JMIR Publications

ABSTRACT

Background:

Although mental health challenges disproportionately affect persons in humanitarian contexts, most refugee youth do not receive needed mental health support. Uganda is the largest refugee-hosting nation in Africa, hosting over 1.58 million refugees in 2022, with more than 111,000 living in the city of Kampala. There is limited information about effective and feasible interventions to improve mental health outcomes and mental health literacy, and reduce mental health stigma, among urban refugee adolescents and youth in low and middle-income countries (LMIC). Virtual Reality (VR) is a promising approach to reduce stigma and improve mental health and coping, yet has not been tested in LMIC, where most forcibly displaced persons live. Group Problem Management Plus (GPM+) is a scalable brief psychological transdiagnostic intervention for persons experiencing a range of adversities, yet has not been tested with adolescents and youth. Further, mobile-health (mHealth) strategies have demonstrated promise in promoting mental health literacy.

Objective:

This study aims to evaluate the feasibility and effectiveness of two youth-tailored mental health interventions (virtual reality alone, virtual reality combined with GMP+) in comparison with the standard of care in improving mental health outcomes among refugee and displaced youth aged 16-24 years in Kampala, Uganda.

Methods:

A three-arm cluster randomized controlled trial will be implemented across five informal settlements grouped into three sites, based on proximity, and randomized in a 1:1:1 method. Approximately 330 adolescents (110 per cluster) are enrolled and will be followed for approximately sixteen weeks. Data will be collected at three-time points: baseline enrolment, eight weeks following enrolment, and sixteen weeks after enrolment. Primary (depression) and secondary outcomes (mental health literacy, attitudes towards mental help-seeking, adaptive coping, mental health stigma, mental wellbeing, level of functioning) will be evaluated.

Results:

The study will be conducted in accordance with CONSORT (Consolidated Standards of Reporting Trials) guidelines. The study has received ethical approval from the University of Toronto (12 May 2021), Mildmay Uganda Research Ethics Committee (MUREC) (24 June 2021) and Uganda National Council for Science & Technology (UNCST) (January 1, 2022). A qualitative formative phase was conducted using focus groups and in-depth, semi-structured key informant interviews to understand contextual factors influencing urban refugee and displaced youth mental wellbeing. Qualitative findings informed the virtual reality intervention, SMS check-in messages, and the adaption of GPM+. Intervention development was conducted in collaboration with refugee youth peer navigators. The trial launched in June 2022, and the final follow-up survey will be conducted in October 2022.

Conclusions:

This study will contribute to the knowledge of youth-tailored mental health intervention strategies for urban refugee and displaced youth living in informal settlements in LMIC contexts. Findings will be shared in peer-reviewed manuscripts, conference presentations and with community dissemination. Clinical Trial: ClinicalTrials.gov NCT05187689.