We used Boolean operators to combine subject headings and relevant search terms related to implementation determinants, primary health-care settings, and common mental disorders to search Medline, EMBASE, PsycINFO, Global Health, and LILACS. We included peer-reviewed qualitative studies published between Jan 1, 1990, and Sept 1, 2017, in English or Spanish. The complete list of search terms can be found in the appendix. Relevant literature was also identified through searches in Google and
ReviewBarriers and facilitators of mental health programmes in primary care in low-income and middle-income countries
Section snippets
Background
Common mental disorders such as depression and anxiety are among the leading causes of years lived with disability globally.1 In low-income and middle-income countries, estimates indicate that 79–93% of people with depression and 85–95% of people with anxiety do not have access to treatment.2 Low availability of human resources for mental health and poor implementation of mental health programmes at scale contribute to this large, unmet need for mental health care.3, 4 WHO promotes the
Methods
This systematic review is reported according to the Preferred Reporting Items for Systematic Review and Meta-Analyses criteria.17 The protocol for this Review was not registered.
To identify relevant literature, we combined search terms related to implementation determinants, primary health-care settings, and common mental disorders. After removing duplicates, GME screened all titles and abstracts, and SH and OQ independently double-screened a 10% random sample of the titles and abstracts. The
Findings
We identified 12 661 records through the databases, internet, and hand searches. 287 papers were eligible for full-text screening. Figure 2 describes the number of papers excluded at each stage. 24 publications that report the findings of 22 studies related to nine mental health-care programme in 11 countries were included in this Review (table 2).
Two of these programmes were in low-income countries,32, 34, 35, 36, 37 four were in lower-middle income countries,33, 38, 39, 40, 41, 42 and one was
Characteristics of the intervention
Strength of evidence, complexity, and cost were reported as barriers. Facilitators included the capacity to adapt the interventions to fit local needs and perceived advantages of using the intervention. No programmes reported information related to the intervention source, trialability, and design quality.
A common implementation challenge was the complexity of interventions for mental health, which require lengthy consultations,31, 43 frequent home visits,37 and considerable coordination
Discussion
This study synthesises stakeholders' perceptions of factors acting as barriers and facilitators to the implementation of programmes for common mental disorders in primary health care in low-income and middle-income countries. To the best of our knowledge, this Review is the first systematic review on this topic. Most frequently discussed were CFIR domains related to contextual factors of the inner and outer setting and characteristics of individuals. Within the inner setting, availability of
Search strategy and selection criteria
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Socioeconomic and racial/ethnic inequalities in depression prevalence and the treatment gap in Brazil: A decomposition analysis
2022, SSM - Population HealthCitation Excerpt :On average, countries spend small shares of their health budgets on mental health services and those funds are largely spent on specialized mental health hospitals (Patel et al., 2018). In low- and middle-income countries (LMICs), between 79% and 93% of people with depression do not receive care (Esponda et al., 2020). Countries must expand services for mental health disorders, including depression, as a key step for achieving universal health coverage (World Health Organization, 2019).
Barriers and facilitators to treatment seeking behaviors for depression, epilepsy, and schizophrenia in low- and middle-income countries: A systematic review
2022, Archives of Psychiatric NursingCitation Excerpt :Mistrust also was a frequently reported barrier to treatment-seeking across all three disorders. Consistent with other reviews, people with neuropsychiatric disorders have reported that health care providers' lack of mental health training, bias, mistreatment, stigmatization, and lack of support of persons with mental illness affect treatment-seeking (Esponda et al., 2020). Compared to their trust in health care providers, patients and family members report greater trust in traditional or faith healers and thus may be more inclined to seek treatment from them (Esponda et al., 2020; von Gaudecker et al., 2019).