{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,16]],"date-time":"2025-12-16T13:25:25Z","timestamp":1765891525523,"version":"3.48.0"},"reference-count":45,"publisher":"BMJ","issue":"6","license":[{"start":{"date-parts":[[2025,6,13]],"date-time":"2025-06-13T00:00:00Z","timestamp":1749772800000},"content-version":"unspecified","delay-in-days":12,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"European Union, Horizon Europe Research and Innovation Programme","award":["101095659"],"award-info":[{"award-number":["101095659"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,5,30]]},"published-print":{"date-parts":[[2025,6]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Adolescence is a time of rapid physical, social and psychological development and many risk factors for mental disorders have their roots in this age period. Primary prevention through school platforms has been extensively used and evaluated, but many interventions have poor uptake, high dropout and limited long-term sustainability. Mental health is a complex phenomenon and may be best supported through multicomponent interventions that more holistically consider inner, social and environmental levels. Character education-focused interventions are effective for improving adolescent psychosocial functioning and mental well-being. Therefore, an intervention that focuses on developing these strengths and is delivered within a school environment, through an adolescent-informed approach using creativity-focused components, has the potential to improve adolescent mental health and well-being.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>This protocol describes the YiPEE cluster-randomised controlled trial with concurrent mixed-methods process evaluation and economic evaluation, which aims to determine the impact of a multilevel multicomponent intervention in schools in Chennai, Tamil Nadu, India. Clusters\u2014defined as schools which include Grades 6\u20138 (ages 11\u201316 years), will be randomised to intervention (n=15) or control (n=15). The intervention consists of: an 8-week classroom-based component, a 12-week teacher-focused component and a board comprising members from across the whole school. All children attending Grade 7 (aged 12\u201315) will be exposed to the classroom component, and teachers who actively teach Grade 7 will be invited to participate in the teacher component. Within schools, students for the individual-level evaluation will be included if they are: (1) aged 12\u201315 years; (2) currently attending Grade 7; (3) competent to give consent and (4) have a legal guardian competent of giving consent. We aim to sample a minimum of 100 students from each school (n=3000). All teachers of Grades 6\u20138 will be recruited for the evaluation. The primary outcome is symptoms of anxiety and depression measured using an abbreviated version of the UNICEF MMAPP tool. The primary analysis will be intention-to-treat, comparing the mean change in mental health score between baseline and endline, between intervention and control clusters. In addition, we will record school monitoring data (student attendance, student grades). Individual interviews with students and teachers, focus group discussions with school staff, and ethnographic observations will provide data for the process evaluation. For the economic evaluation, the combined direct and non-direct costs will be compared with changes in mental health in the intervention arm.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>The trial is approved by the Ethics Council of the Schizophrenia Research Foundation, India, with approval number EC\/NEW\/INST\/2023\/TN\/0329. We plan to publish the main impact, process and economic evaluation results as academic publications in international peer-reviewed journals in 2026.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>Clinical Trials Registry\u2014India (CTRI\/2024\/07\/070949).<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2024-095671","type":"journal-article","created":{"date-parts":[[2025,6,13]],"date-time":"2025-06-13T07:05:36Z","timestamp":1749798336000},"page":"e095671","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Youth co-production for sustainable engagement and empowerment in health (YiPEE): protocol for a cluster-randomised controlled trial of an intervention for mental health promotion among adolescents in schools in Chennai, India"],"prefix":"10.1136","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5517-6175","authenticated-orcid":false,"given":"Vijaya","family":"Raghavan","sequence":"first","affiliation":[{"name":"Schizophrenia Research Foundation, Chennai, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5407-6981","authenticated-orcid":false,"given":"Maria","family":"Niemi","sequence":"additional","affiliation":[{"name":"Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1432-0684","authenticated-orcid":false,"given":"Monika","family":"Martens","sequence":"additional","affiliation":[{"name":"Institute of Tropical Medicine, Antwerp, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3196-8757","authenticated-orcid":false,"given":"Jeroen","family":"de Man","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jill","family":"\u00c5hs","sequence":"additional","affiliation":[{"name":"Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"G J","family":"Melendez-Torres","sequence":"additional","affiliation":[{"name":"University of Exeter, Exeter, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Frances","family":"Mathews","sequence":"additional","affiliation":[{"name":"South Cloisters St Luke\u2019s Campus, Exeter, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Josefien","family":"van Olmen","sequence":"additional","affiliation":[{"name":"ELIZA, University of Antwerp, Antwerp, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anu","family":"Linnansaari","sequence":"additional","affiliation":[{"name":"Tampere University, Tampere, Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9648-4473","authenticated-orcid":false,"given":"Christina A","family":"Laurenzi","sequence":"additional","affiliation":[{"name":"ILCHR, Stellenbosch University, Stellenbosch, South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pilvikki","family":"Absetz","sequence":"additional","affiliation":[{"name":"Tampere University, Tampere, Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fredric","family":"Azariah","sequence":"additional","affiliation":[{"name":"Cities Rise, Chennai, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Moitreyee","family":"Sinha","sequence":"additional","affiliation":[{"name":"Cities Rise, New York City, New York, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Upasana","family":"Sharma","sequence":"additional","affiliation":[{"name":"Cities Rise, Chennai, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Orlaith","family":"O\u2019Sullivan","sequence":"additional","affiliation":[{"name":"Cities Rise, New York City, New York, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yoo Na","family":"Kim","sequence":"additional","affiliation":[{"name":"Cities Rise, New York City, New York, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Akshaya","family":"Rajesh","sequence":"additional","affiliation":[{"name":"Schizophrenia Research Foundation, Chennai, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Samyukta","family":"Saravanan","sequence":"additional","affiliation":[{"name":"Schizophrenia Research Foundation, Chennai, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nivetha","family":"Vasanthan","sequence":"additional","affiliation":[{"name":"Schizophrenia Research Foundation, Chennai, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"N P","family":"Haritha","sequence":"additional","affiliation":[{"name":"Schizophrenia Research Foundation, Chennai, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lander","family":"Willem","sequence":"additional","affiliation":[{"name":"University of Antwerp, Antwerp, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5846-3444","authenticated-orcid":false,"given":"Mark","family":"Tomlinson","sequence":"additional","affiliation":[{"name":"Institute for Life Course Health Research, University of Stellenbosch, Cape Town, South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carina","family":"King","sequence":"additional","affiliation":[{"name":"Karolinska Institute, Stockholm, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,6,13]]},"reference":[{"key":"2025121605211469000_15.6.e095671.1","unstructured":"WHO . Global accelerated action for the health of adolescents (aa-ha!) guidance to support country implementation. WHO; 2017."},{"key":"2025121605211469000_15.6.e095671.2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jadohealth.2014.10.260"},{"key":"2025121605211469000_15.6.e095671.3","doi-asserted-by":"publisher","DOI":"10.1111\/j.1469-7610.2007.01824.x"},{"key":"2025121605211469000_15.6.e095671.4","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(16)00579-1"},{"key":"2025121605211469000_15.6.e095671.5","doi-asserted-by":"publisher","DOI":"10.4103\/psychiatry.IndianJPsychiatry_217_18"},{"key":"2025121605211469000_15.6.e095671.6","article-title":"Mental Health Issues Among School Children and Adolescents in India: A Systematic Review","volume":"16","author":"Balamurugan","year":"2024","journal-title":"Cureus"},{"key":"2025121605211469000_15.6.e095671.7","unstructured":"ESCAP . Achieving the sustainable development goals in South Asia: key policy priorities and implementation challenges. United Nations: New York, 2018."},{"key":"2025121605211469000_15.6.e095671.8","unstructured":"WHO . Tackling NCDs: \u201cBest Buys\u201d and other recommended interventions for the prevention and control of noncommunicable diseases. World Health Organization, 2017."},{"key":"2025121605211469000_15.6.e095671.9","doi-asserted-by":"crossref","DOI":"10.1542\/peds.2018-3488","article-title":"Adolescent Mental Health Program Components and Behavior Risk Reduction: A Meta-analysis","volume":"144","author":"Skeen","year":"2019","journal-title":"Pediatrics"},{"key":"2025121605211469000_15.6.e095671.10","doi-asserted-by":"publisher","DOI":"10.4103\/0019-5545.74310"},{"key":"2025121605211469000_15.6.e095671.11","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(18)31615-5"},{"key":"2025121605211469000_15.6.e095671.12","doi-asserted-by":"crossref","DOI":"10.1186\/1472-6963-12-127","article-title":"The acceptability, feasibility and impact of a lay health counsellor delivered health promoting schools programme in India: a case study evaluation","volume":"12","author":"Rajaraman","year":"2012","journal-title":"BMC Health Serv Res"},{"key":"2025121605211469000_15.6.e095671.13","doi-asserted-by":"crossref","DOI":"10.3389\/fpsyt.2023.1112710","article-title":"What happens when a whole-school health promotion research trial ends? a case study of the SEHER program in India","volume":"14","author":"Shinde","year":"2023","journal-title":"Front Psychiatry"},{"key":"2025121605211469000_15.6.e095671.14","unstructured":"WHO . Engaging young people for health and sustainable development: strategic opportunities for the World Health Organization and Partners. Geneva: World Health Organization, 2018."},{"key":"2025121605211469000_15.6.e095671.15","doi-asserted-by":"crossref","DOI":"10.1186\/s12916-023-03226-6","article-title":"Supporting youth mental health with arts-based strategies: a global perspective","volume":"22","author":"Golden","year":"2024","journal-title":"BMC Med"},{"key":"2025121605211469000_15.6.e095671.16","doi-asserted-by":"crossref","unstructured":"Coholic D , Eys M , Shaw K , et al . Exploring the Benefits of an Arts-Based Mindfulness Group Intervention for Youth Experiencing Challenges in Schooling. Sage Open 2023;13. doi:10.1177\/21582440231192111","DOI":"10.1177\/21582440231192111"},{"key":"2025121605211469000_15.6.e095671.17","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1080\/17533015.2021.2009529","article-title":"Effectiveness of creative arts-based interventions for treating children and adolescents exposed to traumatic events: a systematic review of the quantitative evidence and meta-analysis","volume":"14","author":"Morison","year":"2022","journal-title":"Arts Health"},{"key":"2025121605211469000_15.6.e095671.18","doi-asserted-by":"crossref","first-page":"1771","DOI":"10.3389\/fpsyg.2020.01771","article-title":"Using Arts-Based Therapies to Improve Mental Health for Children and Young People With Physical Health Long-Term Conditions: A Systematic Review of Effectiveness","volume":"11","author":"Wigham","year":"2020","journal-title":"Front Psychol"},{"key":"2025121605211469000_15.6.e095671.19","doi-asserted-by":"crossref","first-page":"364","DOI":"10.1186\/s12888-021-03350-8","article-title":"Effectiveness of arts interventions to reduce mental-health-related stigma among youth: a systematic review and meta-analysis","volume":"21","author":"Gaiha","year":"2021","journal-title":"BMC Psychiatry"},{"key":"2025121605211469000_15.6.e095671.20","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1177\/0013124517747681","article-title":"A Meta-Analysis on the Relationship Between Character Education and Student Achievement and Behavioral Outcomes","volume":"51","author":"Jeynes","year":"2019","journal-title":"Educ Urban Soc"},{"key":"2025121605211469000_15.6.e095671.21","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1080\/03057240.2022.2060196","article-title":"A comprehensive meta-analysis of character education programs","volume":"52","author":"Brown","year":"2023","journal-title":"J Moral Educ"},{"key":"2025121605211469000_15.6.e095671.22","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph182212101"},{"key":"2025121605211469000_15.6.e095671.23","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.h2147","article-title":"The PRECIS-2 tool: designing trials that are fit for purpose","volume":"350","author":"Loudon","year":"2015","journal-title":"BMJ"},{"key":"2025121605211469000_15.6.e095671.24","unstructured":"Chandramouli C . Census of India 2011 - Rural Urban Distribution of Population (Provisional Population Totals). New Delhi: India,"},{"key":"2025121605211469000_15.6.e095671.25","doi-asserted-by":"crossref","first-page":"2539","DOI":"10.14260\/jemds\/2019\/553","article-title":"Screening for Adolescent Depression among 11-14 Years School Going Children in Semi-Urban Chennai","volume":"8","author":"V.","year":"2019","journal-title":"Jemds"},{"key":"2025121605211469000_15.6.e095671.26","doi-asserted-by":"crossref","DOI":"10.3389\/fpubh.2019.00064","article-title":"RE-AIM Planning and Evaluation Framework: Adapting to New Science and Practice With a 20-Year Review","volume":"7","author":"Glasgow","year":"2019","journal-title":"Front Public Health"},{"key":"2025121605211469000_15.6.e095671.27","doi-asserted-by":"publisher","DOI":"10.1258\/1355819054308530"},{"key":"2025121605211469000_15.6.e095671.28","doi-asserted-by":"publisher","DOI":"10.1146\/annurev-publhealth-031816-044451"},{"key":"2025121605211469000_15.6.e095671.29","doi-asserted-by":"crossref","unstructured":"Hughsam M , et al . Chapter 66 - citiesRISE: A Transdisciplinary, Youth-Driven Approach to Scale Social and Technological Innovations in Mental Health and Well-Being Locally and Globally. Academic Press, 2024:797\u2013808.","DOI":"10.1016\/B978-0-443-18529-8.00066-4"},{"key":"2025121605211469000_15.6.e095671.30","doi-asserted-by":"crossref","first-page":"300","DOI":"10.1007\/s40688-015-0061-y","article-title":"Increasing Elementary School Students\u2019 Subjective Well-Being Through a Classwide Positive Psychology Intervention: Results of a Pilot Study","volume":"19","author":"Suldo","year":"2015","journal-title":"Contemp School Psychol"},{"key":"2025121605211469000_15.6.e095671.31","doi-asserted-by":"publisher","DOI":"10.1007\/s10902-005-3650-z"},{"key":"2025121605211469000_15.6.e095671.32","doi-asserted-by":"publisher","DOI":"10.1037\/a0037249"},{"key":"2025121605211469000_15.6.e095671.33","doi-asserted-by":"publisher","DOI":"10.1016\/j.jsp.2007.03.005"},{"key":"2025121605211469000_15.6.e095671.34","doi-asserted-by":"crossref","first-page":"53","DOI":"10.2989\/17280583.2023.2277770","article-title":"Evaluating the efficacy of a school-based Finnish Gutsy Go programme in enhancing adolescents\u2019 positive mental health, experience of social inclusion, and social competence","volume":"34","author":"Ahrnberg","year":"2022","journal-title":"J Child Adolesc Ment Health"},{"key":"2025121605211469000_15.6.e095671.35","doi-asserted-by":"publisher","DOI":"10.2471\/BLT.15.164418"},{"key":"2025121605211469000_15.6.e095671.36","doi-asserted-by":"crossref","first-page":"S27","DOI":"10.1016\/j.jadohealth.2021.11.035","article-title":"Measurement of Mental Health Among Adolescents at the Population Level: A Multicountry Protocol for Adaptation and Validation of Mental Health Measures","volume":"72","author":"Carvajal-Velez","year":"2023","journal-title":"J Adolesc Health"},{"key":"2025121605211469000_15.6.e095671.37","doi-asserted-by":"crossref","DOI":"10.1186\/1477-7525-5-63","article-title":"The Warwick-Edinburgh Mental Well-being Scale (WEMWBS): development and UK validation","volume":"5","author":"Tennant","year":"2007","journal-title":"Health Qual Life Outcomes"},{"key":"2025121605211469000_15.6.e095671.38","doi-asserted-by":"publisher","DOI":"10.1126\/science.277.5328.918"},{"key":"2025121605211469000_15.6.e095671.39","doi-asserted-by":"publisher","DOI":"10.1111\/j.1469-7610.2009.02136.x"},{"key":"2025121605211469000_15.6.e095671.40","doi-asserted-by":"publisher","DOI":"10.1037\/pas0000201"},{"key":"2025121605211469000_15.6.e095671.41","doi-asserted-by":"publisher","DOI":"10.1080\/10705500802222972"},{"key":"2025121605211469000_15.6.e095671.42","doi-asserted-by":"publisher","DOI":"10.1037\/0022-3514.82.1.112"},{"key":"2025121605211469000_15.6.e095671.43","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1002\/pits.21889","article-title":"Measuring kindness at school: Psychometric properties of a school kindness scale for children and adolescents","volume":"53","author":"Binfet","year":"2016","journal-title":"Psychol Sch"},{"key":"2025121605211469000_15.6.e095671.44","doi-asserted-by":"publisher","DOI":"10.1093\/jpepsy\/22.3.399"},{"key":"2025121605211469000_15.6.e095671.45","unstructured":"The warwick-edinburgh mental wellbeing scales. WEMWBS; 2023. Available: https:\/\/warwick.ac.uk\/fac\/sci\/med\/research\/platform\/wemwbs"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2024-095671","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,16]],"date-time":"2025-12-16T13:21:26Z","timestamp":1765891286000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2024-095671"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6]]},"references-count":45,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2025,6,13]]},"published-print":{"date-parts":[[2025,6]]}},"alternative-id":["10.1136\/bmjopen-2024-095671"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2024-095671","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"type":"print","value":"2044-6055"},{"type":"electronic","value":"2044-6055"}],"subject":[],"published":{"date-parts":[[2025,6]]}}}