Mechanistic trial of problem solving and behavioural activation for youth depression

This proposal aims to advance understanding about the effectiveness and mechanisms of problem solving (PS) and behavioural activation (BA) as early interventions for youth depression. Both PS and BA have the potential to be used as brief and effective standalone interventions, yet they have rarely been evaluated outside of multi-component packages. We will investigate these active ingredients in India, which is home to 20% of the world’s youth population, focusing on university students in Delhi who screen positive for subthreshold or case-level depression. A 3-arm, individually randomised controlled trial, with a mediation analysis and embedded process evaluation, will test PS, BA and an attention control condition delivered by Peer Counsellors for N=714 participants. The primary outcome will be self-reported depression at 12 months post-randomisation; self-reported anxiety and social functioning will be secondary outcomes. Intermediate outcomes will be measured at 6 weeks and 6 months. Young people with relevant lived experience will co-adapt existing evidence-based PS and BA protocols prior to the trial. We will also validate measures of putative ingredient-specific and generalised mediators in a pre-trial psychometric study. The project will generate vital evidence on optimally efficient and scalable early interventions for youth depression in low-resource settings.