Corrado Barbui1, Marianna Purgato2, Jibril Abdulmalik3, Ceren Acarturk4, Julian Eaton5, Chiara Gastaldon2, Oye Gureje3, Charlotte Hanlon6, Mark Jordans7, Crick Lund8, Michela Nosè2, Giovanni Ostuzzi2, Davide Papola2, Federico Tedeschi2, Wietse Tol9, Giulia Turrini2, Vikram Patel10, Graham Thornicroft11. 1. WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy. Electronic address: corrado.barbui@univr.it. 2. WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy. 3. WHO Collaborating Centre for Research and Training in Mental Health, Neurosciences and Substance Abuse, Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria. 4. Department of Psychology, Koç University, Istanbul, Turkey. 5. Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, London, UK. 6. Centre for Global Mental Health, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK; WHO Collaborating Centre for Mental Health Research and Capacity Building, Department of Psychiatry, School of Medicine and Centre for Innovative Drug Development and Therapeutic Trials for Africa, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia. 7. Centre for Global Mental Health, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK; Amsterdam Institute for Social Science Research, University of Amsterdam, Amsterdam, Netherlands. 8. Centre for Global Mental Health, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK; Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa. 9. Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA. 10. Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA. 11. Centre for Global Mental Health, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK; Centre for Implementation Science, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK.
Abstract
BACKGROUND: Mental health conditions are leading causes of disability worldwide. Psychosocial interventions for these conditions might have a key role in their treatment, although applicability of findings to poor-resource settings might be a challenge. We aimed to evaluate the strength and credibility of evidence generated in low-income and middle-income countries (LMICs) on the efficacy of psychosocial interventions for various mental health outcomes. METHODS: We did an umbrella review of meta-analyses of randomised studies done in LMICs. Literature searches were done in Medline, Embase, PsychINFO, CINAHL, Cochrane Library, and Epistemonikos from Jan 1, 2010, until May 31, 2019. Systematic reviews of randomised studies investigating the efficacy of psychosocial interventions for mental health conditions in LMICs were included. Systematic reviews of promotion, prevention, and protection interventions were excluded, because the focus was on treatment interventions only. Information on first author, year of publication, outcomes, number of included studies, and reported summary meta-analytic estimates was extracted from included meta-analyses. Summary effects were recalculated using a common metric and random-effects models. We assessed between-study heterogeneity, predictive intervals, publication bias, small-study effects, and whether the results of the observed positive studies were more than expected by chance. On the basis of these calculations, strength of associations was assessed using quantitative umbrella review criteria, and credibility of evidence using the GRADE approach. This study is registered with PROSPERO, number CRD42019135711. FINDINGS: 123 primary studies from ten systematic reviews were included. The evidence on the efficacy of psychosocial interventions in adults with depression in humanitarian settings (standardised mean difference 0·87, 95% CI 0·67-1·07; highly suggestive association, GRADE: moderate) and in adults with common mental disorders (0·49, 0·36-0·62; highly suggestive association, GRADE: moderate) was supported by the most robust evidence. Highly suggestive strength of association was found for psychosocial interventions in adults with schizophrenia for functional outcomes, in adults with depression, and in adults with post-traumatic stress disorder in humanitarian settings. In children in humanitarian settings, and in children with disruptive behaviour, psychosocial interventions were supported by suggestive evidence of efficacy. INTERPRETATION: A relatively large amount of evidence suggests the benefit of psychosocial interventions on various mental health outcomes in LMICs. However, strength of associations and credibility of evidence were quite variable, depending on the target mental health condition, type of population and setting, and outcome of interest. This varied evidence should be considered in the development of clinical, policy, and implementation programmes in LMICs and should prompt further studies to improve the strength and credibility of the evidence base. FUNDING: University of Verona.
BACKGROUND: Mental health conditions are leading causes of disability worldwide. Psychosocial interventions for these conditions might have a key role in their treatment, although applicability of findings to poor-resource settings might be a challenge. We aimed to evaluate the strength and credibility of evidence generated in low-income and middle-income countries (LMICs) on the efficacy of psychosocial interventions for various mental health outcomes. METHODS: We did an umbrella review of meta-analyses of randomised studies done in LMICs. Literature searches were done in Medline, Embase, PsychINFO, CINAHL, Cochrane Library, and Epistemonikos from Jan 1, 2010, until May 31, 2019. Systematic reviews of randomised studies investigating the efficacy of psychosocial interventions for mental health conditions in LMICs were included. Systematic reviews of promotion, prevention, and protection interventions were excluded, because the focus was on treatment interventions only. Information on first author, year of publication, outcomes, number of included studies, and reported summary meta-analytic estimates was extracted from included meta-analyses. Summary effects were recalculated using a common metric and random-effects models. We assessed between-study heterogeneity, predictive intervals, publication bias, small-study effects, and whether the results of the observed positive studies were more than expected by chance. On the basis of these calculations, strength of associations was assessed using quantitative umbrella review criteria, and credibility of evidence using the GRADE approach. This study is registered with PROSPERO, number CRD42019135711. FINDINGS: 123 primary studies from ten systematic reviews were included. The evidence on the efficacy of psychosocial interventions in adults with depression in humanitarian settings (standardised mean difference 0·87, 95% CI 0·67-1·07; highly suggestive association, GRADE: moderate) and in adults with common mental disorders (0·49, 0·36-0·62; highly suggestive association, GRADE: moderate) was supported by the most robust evidence. Highly suggestive strength of association was found for psychosocial interventions in adults with schizophrenia for functional outcomes, in adults with depression, and in adults with post-traumatic stress disorder in humanitarian settings. In children in humanitarian settings, and in children with disruptive behaviour, psychosocial interventions were supported by suggestive evidence of efficacy. INTERPRETATION: A relatively large amount of evidence suggests the benefit of psychosocial interventions on various mental health outcomes in LMICs. However, strength of associations and credibility of evidence were quite variable, depending on the target mental health condition, type of population and setting, and outcome of interest. This varied evidence should be considered in the development of clinical, policy, and implementation programmes in LMICs and should prompt further studies to improve the strength and credibility of the evidence base. FUNDING: University of Verona.
Authors: Mark J D Jordans; Brandon A Kohrt; Manaswi Sangraula; Elizabeth L Turner; Xueqi Wang; Pragya Shrestha; Renasha Ghimire; Edith Van't Hof; Richard A Bryant; Katie S Dawson; Kedar Marahatta; Nagendra P Luitel; Mark van Ommeren Journal: PLoS Med Date: 2021-06-17 Impact factor: 11.069
Authors: M Claire Greene; Terry T K Huang; Ali Giusto; Kathryn L Lovero; Melissa A Stockton; Rachel C Shelton; Palmira Dos Santos; Francisco Saúte; Milton L Wainberg Journal: Harv Rev Psychiatry Date: 2021 Jul-Aug 01 Impact factor: 3.868