Efficacy of psychosocial interventions for mental health outcomes in low-income and middle-income countries: an umbrella review.,The Lancet Psychiatry

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Efficacy of psychosocial interventions for mental health outcomes in low-income and middle-income countries: an umbrella review.
The Lancet Psychiatry ( IF 30.8 ) Pub Date : 2020-01-13 , DOI: 10.1016/s2215-0366(19)30511-5
Corrado Barbui ₁ , Marianna Purgato ₁ , Jibril Abdulmalik ₂ , Ceren Acarturk ₃ , Julian Eaton ₄ , Chiara Gastaldon ₁ , Oye Gureje ₂ , Charlotte Hanlon ₅ , Mark Jordans ₆ , Crick Lund ₇ , Michela Nosè ₁ , Giovanni Ostuzzi ₁ , Davide Papola ₁ , Federico Tedeschi ₁ , Wietse Tol ₈ , Giulia Turrini ₁ , Vikram Patel ₉ , Graham Thornicroft ₁₀

Affiliation

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.
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.
Department of Psychology, Koç University, Istanbul, Turkey.
Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, London, UK.
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.
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.
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.
Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.
Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.
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.

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.

中文翻译：

社会心理干预对低收入和中等收入国家心理健康结果的疗效：综合审查。

背景

精神健康状况是全球残疾的主要原因。针对这些情况的心理社会干预可能在治疗中发挥关键作用，尽管将研究结果应用于资源贫乏的环境可能是一个挑战。我们的目的是评估低收入和中等收入国家 (LMIC) 产生的关于社会心理干预对各种心理健康结果的有效性的证据的强度和可信度。

方法

我们对在中低收入国家进行的随机研究的荟萃分析进行了全面审查。从 2010 年 1 月 1 日到 2019 年 5 月 31 日，在 Medline、Embase、PsychINFO、CINAHL、Cochrane Library 和 Epistemonikos 中进行了文献检索。包括对调查社会心理干预对 LMIC 心理健康状况疗效的随机研究的系统评价。对促进、预防和保护干预措施的系统评价被排除在外，因为重点仅在于治疗干预措施。从纳入的荟萃分析中提取了有关第一作者、出版年份、结果、纳入研究的数量和报告的汇总荟萃分析估计的信息。使用通用度量和随机效应模型重新计算汇总效应。我们评估了研究间的异质性、预测区间、发表偏倚、小型研究的影响，以及观察到的阳性研究结果是否偶然超出预期。在这些计算的基础上，使用定量总括审查标准评估关联强度，并使用 GRADE 方法评估证据的可信度。本研究已在 PROSPERO 注册，注册号为 CRD42019135711。

发现

来自 10 项系统评价的 123 项初步研究被纳入。人道主义环境下心理社会干预对成年抑郁症患者（标准化平均差 0·87，95% CI 0·67–1·07；高度暗示性关联，等级：中等）和患有常见精神障碍的成年患者（ 0·49、0·36–0·62；高度暗示关联，等级：中等）得到最有力证据的支持。在精神分裂症成人、抑郁症成人和人道主义环境中患有创伤后应激障碍的成人中，针对功能结果的心理社会干预发现了高度暗示性的关联强度。在人道主义环境中的儿童和具有破坏性行为的儿童中，社会心理干预得到了有效证据的支持。