Adolescent Mental Health Care and Stigma: The ARTEMIS Randomized Clinical Trial

Area of Science:

• Global Mental Health
• Adolescent Health
• Public Health Interventions

Background:

• Limited mental health care access in Indian slums affects 12 million adolescents.
• Multiple stressors exacerbate mental health challenges in this vulnerable population.
• A critical research gap exists in community-based adolescent mental health care for low- and middle-income countries.

Purpose of the Study:

• To evaluate a multimedia antistigma campaign's impact on community stigma among adolescents.
• To assess a primary care health worker-led digital intervention's effectiveness in reducing depression risk in slum-dwelling adolescents.
• To address the mental health needs of adolescents in urban slums in India.

Main Methods:

• A parallel, cluster randomized, usual care-controlled trial was conducted in 60 slums across New Delhi and Vijayawada.
• Adolescents aged 10-19 years at high risk for depression or self-harm were recruited.
• Interventions included a multimedia antistigma campaign and a digital intervention delivered by primary care health workers.

Main Results:

• The antistigma campaign significantly improved adolescent knowledge, attitudes, and anticipated behavior toward mental illness (P<.001).
• The digital intervention led to lower depression scores (PHQ-9) in the intervention group (P=.03).
• While remission rates for high-risk adolescents were higher in the intervention group, the difference was not statistically significant (P=.10).

Conclusions:

• Community-based antistigma campaigns can positively influence adolescent perceptions of mental illness.
• Training primary care professionals in digital interventions shows potential for improving adolescent mental health outcomes in resource-limited settings.
• Integrated community and primary care approaches are crucial for addressing adolescent mental health in urban slums.