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 Table of Contents  
RESEARCH PROTOCOL
Year : 2022  |  Volume : 7  |  Issue : 1  |  Page : 46-51

Burden of mental health disorders and synthesis of community-based mental health intervention measures among adolescents after the onset of COVID-19 pandemic time in low middle-income countries: Protocol for systematic review and meta-analysis


1 Department of Mental Health, ICMR-Centre for Ageing and Mental Health, Kolkata, West Bengal, India
2 ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India
3 Specialty Doctor in Psychiatry, Southern Health NHS Foundation Trust, UK

Date of Submission26-Nov-2021
Date of Decision22-Jan-2022
Date of Acceptance23-Jan-2022
Date of Web Publication31-Mar-2022

Correspondence Address:
Dr. Indranil Saha
ICMR-Centre for Ageing and Mental Health, Indian Council of Medical Research., Block DP 1, Sector V, Salt Lake, Kolkata - 700 091, West Bengal
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jncd.jncd_75_21

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  Abstract 


Adolescents have become victims of the COVID-19 pandemic, leading to the development of several mental health problems. This protocol is aimed to determine the pooled prevalence of mental health disorders among adolescents (10–19 years) during the COVID-19 pandemic time in low middle-income countries (LMIC) and to find different community-based mental health intervention measures in addressing adolescent mental health disorders during COVID-19 pandemic time in LMIC. Articles will be retrieved from databases such as PubMed, EmBase, Scopus, Cochran Central, and Google Scholar using Medical Subject Headings terms, keywords, and text words for each concept. Preprint search servers (MedRx, Cogprints, IndiaRxiv, medRxiv, SSRN) will also be accessed in addition to hand-searching of retrieved articles by forward and backward searching strategies. Data analysis will be conducted as per guidelines provided in the Handbook of Cochrane Systematic Review. RevMan version 5.4 or suitable software will be used for pooled analysis. This proposal is registered in the PROSPERO register (CRD42021278714). Pooled prevalence will depict the overall burden of these neglected health issues. The proposed study would further suffice in identifying evidence-based intervention measures in community settings among adolescents in the background of an ongoing highly infectious disease pandemic.

Keywords: Adolescents, burden, community-based mental health intervention, COVID-19, low middle-income countries, mental health


How to cite this article:
Saha I, Majumder J, Bagepally BS, Ray S, Saha A, Chakrabarti A. Burden of mental health disorders and synthesis of community-based mental health intervention measures among adolescents after the onset of COVID-19 pandemic time in low middle-income countries: Protocol for systematic review and meta-analysis. Int J Non-Commun Dis 2022;7:46-51

How to cite this URL:
Saha I, Majumder J, Bagepally BS, Ray S, Saha A, Chakrabarti A. Burden of mental health disorders and synthesis of community-based mental health intervention measures among adolescents after the onset of COVID-19 pandemic time in low middle-income countries: Protocol for systematic review and meta-analysis. Int J Non-Commun Dis [serial online] 2022 [cited 2022 May 21];7:46-51. Available from: https://www.ijncd.org/text.asp?2022/7/1/47/342082




  Introduction Top


The whole world has come to a standstill due to the COVID-19 pandemic, and adolescents, too, have become victims of this present situation due to their home confinement and school/college closure. In India, the adolescent population is approximately 243 million that constitutes a quarter of the country's population.[1] The usual routine of school-going, physical activities, and interaction with teachers and peer group has been completely disrupted and replaced by attending classes through online platform that can be availed only by children of middle or upper socioeconomic strata. In rural areas, some adolescents have been forced to child marriage, child labor, and other adversities.[2],[3] Some have been orphaned and mentally traumatized in the pandemic. All these factors have cumulatively affected the mental health of adolescents leading to the development of behavioral problems along with cognitive impairment.[4],[5]

These problems may vary according to environmental and social influencers, which are different for urban areas, slums, and villages in low middle-income countries (LMIC). About 34.5%, 41.7%, 42.3%, and 30.8% of children have been identified to be suffering from anxiety, depression, irritability, and inattention during this pandemic time in a recently published meta-analysis.[5] Therefore, there is an imminent need to enumerate the quantum of mental health problems among adolescents and address the same. This would help in the development of strategic action plans for mental health support at all levels (institutional, community, and family levels) in LMIC. This would also help the program implementers to provide the psychosocial and mental health requirements of the adolescents based on available pieces of evidence from LMIC.

In India, most care is institutionally based, with poor attention to community mental health.[6] Moreover, the behavioral problems have a good prognosis if they are recognized earlier. The family has a crucial role in preventing behavioral problems in children, as documented from earlier studies; thus, parental counseling might be helpful.[7] One of the biggest challenges in delivering adolescent health care is ensuring that at-risk individuals are linked with the appropriate support.[8] In India, programs such as “Manodarpan,” “Snehi,” “Kutty desk” (student-run program in Kerala) were launched to tackle the mental health challenges during this pandemic. Still, these efforts were not uniform throughout our country.[9] COVID-19 pandemic has also interrupted the community-based activities to address mental health issues under Rashtriya Kishor Swasthya Karyakram.[9]

The effectiveness of community-based mental health interventions has already been established in decreasing the patient's disability, the burden on the family and the costs incurred by the family, and it has also been proved during the COVID-19 pandemic.[10],[11],[12],[13],[14] Further, mental health interventions with psychoeducation, peer support, referral, nonspecialized care program, mobile technology-based program, or tele-mental health program have a positive impact on their mental health.[10],[11] Active involvement of family and community is the need of the hour, as also emphasized in the National Mental Health Program for the success of the community-based mental health-care program.[11],[12]

Identifying the burden of mental health problems among adolescents and the appropriate interventions at community settings in different set-ups is the need of the hour to develop a road map for effective intervention. This proposal envisages estimating the burden of mental health impairment and finding appropriate community-level intervention measures in tackling these problems in LMIC. So that specific interventions which will come out from the findings can be proposed to implement in community settings in LMIC. The children, who are the future citizens of our country, will be emotionally empowered to tackle the ongoing pandemic crisis or any other future disaster.


  Research Questions Top


Primary research question

What is the burden of mental health disorders among adolescents (10–19 years) after the onset of COVID-19 pandemic time in LMIC?

Secondary research question

Descriptive synthesis of various community-based mental health intervention measures taken to tackle mental health disorders among adolescents (10–19 years) during COVID-19 pandemic time in LMIC.

Objectives

  1. To systematically review the literature and pool the prevalence of mental health disorders among adolescents (10–19 years) during the COVID-19 pandemic in LMIC
  2. To systematically review and conduct a descriptive synthesis of community-based mental health intervention measures in addressing adolescent mental health disorders during COVID-19 pandemic time in LMIC.



  Methods and Outcomes Top


This protocol has been written with the available guideline of the PRISMA-P 2015 Checklist[13] [Supplementary File 1].

Study eligibility criteria

The following study selection criteria will be considered for this proposed systematic review and meta-analysis.

Types of studies/article types

  • Randomized controlled trials
  • Nonrandomized controlled trials


  • Uncontrolled trials
  • Observational analytical studies of prospective or retrospective design
  • Case study
  • Case series.


Filter

  • Publications in the English language.


Inclusion criteria

  • Articles dealing with the prevalence or incidence of mental health disorders
  • Articles addressing adolescent mental health disorders
  • Articles stating the use of community-based mental health promotion interventions
  • Articles stating psychosocial support as rehabilitative measures for mental health disorders
  • Articles included adolescents aged 10–19 years
  • Articles stating work in LMIC
  • Articles dealing during COVID-19 pandemic time.


Exclusion criteria

  • Expert opinion
  • Narrative review
  • Editorial
  • Commentary
  • Conference proceedings.



  Literature Search Top


Published literature

The literature search strategy will be designed using the PICOS strategy with P (Population/patient), I (Intervention), C (Comparator), O (Outcome), and S (Settings) format. The proposed study will focus on the databases such as PubMed, Embase, Scopus, Google Scholar, and Preprint search servers (MedRx, Cogprints, IndiaRxiv, medRxiv, SSRN).

The primary and secondary research question was split up in different concepts. In the “Population (P)” component, “adolescent” concept was placed. In “Intervention (I)” component, “mental health counseling,” “community mental health services,” “community based services,” “mental health promotion” were kept as concept. Similarly, “mental health disorders,” behavioral problems,” “cognitive impairment,” “substance use,” “trauma,” “self harm,” and “suicide” were placed as concept in 'Outcome (O)' component. Since our objective was to find articles during COVID-19 pandemic in LMIC, thus we have kept “COVID-19” and “low middle-income countries” in the “Settings (S)” component in the search strategy. For each concept, “Medical Subject Headings (MeSH) term” was identified in PubMed (https://pubmed.ncbi.nlm.nih.gov/) using MeSH terms (https://www.ncbi.nlm.nih.gov/mesh/). Text words, i.e., each of MeSH term will be separately identified from “Entry terms” listed under each “MeSH term.” Articles will be retrieved from separate (MeSH) term and relevant open terms from “PubMed advanced Search Builder” (https://pubmed.ncbi.nlm.nih.gov/advanced/). Afterward, appropriate “Boolean Operators” such as “OR” will be used within and “AND” will be used between each of the search terms in the PICOS search strategy. The final search strategy in each search engine will be built separately to address the research questions [Box 1] and [Box 2] are preliminary search strategies for primary and secondary research questions, respectively]). Various terms for each concept (e.g., MeSH terms, keywords, text words) will be entered similarly, as appropriate for each database, such as Embase, Scopus, Cochran Central, and Google Scholar.




  Unpublished Literature Top


Manual searching will also be conducted in other sites to identify missing articles if any. Both forward (prospective citations) and backward searching (cross-references) of the retrieved articles will also be done to identify additional unidentified publications.

Study selection

Articles will be retrieved by two independent authors. Titles and abstracts will be initially screened to eliminate evidently unrelated records, and then full articles of relevant studies will be inspected to determine eligible studies. Any disagreement between the two authors will be resolved by consulting a third author. If necessary, authors of the respective articles will also be contacted over E-mail. Any discrepancies will be resolved at each stage, and consensus will be achieved after the calculation of inter-rater reliability.

Assessment of methodological quality for individual studies

At first, a common data extraction form will be prepared based on the Cochrane Data Extraction Form,[14],[15],[16] which will be pretested with some selected articles. Data will be put on the final Data Extraction Form, which will include study identification details, general information, study eligibility based on PICOS components, inclusion/exclusion criteria, population and setting, methods, participants, outcomes, intervention group, results and findings, limitation and mitigation strategy, conclusion and other information, risk of bias assessment. Article quality will be judged on the basis of inclusion and exclusion criteria and accordingly retrieved articles will either be chosen or rejected. For rejected articles, notes will be taken mentioning the reason for exclusion in the extraction form.


  Quality Assessment Top


Quality assessment of the articles will be judged by the authors according to the existing guideline. STROBE, CONSORT, and TREND guidelines will be used for assessing the quality of report and adherence to guidelines for observational studies, randomized trials, and nonrandomized designs, respectively. Objective assessment of the quality of studies will be done by The Effective Public Health Practice Project Quality Assessment Tool 2003.[17] Risk of bias will be assessed by ROB-2 (for RCT https://methods.cochrane.org/risk-bias-2), NewCastleOttowa (http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp) or Axistools (https://bmjopen.bmj.com/content/6/12/e011458) (for observational studies).[16],[17],[18],[19] Publication bias of an article will be checked by Funnel plot.[20] The strength of the body of the evidence for each of the effect measures will be assessed using the GRADE Approach.[21]

Data abstraction

PRISMA flow diagram will be prepared to depict the process of selection of studies for review such as identification of articles screening eligibility included. All relevant details of studies included in a review, such as study design, sample size, population groups, intervention, results, and outcomes will be abstracted for all studies and presented as a table for a summary of studies.

Registration on prospero

This proposal has been registered in the PROSPERO register [CRD42021278714].

Statistical analysis

Data analysis will be conducted as per guidelines provided in the Handbook of Cochrane Systematic Review.[16] Meta-analysis for pooled output will be performed for the primary objective, using the RevMan version 5.4 software or Stata software version 16. Results will be expressed through forest plot analysis and statistical heterogeneity. Statistical heterogeneity will be further evaluated for clinical or methodological heterogeneity through Cochran's Q and I[2] statistic. At the end, sensitivity analysis will be done to check the robustness of the conclusions from the meta-analysis. Several sensitivity/subgroup analyses will be done to explore heterogeneity and stratified analysis using several subgroups, i.e., age, gender, first/second wave, mental health parameters, etc. Depending upon the availability of information from the selected studies, further meta-regression will be performed for these variables like the age to explore the role of age on the effect measures.


  Translational Value for Implementation Top


Mental health implications associated with COVID-19 will likely persist beyond the pandemic. The present research is proposed to recognize the burden of mental health problems among adolescents in LMIC after the onset of COVID-19 pandemic times. Pooled prevalence will depict the overall burden of these neglected health issues.

The proposed study would further suffice in identifying evidence-based intervention measures in community settings among the adolescents in the backdrop of the ongoing COVID-19 pandemic. Although many different strategies might work out, identification of effective, scalable, and feasibly delivered mental health interventions is the need of the hour. Thus, it can also be decided about the mode of delivery of the services required like through teleconsultation or formation of community volunteers, etc., that will be sustainable and culturally acceptable at family level and programmatic level so that these vulnerable children will be protected from the vagaries of sufferings in future pandemic or COVID-19 surge.

Ethical approval statement

Since this proposal is for a systematic review and meta-analysis, Institutional Ethics Committee has waived off and gave approval.

Financial support and sponsorship

This study was financially supported by Intramural project of ICMR-Centre for Ageing and Mental Health, Salt Lake, Kolkata.

Conflicts of interest

There are no conflicts of interest.


  Supplementary File Top


Supplementary File 1: PRISMA-P 2015 Checklist

This checklist has been adapted for use with protocol submissions to Systematic Reviewsfrom [Table 3] in Moher D et al: Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Systematic Reviews2015 4:1





 
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