Exploratory Cluster Randomized Controlled Trial (cRCT) of Saving and Empowering young lives in PAKistan (SEPAK)

We aim to conduct an exploratory study for a large-scale cluster randomised controlled trial (cRCT) involving 40 secondary schools and local health and social care services across eight regions in Pakistan.

The aims of the feasibility study are to: 

  • Develop culturally adapted preventative interventions for self-harm among pupils in secondary schools across Pakistan targeting pupils, parents, teachers and local health practitioners.
  • Investigate the feasibility and acceptability of the culturally adapted preventative interventions among participants (pupils, parents/guardians, teachers, health practitioners) and the intervention facilitators including the perceived benefits and adverse or negative experiences.
  • Collect baseline and post-intervention assessments of the mental health and wellbeing, alongside demographic data, information about lifestyles, values, risk behaviours and other psychosocial information of Pakistan adolescents and explore the feasibility of compiling a pragmatic trial database as part of a future large-scale cRCT.

Sepak Interventions:

Awareness Training of Pupils: We have used the LEADS (Linking Education and Awareness of Depression and Suicide) for youth. LEADs aims to increase knowledge of depression and suicide, modify perceptions of depression and suicide, increase knowledge of suicide prevention resources, and improve intentions to engage in help-seeking behaviours. This intervention covers depression and its symptoms, the link between depression and suicide, the risk and protective factors associated with suicide, the warning signs of suicide, seeking help and overcoming barriers to seeking help, and school and community suicide prevention resources. Intervention will be delivered over the period of three consecutive days and consists of a two-hour interactive session.








Gatekeeper Training (Teachers and parents): We used manualised programme for (teachers/school staff), the Question, Persuade, and Refer (QPR), which is originally developed in the USA, http://www.qprinstitute.com/. QPR aims to train teachers/school staff to identify the suicide risk in pupils and encourage pupils at risk of suicide to seek professional help. The QPR involves asking pupils questions concerning their behaviour, persuading them to seek help if they are displaying suicidal warning signs and, when appropriate, referring the pupil to a treatment facility. Teachers/school staff in the participating schools are trained by research practitioners that have undergone the official QPR training programme online. Training consists of a two-hour interactive lecture and a one-hour role play session. 

Professional Screening: We have used the Screening by Professionals programme (ProfScreen), an indicated or selective intervention which is based on students’ responses to the baseline questionnaires. Participating health practitioners reviewed pupils’ responses to the questionnaires used in the study and pupils whose scores meet pre-established cut-off points will be invited to participate in a professional mental health clinical assessment and if needed, referred to clinical services. This intervention is designed to help health practitioners to identify at-risk adolescents by using cut-off points for positive responses based on specific scales of adolescent mental health in the baseline questionnaire. All pupils with a predetermined cut-off for depression, anxiety, non-suicidal self-injury (NSSI) and suicidality will be referred for professional treatment. Pupils with social problems are referred to an appropriate non-clinical healthy-lifestyle group.


 Control group/Minimal intervention: The control group exposed to the six educational posters displayed in their classrooms which display six key points which are also covered in the awareness arm booklet and provide contact details for the local healthcare services and healthy lifestyle groups. Pupils in the control group who self-recognise the need for help are able contact local health practitioners or a healthy lifestyle group. The posters hang in the classroom for four weeks

Cultural Adaptation of SEPAK Interventions

Culturally Adapted SEPAK Educational Posters

SEPAK LEADS Intervention Videos

QPR Intervention Videos

Study Progress

SEPAK Study Presentation at Culture and International Mental Health Conference 2020