Association of Task-Shared Psychological Interventions With Depression Outcomes in Low- and Middle-Income Countries: A Systematic Review and Individual Patient Data Meta-analysis.


Karyotaki, Eirini, Araya, Ricardo, Kessler, Ronald C, Waqas, Ahmed ORCID: 0000-0002-3772-194X, Bhana, Arvin, Rahman, Atif ORCID: 0000-0002-2066-4467, Matsuzaka, Camila T, Miguel, Clara, Lund, Crick, Garman, Emily C et al (show 16 more authors) (2022) Association of Task-Shared Psychological Interventions With Depression Outcomes in Low- and Middle-Income Countries: A Systematic Review and Individual Patient Data Meta-analysis. JAMA psychiatry, 79 (5). pp. 430-443.

[img] Text
Main manusciptJAMAPsych_Revised2.docx - Author Accepted Manuscript
Download (261kB)

Abstract

<h4>Importance</h4>Task sharing, the training of nonspecialist workers with no formal experience in counseling, is a promising strategy for addressing the large gap in treatment for depression in low- and middle-income countries (LMICs).<h4>Objective</h4>To examine the outcomes and moderators of task-shared psychological interventions associated with depression severity, response, and remission.<h4>Data sources</h4>Systematic literature searches in PubMed, Embase, PsycINFO, and Cochrane Library up to January 1, 2021.<h4>Study selection</h4>Randomized clinical trials (RCTs) of task-shared psychological interventions compared with control conditions for adults with depressive symptoms in LMICs were included.<h4>Data extraction and synthesis</h4>Two researchers independently reviewed the titles, abstracts, and full text of articles from an existing generic meta-analytic database that includes all RCTs on psychotherapy for depression. A systematic review and individual patient data (IPD) meta-analysis was used to estimate the outcomes of task-shared psychological interventions across patient characteristics using mixed-effects models. Procedures for abstracting data and assessing data quality and validity followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guideline.<h4>Main outcomes and measures</h4>Primary outcome was reduction in depression symptom severity measured by the 9-item Patient Health Questionnaire (PHQ-9). Response and remission rates were also estimated.<h4>Results</h4>Of 13 eligible trials, 11 (4145 participants) contributed IPD. Task-shared psychological interventions were associated with a greater decrease in depressive symptom severity than control conditions (Hedges g, 0.32; 95% CI, -0.26 to -0.38). Participants in the intervention groups had a higher chance of responding (odds ratio, 2.11; 95% CI, 1.60 to 2.80) and remitting (odds ratio, 1.87; 95% CI, 1.20 to 1.99). The presence of psychomotor symptoms was significantly associated with the outcomes of task-shared psychological interventions (β [SE], -1.21 [0.39]; P = .002). No other significant associations were identified. Heterogeneity among the trials with IPD was 74% (95% CI, 53%-86%).<h4>Conclusions and relevance</h4>In this meta-analysis of IPD, task-shared psychological interventions were associated with a larger reduction in depressive symptom severity and a greater chance of response and remission than control conditions. These findings show potential for the use of task-sharing of psychological interventions across different groups of patients with depression. Further research would help identify which people are most likely to benefit and strengthen larger-scale implementation of this strategy to address the burden of depression in LMICs.

Item Type: Article
Uncontrolled Keywords: Humans, Depression, Counseling, Psychotherapy, Developing Countries, Adult, Psychosocial Intervention
Divisions: Faculty of Health and Life Sciences
Faculty of Health and Life Sciences > Institute of Population Health
Depositing User: Symplectic Admin
Date Deposited: 19 Apr 2022 10:22
Last Modified: 15 Mar 2024 07:15
DOI: 10.1001/jamapsychiatry.2022.0301
Related URLs:
URI: https://livrepository.liverpool.ac.uk/id/eprint/3153143
Dimensions
Altmetric
CORE (COnnecting REpositories)