A culturally sensitive act-belong-commit-based school intervention reduces the burden of anxiety and depression in adolescents: A pilot cluster-randomized trial from Uganda

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INTRODUCTION: Schools can be pivotal in addressing mental health challenges, especially in low-income settings like Uganda. However, randomized controlled trials tailored to cultural and contextual factors are scarce. This pilot cluster-randomized trial examines the impact of a culturally sensitive Act-Belong-Commit (ACT) intervention, combined with physical activity, sleep hygiene and stress management measures on anxiety and depression among Ugandan adolescents attending secondary school. METHODS: A total of 2598 adolescents (1295 intervention; 1303 control; 1199 boys [46.1 %]; mean age 16.3 ± 1.0 years) from four secondary schools were randomized by school to either a 12-week, weekly two-hour teacher- and peer-led ACT intervention or a care-as-usual control. Anxiety (GAD-7) and depression (PHQ-9-A) were measured at baseline and immediately post-intervention. Childhood trauma (CTQ-SF), self-reported health, wealth, and food security were assessed at baseline. Linear mixed modeling was used to evaluate intervention effects. RESULTS: At baseline, the mean GAD-7 score was 6.4 ± 4.4 and PHQ-9-A was 7.4 ± 5.1. The intervention group showed greater improvements in mental health, with moderate effects on anxiety (Cohen's d = 0.50, 95 % CI = 0.42-0.57) and small effects on depression (Cohen's d = 0.44, 95 % CI = 0.36-0.52). Moderation analyses were based on pre-specified baseline variables. CONCLUSION: This pilot trial provides preliminary evidence that a culturally adapted ACT intervention combined physical activity, sleep hygiene and stress management measures may be a promising whole-school approach to reduce anxiety and depression in adolescents. Further trials with more clusters are needed.