Testing the Shamiri Intervention and Its Components With Kenyan Adolescents During the COVID-19 Pandemic: Outcomes of a Universal, 5-Arm Randomized Controlled Trial - 26/06/25
, Tom L. Osborn, BA a, Thomas Rusch, PhD e, Brenda Kemuma Ochuku, MA a, Natalie E. Johnson, MPH a, c, Afra van der Markt, MD, PhD a, Christine M. Wasanga, PhD a, d, John R. Weisz, PhD b
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Abstract |
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. Longitudinal multilevel models showed that, across all conditions, anxiety scores significantly improved at midpoint (B = −0.847), end point (B = −2.948), 1-month (B = −1.587), 3-month (B = −2.374), and 8-month (B = −1.917) follow-ups. Depression scores also improved significantly at midpoint (B = −0.796), end point (B = −3.126), 1-month (B = −2.382), 3-month (B = −2.521), and 8-month (B = −2.237) follow-ups. Well-being scores improved significantly at midpoint (B = 1.73), end point (B = 3.44), 1-month (B = 2.21), 3-month (B = 1.78), and 8-month (B = 1.59) follow-ups. Symptom reduction with Shamiri matched that of pre–COVID-19 trials, but symptom reduction with study skills far outpaced that of trials before the COVID-19–related school shutdown (31% greater anxiety reduction and 60% greater depression reduction). Thus, in contrast to previous RCTs, this COVID-19–era trial showed no significant differences between outcomes in any intervention and active control groups.
Conclusion |
Our RCT conducted during a post–COVID-19 period of heightened academic pressure produced unexpected results. Improvements in youth-reported anxiety and depression were consistent with previous trials for Shamiri, but markedly larger than in previous trials for study skills. Control interventions teaching life skills may produce mental health benefits when they convey skills of particular contextual relevance.
Plain language summary |
In this large 5-group randomized controlled trial involving 1,252 Kenyan adolescents, the authors compared the Shamiri intervention to its component interventions (growth mindset, gratitude, and values affirmation) and a study-skills control. This study was conducted right after an unanticipated government-mandated COVID-19 shutdown forced 3 years of schoolwork into 2 years. Benchmarking analyses against previous trials showed approximately equal effects of Shamiri over time, but a 31% greater anxiety reduction and 60% greater depression reduction for the study-skills condition. These findings highlight the potential of teaching highly relevant study-skills for improving mental health when youth are under considerable academic pressure.
Clinical trial registration |
Five-Arm Shamiri Trial; TrialDisplay.aspx?TrialID=14677
Le texte complet de cet article est disponible en PDF.Key words : anxiety, child and adolescent psychotherapy, COVID-19 pandemic, depression, global mental health
Plan
| This research was funded by the Templeton World Charity Foundation (grant TWCF0509). The funder of this study had no role in study design, data collection, data analysis, data interpretation, or writing of the report. |
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| Ethical approval was obtained from the Kenyatta University Ethics Review Committee (PKU/2176/1320), and a reliance agreement was established with the Harvard University Institutional Review Board. |
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| Data Sharing: Deidentified participant data are available upon request from the authors (kventuroconerly@g.harvard.edu). Analytic code is publicly available at the following link: vynw9/. Study protocol information (including full intervention protocols) is publicly available at the following link: 6xdka/. |
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| Thomas Rusch served as the statistical expert for this research. |
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| The authors thank the principals, school administrators, and teachers at the high schools in Kenya. They also thank the staff of the Shamiri Institute including the group leaders, supervisors, and research assistants involved in this study. |
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| Disclosure: Thomas Rusch has reported paid consulting for the Shamiri Institute, a 501(c)3 non-profit organization. Afra van der Markt has reported working for the Shamiri Institute. John R. Weisz has reported funding from the Institute of Education Sciences (R305A140253), the National Institute of Mental Health (R01MH 124965, P50 MH129699-01-A1), the Manton Foundation, the Marriott Foundation, School Mental Health Ontario, and the Templeton World Charity Foundation (TWCF0633 and TWCF0509). He has received royalties from Cambridge University Press, Guilford Press, and PracticeWise. Katherine E. Venturo-Conerly, Tom L. Osborn, Brenda Kemuma Ochuku, and Natalie E. Johnson have reported working for the Shamiri Institute. Katherine E. Venturo-Conerly has reported funding from the Templeton World Charity Foundation, the Harvard University Dean’s Competitive Fund, the Agency Fund, the Fund for Innovation in Development, and the National Institute of Mental Health (F31MH134555). Tom L. Osborn has reported funding from the Templeton World Charity Foundation Wellspring Philanthropic Fund, the Agency Fund, and the Fund for Innovation in Development. He has received royalties from Westwood Press and holds stock options in Shamiri Health, Inc. Christine M. Wasanga has reported no biomedical financial interests or potential conflicts of interest. |
Vol 64 - N° 7
P. 786-798 - juillet 2025 Retour au numéro
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