{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T17:19:14Z","timestamp":1786123154750,"version":"build-2736575974"},"reference-count":38,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T00:00:00Z","timestamp":1777248000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T00:00:00Z","timestamp":1777248000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["acamh.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Child Psychology Psychiatry"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Strategies to expand access to care and sustain evidence\u2010based mental health interventions (EBIs) must be tested within novel delivery platforms to extend the reach of services in fragile and conflict\u2010affected settings. Integration into broader development programs may help maintain long\u2010term effects. This study presents a four\u2010year follow\u2010up of a previously conducted Hybrid Type II implementation\u2010effectiveness cluster\u2010randomized trial (CRT) of the Youth Readiness Intervention (YRI)\u2014an EBI drawing on cognitive\u2010behavioral, interpersonal, and mindfulness\u2010based approaches\u2014delivered within a youth entrepreneurship program in Sierra Leone (2018\u20132019).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Long\u2010term mental health outcomes (emotion regulation, psychological distress, and interpersonal functioning) were examined among a randomly selected subgroup of 584 participants across three study arms: a control group, a group that only received entrepreneurship training (\u2018ENTR\u2019), and a group that received both YRI and ENTR (\u2018YRI\u2009+\u2009ENTR\u2019). Linear mixed\u2010effect models accounted for the nested structure of the data. Impact of the COVID\u201019 pandemic was also assessed through economic and relationship stressors using structural equation modeling.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Four years postintervention, YRI\u2009+\u2009ENTR\u2010youth maintained improvements in depression (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u2009=\u2009\u2212.057; 95% CI \u22120.09 to \u22120.02; [effect size]\n                      <jats:italic>d<\/jats:italic>\n                      \u2009=\u2009\u2212.111) and combined depression\/anxiety symptoms (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u2009=\u2009\u2212.047; 95% CI \u22120.08 to \u22120.01; [effect size]\n                      <jats:italic>d<\/jats:italic>\n                      \u2009=\u2009\u2212.096) though no sustained effects were observed for daily functioning or emotion regulation. No differences were found for ENTR\u2010only participants versus controls and YRI\u2009+\u2009ENTR. COVID\u201019\u2010related economic stressors mediated the relationship between study arm and mental health, revealing small but significant effects.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In low\u2010income settings like Sierra Leone, where formal mental health services are scarce, sustainable community\u2010based interventions such as the combined YRI\u2009+\u2009ENTR intervention offer a critical approach to reducing psychological distress. Sustained long\u2010term benefits suggest that participants developed coping strategies that supported resilience during challenges like the COVID\u201019 pandemic. These gains may also foster broader community resilience, enhancing both individual well\u2010being and collective capacity to withstand future adversity.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jcpp.70158","type":"journal-article","created":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T06:09:40Z","timestamp":1777356580000},"page":"1537-1546","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Sustained mental health outcomes from the youth readiness intervention: A four\u2010year effectiveness follow\u2010up of a hybrid type\n                    <scp>II<\/scp>\n                    trial in Sierra Leone"],"prefix":"10.1111","volume":"67","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5981-7689","authenticated-orcid":false,"given":"Wijnand","family":"Van Den Boom","sequence":"first","affiliation":[{"name":"Research Program on Children and Adversity, School of Social Work Boston College  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