Scalable Technology for Adolescents and Youth to Reduce Stress (STARS) in the Treatment of Common Mental Disorders in Jordan: Study Protocol for a Randomized Controlled Trial (Preprint)

Abstract

Young people in low- and middle-income countries (LMICs) encounter significant barriers to accessing mental health support due to various factors, including a substantial treatment gap and limited healthcare budgets allocated to mental health. Utilizing innovative strategies, such as scalable digital self-help psychological interventions, offers a potential solution for improving access to mental health support. However, digital mental health interventions come with their own set of challenges, including issues related to low user engagement. Chatbots, with their interactive and engaging nature, may present a promising avenue for the delivery of these interventions.

The objective of this study is to explore the effectiveness of a newly developed World Health Organization digital mental health intervention, titled Scalable Technology for Adolescents and youth to Reduce Stress (STARS).

A single-blind, two-armed randomized controlled trial (RCT) will be conducted nationally across Jordan. Participants will include 344 young adults, aged 18-21 years, currently residing in Jordan. Inclusion criteria are heightened levels of psychological distress as determined through the 10-item Kessler Psychological Distress Scale (K10 ≥ 20). Assessment measures will be conducted at baseline, one-week post-intervention, and 3-month follow-up. Following baseline assessments, eligible participants will be randomized to receive STARS or enhanced usual care. The primary outcomes are reduction of symptoms of depression and anxiety (Hopkins Symptom Checklist; HSCL-25 subscales) at 3-months follow-up. Secondary outcomes include general functioning (WHO Disability Assessment Schedule; WHODAS 2.0), well-being (WHO Well-Being Index; WHO-5), personal problems (PSYCHLOPS), agency (State Hope Scale subscale).

The study was funded in January 2020 by R2HC (Elhra) and recruitment for the trial started on 16 July 2023. As of 15 November 2023, we randomized 228 participants.

This trial intends to contribute to the growing digital mental health evidence base by exploring technological solutions to address global public health challenges. Given the widespread use of technology globally, even in resource-constrained settings and the high adoption rates among adolescents and young individuals, digital initiatives such as STARS present promising opportunities for the future of mental healthcare in LMIC.

https://www.isrctn.com/ISRCTN10152961