An intervention to reduce stigma and improve management of depression, risk of suicide/self-harm and other significant emotional or medically unexplained complaints among adolescents living in urban slums: protocol for the ARTEMIS project

Abstract Background: There are around 250 million adolescents in India. Adolescents are vulnerable to common mental disorders with depression and self-harm accounting for a major share of the burden of death and disability in this age group. Around 20 percent of children and adolescents are diagnosed with/ or live with a disabling mental illness. A national survey has found that suicide is the third leading cause of death among adolescents in India. The authors hypothesise that an intervention involving an anti-stigma campaign co-created by adolescents themselves, and a mobile technology based electronic decision support system will help reduce stigma, depression, suicide risk and improve mental health for high-risk adolescents living in urban slums in India.Methods: The intervention will be implemented as a cluster randomised control trial in 30 slum clusters in each of the cities of Vijayawada and New Delhi in India. Adolescents aged 10 to 19 years will be screened for depression and suicide ideation using the Patient Health Questionnaire (PHQ-9). Two evaluation cohorts will be derived – a high-risk cohort with elevated PHQ-9 score ≥ 10 and/or a positive response (score ≥ 2) to the suicide risk question on the PHQ-9, and a non-high-risk cohort comprising an equal number of adolescents not at elevated risk based on these scores.Discussion: The key elements that ARTEMIS will focus on is increasing awareness among adolescents and the slum community on these mental health conditions as well as strengthening the skills of existing primary healthcare workers and promoting task sharing. The findings from this study will provide evidence to governments about strategies with potential for addressing the gaps in providing care for adolescents living in urban slums and experiencing depression, other significant emotional or medically unexplained complaints or increased suicide risk/self- harm and should have relevance not only for India but also for other low-and middle-income countries. Trial Status:Protocol version – V7, 20 Dec 2021Recruitment start date: tentatively after 2nd May 2022Recruitment end date: tentatively 1st May 2023 (one year after the trial start date)Trial registration: The trial has been registered in the Clinical Trial Registry India, Reference No. CTRI/2022/02/040307. Registered 18 February 2022, http://ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=47111&EncHid=&userName=ARTEMIS-%20CTRI/2022/02/040307The tentative start date of participant recruitment for the trial will begin after 2nd May 2022