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Table 2 Outcome measures in the host trial

From: The effectiveness of a low-intensity problem-solving intervention for common adolescent mental health problems in New Delhi, India: protocol for a school-based, individually randomized controlled trial with an embedded stepped-wedge, cluster randomized controlled recruitment trial

Measures Description Respondent
Primary outcomes at 6 weeks post-randomization
Strengths and Difficulties Questionnaire (SDQ) Total Difficulties score The SDQ is the most widely used measure for psychopathology in children and adolescents globally and in South Asia. It has been used in a number of other research studies in India, and has been translated into Hindi and several other Indian languages [34, 46,47,48]. A Total Difficulties scale score is derived by summing items from four problem subscales (emotional, conduct, hyperactivity/inattention, and peer relationship), while a fifth subscale measures prosocial functioning and does not contribute to the overall severity score. Individual problem scale items are scored from 0 to 2 (with higher scores indicating greater problem severity), giving a range of 0–40. The Total Difficulties score at 6 weeks will be our co-primary outcome Adolescent-reported
Youth Top Problems (YTP) The YTP is a brief, idiographic measure on which the respondent identifies, prioritizes, and rates three main problems [43]. Each of the three problems is scored from 0 to 10 according to perceived problem severity (with higher scores indicating greater severity). A mean severity score is calculated by summing individual problem scores and then dividing by the number of nominated problems. The YTP was translated into Hindi for our pilot studies, where it was found to be highly sensitive to change over the course of the problem-solving intervention. The mean YTP score at 6 weeks will be our co-primary outcome Adolescent-reported
Secondary outcomes over a 12-week period post-randomizationa
SDQ Total Difficulties score (See above for description of the measure) Adolescent-reported
YTP (See above for description of the measure) Adolescent-reported
SDQ Impact Supplement The SDQ Impact Supplement measures distress and functional impairment associated with index mental health difficulties identified on the main SDQ scale [35]. One item on overall distress and four items on domain-specific functional impairment (home life, friendships, classroom learning, leisure activities) are individually scored from 0 to 2 (with higher scores indicating greater impact), generating a total impact score from 0 to 10 Adolescent-reported
SDQ internalizing subscale The internalizing symptom subscale score is calculated by adding the score of the peer relationship and emotional problem subscales. The score ranges from 0 to 20 Adolescent-reported
SDQ externalizing subscale The externalizing symptom subscale score is calculated by adding the score of the conduct and hyperactivity/inattention problem subscales. The score ranges from 0 to 20 Adolescent-reported
Perceived Stress Scale-4 (PSS-4) The PSS-4 measures perceptions of stress, reflecting the degree to which situations are appraised as stressful during the preceding month. This brief measure was chosen because of its feasibility and relevance as a presumed mechanism of change within the problem-solving intervention, consistent with stress-coping theory. It has been translated into Hindi and used in a number of surveys and as an outcome measure in trials around the world. This brief instrument uses a five-point scale (0 = never, 1 = almost never, 2 sometimes, 3 = fairly often, 4 = very often) to assess how often the respondent has experienced primary appraisals of events as stressful. The total score ranges between 0 and 16, with higher scores indicating a stronger tendency towards stressful appraisals. A study of secondary students in Hyderabad, India reported high internal consistency (Cronbach’s alpha = 0.84) and test-retest reliability (0.85) for the longer 14-item form of the PSS [49] Adolescent-reported
Short Warwick-Edinburgh Mental Wellbeing Scale (SWEMWBS) The SWEMWBS is a commonly used measure for mental wellbeing. Wellbeing has been closely linked with social factors such as peer bullying and perception of school connectedness [50]; it may therefore be especially amenable to problem solving. The SWEMWBS is a unidimensional scale that comprises seven items scored on a five-point scale (1 = none of the time, 2 = rarely, 3 = some of the time, 4 = often and 5 = all of the time) with a total range from 7 to 35, where higher scores indicate more positive mental wellbeing. Strong internal consistency has been previously reported in adolescent samples [45]. The measure has been used internationally and a Hindi version is available [51] Adolescent-reported
Remissiona Remission will be defined using the ‘crossing clinical threshold’ method [52] for two clinical criteria (both of which must be met): (i) SDQ Total Difficulties score < 19 for boys or < 20 for girls, and (ii) Impact score < 2 Adolescent-reported
Exploratory outcomes over a 12-week period post-randomizationa
SDQ Total Difficulties score (See above for description of the measure) Caregiver-reported
SDQ Impact Supplement (See above for description of the measure) Caregiver-reported
SDQ internalizing subscale (See above for description of the measure) Caregiver-reported score
SDQ externalizing subscale (See above for description of the measure) Caregiver-reported score
SDQ prosocial subscale (See above for description of the measure) Adolescent-reported score
  1. aRepeated measures analysis of 6-week and 12-week endpoints, adjusting for baseline values