Efficacy of a school-based mental health intervention among Zambian youth: a cluster-randomized controlled trial

While many children in Africa face notable psychological problems, the majority do not receive needed mental health services. The My FRIENDS Youth Program, a universal cognitive-behavioral intervention for anxiety prevention and resilience enhancement, has demonstrated effectiveness across cultures in children and adolescents. This study explores whether the program's effectiveness extends to Zambian children. Participants were 75 children and adolescents (53% female, ages 10-15) attending low-income schools in Zambia. Four schools were randomly assigned to an intervention (n = 44) or waitlist control (n = 31). The intervention consisted of 10 weekly sessions plus two booster sessions administered in group format. Assessments were conducted at pre-intervention, immediately post-intervention and 3-month follow-up. Data were analyzed using longitudinal multilevel modeling and controlled for child and parent sociodemographic characteristics. Intervention participation did not lead to reductions in anxiety, depression or parent-child relationship conflict but was associated with reductions in parent-reported internalizing and externalizing symptoms, attention problems and increases in positive parent-child relationships. However, both the intervention and control groups exhibited lower anxiety symptoms from Post-Intervention to 3-Month Follow-Up, suggesting potentially delayed effects. Future research may need to adapt this intervention to meet the needs of children in Zambia.