from the group include a strong network of women global mental health researchers advocating for a changing in research culture, and a draft commentary written for Transcultural Psychiatry Journal.
Start Year 2022
 
Description Establishment of the Women in Global Mental Health Research Group 
Organisation Boston College
Country United States 
Sector Academic/University 
PI Contribution Dr Kelly Rose-Clarke, along with colleagues from TPO Nepal (Prasansa Subba, Dristy Gurung), King's College London (Doerte Bemme, Charlotte Hanlon) and University College London (Joanna Morrison) established the Women in Global Mental Health Research Group. The group aims to promote gender equity in global mental health research by raising awareness about the issues women researchers face, identifying possible solutions, and building a network of women to facilitate peer support, research collaboration and mentorship. Members of the group are from the Global South and North including Ethiopia, Malawi, South Africa, Nepal, India, Bangladesh, Denmark, UK, Australia and the US.
Collaborator Contribution Members of the group met in person in London and filled out questionnaires online about key challenges for women researchers in global mental health. We have drafted a commentary for Transcultural Psychiatry to be published later this year.
Impact The group is multidisciplinary including anthropologists, epidemiologists, psychiatrists, psychologists, public health researchers, and global mental health researchers. So far, outputs from the group include a strong network of women global mental health researchers advocating for a changing in research culture, and a draft commentary written for Transcultural Psychiatry Journal.
Start Year 2022
 
Description Establishment of the Women in Global Mental Health Research Group 
Organisation Monash University
Country Australia 
Sector Academic/University 
PI Contribution Dr Kelly Rose-Clarke, along with colleagues from TPO Nepal (Prasansa Subba, Dristy Gurung), King's College London (Doerte Bemme, Charlotte Hanlon) and University College London (Joanna Morrison) established the Women in Global Mental Health Research Group. The group aims to promote gender equity in global mental health research by raising awareness about the issues women researchers face, identifying possible solutions, and building a network of women to facilitate peer support, research collaboration and mentorship. Members of the group are from the Global South and North including Ethiopia, Malawi, South Africa, Nepal, India, Bangladesh, Denmark, UK, Australia and the US.
Collaborator Contribution Members of the group met in person in London and filled out questionnaires online about key challenges for women researchers in global mental health. We have drafted a commentary for Transcultural Psychiatry to be published later this year.
Impact The group is multidisciplinary including anthropologists, epidemiologists, psychiatrists, psychologists, public health researchers, and global mental health researchers. So far, outputs from the group include a strong network of women global mental health researchers advocating for a changing in research culture, and a draft commentary written for Transcultural Psychiatry Journal.
Start Year 2022
 
Description Establishment of the Women in Global Mental Health Research Group 
Organisation Sangath
Country India 
Sector Charity/Non Profit 
PI Contribution Dr Kelly Rose-Clarke, along with colleagues from TPO Nepal (Prasansa Subba, Dristy Gurung), King's College London (Doerte Bemme, Charlotte Hanlon) and University College London (Joanna Morrison) established the Women in Global Mental Health Research Group. The group aims to promote gender equity in global mental health research by raising awareness about the issues women researchers face, identifying possible solutions, and building a network of women to facilitate peer support, research collaboration and mentorship. Members of the group are from the Global South and North including Ethiopia, Malawi, South Africa, Nepal, India, Bangladesh, Denmark, UK, Australia and the US.
Collaborator Contribution Members of the group met in person in London and filled out questionnaires online about key challenges for women researchers in global mental health. We have drafted a commentary for Transcultural Psychiatry to be published later this year.
Impact The group is multidisciplinary including anthropologists, epidemiologists, psychiatrists, psychologists, public health researchers, and global mental health researchers. So far, outputs from the group include a strong network of women global mental health researchers advocating for a changing in research culture, and a draft commentary written for Transcultural Psychiatry Journal.
Start Year 2022
 
Description Establishment of the Women in Global Mental Health Research Group 
Organisation Transcultural Psychosocial Organization
Country Nepal 
Sector Charity/Non Profit 
PI Contribution Dr Kelly Rose-Clarke, along with colleagues from TPO Nepal (Prasansa Subba, Dristy Gurung), King's College London (Doerte Bemme, Charlotte Hanlon) and University College London (Joanna Morrison) established the Women in Global Mental Health Research Group. The group aims to promote gender equity in global mental health research by raising awareness about the issues women researchers face, identifying possible solutions, and building a network of women to facilitate peer support, research collaboration and mentorship. Members of the group are from the Global South and North including Ethiopia, Malawi, South Africa, Nepal, India, Bangladesh, Denmark, UK, Australia and the US.
Collaborator Contribution Members of the group met in person in London and filled out questionnaires online about key challenges for women researchers in global mental health. We have drafted a commentary for Transcultural Psychiatry to be published later this year.
Impact The group is multidisciplinary including anthropologists, epidemiologists, psychiatrists, psychologists, public health researchers, and global mental health researchers. So far, outputs from the group include a strong network of women global mental health researchers advocating for a changing in research culture, and a draft commentary written for Transcultural Psychiatry Journal.
Start Year 2022
 
Description Establishment of the Women in Global Mental Health Research Group 
Organisation University College London
Country United Kingdom 
Sector Academic/University 
PI Contribution Dr Kelly Rose-Clarke, along with colleagues from TPO Nepal (Prasansa Subba, Dristy Gurung), King's College London (Doerte Bemme, Charlotte Hanlon) and University College London (Joanna Morrison) established the Women in Global Mental Health Research Group. The group aims to promote gender equity in global mental health research by raising awareness about the issues women researchers face, identifying possible solutions, and building a network of women to facilitate peer support, research collaboration and mentorship. Members of the group are from the Global South and North including Ethiopia, Malawi, South Africa, Nepal, India, Bangladesh, Denmark, UK, Australia and the US.
Collaborator Contribution Members of the group met in person in London and filled out questionnaires online about key challenges for women researchers in global mental health. We have drafted a commentary for Transcultural Psychiatry to be published later this year.
Impact The group is multidisciplinary including anthropologists, epidemiologists, psychiatrists, psychologists, public health researchers, and global mental health researchers. So far, outputs from the group include a strong network of women global mental health researchers advocating for a changing in research culture, and a draft commentary written for Transcultural Psychiatry Journal.
Start Year 2022
 
Description Establishment of the Women in Global Mental Health Research Group 
Organisation University of Bristol
Country United Kingdom 
Sector Academic/University 
PI Contribution Dr Kelly Rose-Clarke, along with colleagues from TPO Nepal (Prasansa Subba, Dristy Gurung), King's College London (Doerte Bemme, Charlotte Hanlon) and University College London (Joanna Morrison) established the Women in Global Mental Health Research Group. The group aims to promote gender equity in global mental health research by raising awareness about the issues women researchers face, identifying possible solutions, and building a network of women to facilitate peer support, research collaboration and mentorship. Members of the group are from the Global South and North including Ethiopia, Malawi, South Africa, Nepal, India, Bangladesh, Denmark, UK, Australia and the US.
Collaborator Contribution Members of the group met in person in London and filled out questionnaires online about key challenges for women researchers in global mental health. We have drafted a commentary for Transcultural Psychiatry to be published later this year.
Impact The group is multidisciplinary including anthropologists, epidemiologists, psychiatrists, psychologists, public health researchers, and global mental health researchers. So far, outputs from the group include a strong network of women global mental health researchers advocating for a changing in research culture, and a draft commentary written for Transcultural Psychiatry Journal.
Start Year 2022
 
Description Presentation for the Centre for Global Mental Health 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Other audiences
Results and Impact Dr Kelly Rose-Clarke gave a presentation on SAATHI and SAATHI-2 projects to around 30 members of the KCL/LSHTM Centre for Global Mental Health, including researchers and students based in Africa, South Asia and the UK. Following the presentation there was a Q&A session and members who attended the presentation emailed Dr Rose-Clarke regarding a job vacancy linked to the projects.
Year(s) Of Engagement Activity 2022
URL https://www.centreforglobalmentalhealth.org/
 
Description Presentation to the UK Interpersonal Psychotherapy Research Group 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Other audiences
Results and Impact Dr Kelly Rose-Clarke gave an online presentation to the UK Interpersonal Psychotherapy Research Group comprising researchers and psychologists in England and Scotland. Dr Rose-Clarke presented findings from SAATHI and received feedback on plans for SAATHI-2. As a result of the presentation Dr Rose-Clarke has new collaborations with several members of the group.
Year(s) Of Engagement Activity 2022
 
Description Theory of Change Workshops 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact We held four online workshops to build a globally relevant theory of change for interpersonal therapy. The workshops engaged psychologists, counsellors, therapists and researchers across the world, including Ethiopia, Lebanon, UK, Turkey, US and Nepal. Discussions focused on eliciting the key mechanisms and outcomes of group-based interpersonal therapy for adolescents. The outcome is model informed by the global interpersonal therapy community which can be tested in future research.
Year(s) Of Engagement Activity 2023