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School based stepped care TrEatment for adolescent depression in Pakistan- a Sequential Multiple Assignment Randomized Trial (SMART-STEP)

Award Number: R01MH131025
ORGANIZATION: NATIONAL INSTITUTE OF MENTAL HEALTH
OPDIV: NIH
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)
PERIOD OF PERFORMANCE START DATE: 09/14/2022
PERIOD OF PERFORMANCE END DATE: 06/30/2027

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School based stepped care TrEatment for adolescent depression in Pakistan- a Sequential Multiple Assignment Randomized Trial (SMART-STEP) - Depression and anxiety (common mental disorders; CMDs) are leading contributors to disease burden among adolescents worldwide. In Pakistan, prevalence estimates of emotional problems among school-going adolescents range from 25%–35%. Schools are increasingly recognized as scalable platforms to address the youth mental health treatment gap. Through our NIMH U19 Global Mental Health Research Hub, SHINE (School Health Implementation Network: Eastern Mediterranean Region), we adapted and feasibility tested the WHO School Mental Health Program into an online teacher training intervention (Enhanced School Mental Health Program [eSMHP]) and supported development of the CBT-based self-help application for adolescents in public schools. Pilot research identified the need to integrate these interventions into a stepped-care package and determine optimal sequencing to address heterogeneity in symptom progression while ensuring scalable and cost-efficient program. Therefore, the SMART-STEP study will investigate the effectiveness of eSMHP (vs. treatment as usual [TAU]) as a first-line intervention for adolescent depression, and evaluate the CBT-based self-help app as an augmentation strategy for adolescents showing early non-response. Using an innovative and rigorous Sequential Multiple Assignment Randomized Trial (SMART) design, the study will evaluate timing and dosage of adaptive intervention strategies to determine “what works, for whom, under what conditions, and why” for adolescent depression. Pakistan provides a unique and cost-effective research site because large, resource-constrained school systems, shortages of child mental health specialists, high levels of unmet need, and the ability to reach large populations of adolescents through centralized public education systems create real-world conditions necessary to evaluate stepped-care intervention that are difficult to study at comparable scale in USA. The study is being conducted in close collaboration with investigators from the University of Washington and Data Science for Dynamic Intervention Decision-making Laboratory(d3lab) at University of Michigan, USA. Findings will generate evidence on scalable stepped-care digital mental health approaches that can inform efforts to address the growing burden of adolescent mental health problems in the United States, particularly within school systems facing increasing demand for mental health services, workforce shortages, and the need for cost-effective community-based interventions. We hypothesize that adolescents receiving eSMHP will show greater reductions in depressive symptoms compared to TAU, and that among non-responders, augmenting care with a self-help application will further improve outcomes over 9 months. The study will begin with stakeholder consultations, youth engagement activities, and establishment of an External Advisory Committee to strengthen policy relevance, and support future scale-up of evidence-based school mental health services across public education systems, globally.


Issue Date FY	Funding FY	Legal Entity Name	Legal Entity Address	Legal Entity City	Legal Entity State	Legal Entity Zip Code	Legal Entity COUNTY	Legal Entity COUNTRY	Assistance Listing	Award Code	Budget Year	Action Date	Action Type	Action Amount

Issue Date FY: 2026 ( Subtotal = $434,007 )
2026	2026	SHIFA TAMEER E MILLAT UNIVERSITY	SECTOR H-8/4	ISLAMABAD				PAK	Mental Health Research Grants	000	5	9/3/2026	NON-COMPETING CONTINUATION	$434,007
														Subtotal = $434,007

Issue Date FY: 2025 ( Subtotal = $432,104 )
2025	2025	SHIFA TAMEER E MILLAT UNIVERSITY	SECTOR H-8/4	ISLAMABAD				PAK	Mental Health Research Grants	000	4	9/23/2025	NON-COMPETING CONTINUATION	$432,104
														Subtotal = $432,104

Issue Date FY: 2024 ( Subtotal = $459,308 )
2024	2024	SHIFA TAMEER E MILLAT UNIVERSITY	SECTOR H-8/4	ISLAMABAD				PAK	Mental Health Research Grants	001	3	7/12/2024	NON-COMPETING CONTINUATION	$459,308
2024	2023	SHIFA TAMEER E MILLAT UNIVERSITY	SECTOR H-8/4	ISLAMABAD				PAK	Mental Health Research Grants	000	2	3/1/2024	NON-COMPETING CONTINUATION	$0
														Subtotal = $459,308

Issue Date FY: 2023 ( Subtotal = $483,928 )
2023	2023	SHIFA TAMEER E MILLAT UNIVERSITY	SECTOR H-8/4	ISLAMABAD				PAK	Mental Health Research Grants	000	2	7/5/2023	NON-COMPETING CONTINUATION	$483,928
2023	2023	SHIFA TAMEER E MILLAT UNIVERSITY	SECTOR H-8/4	ISLAMABAD				PAK	Mental Health Research Grants	001	2	8/16/2023	NON-COMPETING CONTINUATION	$0
														Subtotal = $483,928

Issue Date FY: 2022 ( Subtotal = $503,970 )
2022	2022	SHIFA TAMEER-E-MILLAT UNIVERSITY	SERVICES ROAD, NCBMS TOWER	ISLAMABAD	ISLAMABAD			PAK	Mental Health Research Grants	000	1	9/13/2022	NEW	$503,970
														Subtotal = $503,970

Grand Total All Awards = $2,313,317

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School based stepped care TrEatment for adolescent depression in Pakistan- a Sequential Multiple Assignment Randomized Trial (SMART-STEP)

Award Number: R01MH131025

ORGANIZATION: NATIONAL INSTITUTE OF MENTAL HEALTH

OPDIV: NIH

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

PERIOD OF PERFORMANCE START DATE: 09/14/2022

PERIOD OF PERFORMANCE END DATE: 06/30/2027

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