SRINAGAR: A culturally tailored mental-health intervention being developed for young people in Kashmir could eventually be introduced as a curriculum in schools and colleges to help prevent substance-use disorders, suicide and other mental-health problems, according to a 2025 study protocol by researchers at the University of Kashmir and PGIMER-linked Centre of Excellence in Mental Health.
The intervention is designed specifically around the social, cultural and psychological circumstances of young people in Kashmir and is expected to improve mental well-being, reduce symptoms and help build skills in mindfulness, emotional regulation, interpersonal relationships and dealing with addictions. The researchers say the programme could provide a basis for shifting the focus of mental-health policy from treatment towards primary prevention.
The paper, A Study Protocol of Primary Prevention Interventions for Substance Use and Suicide Prevention Among Youth in Kashmir: Development, Administration, and Evaluation, was written by Aadil Bashir and Misbah Rafiq of the Department of Social Work, University of Kashmir, Hazratbal, Srinagar, and Triptish Bhatia of Indo-US Projects, Department of Psychiatry, Centre of Excellence in Mental Health, PGIMER-Dr Ram Manohar Lohia Hospital, New Delhi.
Published by SAGE Publishing in the Indian Journal of Psychological Medicine, the paper appeared online on April 21, 2025 (Volume 47, Issue 5).
Rising Risk
The researchers place the proposed intervention against what they describe as an increasingly serious mental-health situation among young people in Kashmir.
The paper cites estimates that more than 20 per cent of Kashmir’s population suffers from mental disorders, including depression, anxiety, post-traumatic stress disorder and schizophrenia. It also points to a sharp rise in visits for substance-use treatment reported by the Institute of Mental Health and Neurological Sciences, from 489 patients in 2016 to 7,420 in 2019.
The study cites an estimate that 1.95 per cent of Kashmir’s population suffers from substance dependence. It also refers to 287 reported suicides in 2020 and research suggesting that 29 per cent of young people aged 15–29 had experienced suicidal ideation, while 9 per cent had attempted suicide.
The authors argue that substance use and suicide cannot be addressed in isolation because the two conditions share several psychosocial drivers. Primary prevention, they suggest, offers a way of identifying vulnerability before serious mental disorders develop rather than concentrating exclusively on treatment after illness has emerged.
Local Context
The intervention is intended to be the first culturally tailored primary-prevention programme of its kind developed and tested for young people in Kashmir, according to the researchers.
Rather than importing an existing programme without modification, the researchers propose mapping the risk factors specific to young people in Kashmir and adapting an established psychological skills programme accordingly. The study identifies psychiatrists, clinical psychologists, lawyers, clergy, teachers, students, parents, police and people with lived experience among the stakeholders whose perspectives will be considered.
The researchers divide stakeholders according to their level of power and interest in youth mental health. Mental-health professionals, for example, are placed in the high-power, high-interest category, while students, families, caregivers and community members are identified as having relatively low institutional power but high interest.
Interviews with these groups are intended to identify the underlying factors affecting youth mental health. The interviews will be recorded, transcribed and subjected to thematic analysis, allowing the researchers to identify recurring patterns and themes that can inform the intervention.
Cultural Adaptation
The researchers selected skill-training modules from dialectical behaviour therapy, or DBT, as the foundation of the intervention.
The proposed programme includes mindfulness, emotional regulation and interpersonal skills. The researchers say DBT is particularly suitable because its skills-based format allows it to be administered collectively in schools and colleges, while its transdiagnostic character means that it can address psychological processes common to different problems, including emotional dysregulation associated with suicide and substance use.
But the intervention is to be adapted at three levels, linguistic, contextual and situational, rather than simply translated.
The adaptation will take account of risk factors operating in Kashmir as well as inputs from mental-health professionals, linguists and people with lived experience. The researchers also propose drawing on elements of local culture, including Kashmiri poetry, nature and spiritual traditions.
For instance, mindfulness exercises may incorporate breathing practices and Kashmir-relevant imagery and symbols. Emotional-regulation work will seek to enrich the Kashmiri emotional vocabulary, while interpersonal-skills training will take account of the region’s collectivist social environment.
A further component addresses what the researchers identify as a distinctive risk factor: the tension between tradition and modernity and what they describe as a lack of spirituality. Psycho-spiritual interventions will therefore incorporate Kashmiri poetry and cultural symbols while attempting to balance tradition with contemporary life.
Seven Modules
The resulting intervention consists of seven modules covering locus of control, self-knowledge, mindfulness, emotional regulation, interpersonal effectiveness, dealing with addictions and psycho-spiritual development.
The modules are not restricted to conventional classroom instruction. They include demonstrations, guided meditation, reflective exercises, art, storytelling and folklore. The researchers have prepared a hard-copy manual along with presentation material and handouts for participants.
The programme is designed to run for four weeks. It comprises 15 sessions, with four sessions each week. The researchers estimate that eight sessions will last one hour and the remaining seven will last one hour and 20 minutes.
Before it is administered, the intervention will undergo content validation and a feasibility test using both quantitative and qualitative methods.
Youth Screening
The target population is young people aged 16 to 24 studying in higher secondary schools and colleges.
The researchers plan to screen students for risks associated with substance use, depression and anxiety using three established instruments: the Problem Oriented Screening Instrument for Teenagers, or POSIT; the Patient Health Questionnaire-9, or PHQ-9; and the Generalised Anxiety Disorder-7, or GAD-7.
The POSIT will itself be culturally adapted because the original instrument was developed for adolescents aged 12 to 19. The researchers intend to extend its upper age limit to 24, translate it into the local language and modify selected items to reflect the risk and protective factors relevant to Kashmir.
The PHQ-9 will be used to assess depression, while the GAD-7 will assess anxiety. The researchers say depression and anxiety have been included because their assessment of risk factors indicated that underlying psychopathology may contribute to vulnerability to substance use and suicide.
Target Group
The study proposes selecting two higher secondary schools and two colleges in an urban district of Jammu and Kashmir, with separate boys’ and girls’ institutions. The researchers say an urban educational hub would provide demographic diversity in terms of age, gender, socio-economic background, rural and urban origins and public and private institutions.
All students in the selected institutions will first undergo screening. Those falling into the high-risk category will then be considered for the intervention.
The final intervention sample has been fixed at 60 participants — 15 from each of the four institutions. The researchers’ statistical calculation initially produced a requirement of 36 participants, but the sample was increased to 60 to allow for possible attrition.
Students already receiving psychiatric treatment may also be included if they are identified through screening, the researchers say, because withholding a potentially beneficial intervention would be unethical.
Measuring Change
The intervention will be evaluated through a single-group pre-and-post design rather than a randomised controlled trial.
Participants will complete the POSIT, PHQ-9 and GAD-7 assessments before the intervention and again eight weeks after the baseline assessment. The researchers intend to examine changes not only in symptoms but also in areas such as mindfulness, emotional regulation, interpersonal skills and the ability to deal with addictions.
The paper acknowledges an important limitation: there will be no control group. The authors therefore caution that the design may limit the generalisation of the findings, even as they argue that it can generate empirical evidence about the intervention’s effectiveness.
Three Phases
The project is structured over three years.
The first year was devoted to mapping risk factors and developing the intervention. Screening and baseline assessment were listed as ongoing in the second year, while administration of the intervention and follow-up were still to begin in the third year.
This timeline is significant because the 2025 paper is a protocol rather than a report of completed treatment results. Its claim is therefore not that the intervention has already reduced substance use, suicide risk or mental disorders, but that the researchers have developed a structured programme and intend to test whether it can do so.
The stated expected outcome is that a culturally tailored intervention could form the basis of a mental-health curriculum for schools and colleges and help improve Kashmir’s wider mental-health landscape. The authors also hope that evidence generated through the project will encourage policymakers to give greater attention to primary prevention.
Policy Shift
The broader argument of the paper is that Kashmir’s response to youth mental health needs to move beyond treating established illness.
Primary prevention, the researchers contend, can identify vulnerable young people and strengthen protective psychological capacities before problems develop or become more severe. Their proposed model combines risk detection with the development of what they describe as psychological capital through mindfulness, emotional regulation, interpersonal effectiveness and skills for dealing with addiction.
If the intervention demonstrates effectiveness in its planned evaluation, its authors envisage it being incorporated into educational settings rather than remaining confined to specialist psychiatric services.
