Community-based psychosocial interventions for people with schizophrenia in low and middle-income countries: systematic review and meta-analysis

Abstract

BackgroundThere is consensus that the treatment of schizophrenia should combine anti-psychotic medication and psychosocial interventions in order to address complex social, economic and health needs. It is recommended that family therapy or support; community-based rehabilitation; and/or self-help and support groups should be provided for people with schizophrenia in low and middle-income countries. The effectiveness of community-based psychosocial interventions in these settings is unclear.MethodsStudies evaluating community-based psychosocial interventions for people with schizophrenia were identified through database searching up to April 2016. Randomised controlled trials were included if they compared the intervention group with a control group receiving treatment as usual including medication. Only studies set in low and middle-income countries were included. Random effects meta-analyses were performed separately for each intervention type.ResultsEleven randomised controlled trials in five middle-income countries were identified, with a total of 1580 participants. The content of included interventions varied from single-faceted psychoeducational interventions, to multi-component rehabilitation-focused interventions, to case management interventions. A third of the included studies did not incorporate any community involvement in the intervention. The quality of evidence was often low. Amongst the seven studies that reported on symptom severity up to 18 months post intervention, the pooled standardised mean difference (SMD) across all intervention types was 0.95 (95% CI 0.28, 1.61; P 0.005; I 2 = 95%; n = 862), representing a strong effect. A strong effect on symptom severity remained after excluding two studies with a high risk of bias (SMD 0.80; 95% CI 0.07, 1.53; P 0.03; I 2 = 94%; n = 676). Community-based psychosocial interventions may also have beneficial impacts on functioning (SMD 1.12; 95% CI 0.25, 2.00; P 0.01; I 2 = 94%; n = 511) and reducing hospital readmissions (SMD 0.68; 95% CI 0.27, 1.09; P 0.001; I2 = 33%; n = 167).ConclusionThe limited evidence from low and middle-income countries supports the feasibility and effectiveness of community-based psychosocial interventions for schizophrenia, even in the absence of community mobilisation. Community-based psychosocial interventions should therefore be provided in these settings as an adjuvant service in addition to facility-based care for people with schizophrenia.Electronic supplementary materialThe online version of this article (10.1186/s12888-017-1516-7) contains supplementary material, which is available to authorized users.

Systematic review and meta‐analyses of randomized control trials of the effectiveness of psychosocial interventions for homeless adults

“…The subgroup meta‐analyses by types of interventions found that there were no significant effects of case management on mental health status and self‐efficacy, which are consistent with results of previous studies (Asher, Patel, & Silva, ; Vanderplasschen, Rapp, Maeyer, & Noortgate, ). Among the three included studies where case management for the homeless person was provided, two studies provided intensive case management and one provided strength‐based case management.…”

Assessing capability for implementing mental health counselling within primary care facilities in a middle‐income country: A feasibility study

“…As CHWs form an important part of these WBOTs, they could be trained to provide community‐based psychosocial interventions for people with common mental disorders. Although a recent systematic review of community‐based psychosocial interventions in LMICs provided evidence of their feasibility, acceptability and effectiveness for reducing symptom severity and hospital readmissions among people with schizophrenia (Asher, Patel, & De Silva, ), the extent to which community‐based mental health counselling is feasible to implement and acceptable to patients with common mental disorders must still be established for the South African context.…”

Retrospective Evaluation of the Correlation Between Previous Hospitalizations, the Type of Current Living Space, and Quality of Family Function

“…The sample was originally recruited from persons living with schizophrenia in the community rehabilitation facility of the Shanghai Pudong New Area Mental Health Center. The following were the inclusion criteria: (1) met the diagnostic criteria for schizophrenia in the Tenth Edition of the International Statistical Classification of Diseases and Related Health Problems; (2) aged between 18 and 65; (3) were male or female; (4) had no history of head trauma, obvious intellectual disability, or other serious or uncontrolled stable physical illness; (5) had no current use (within the previous 3 months) of alcohol or drugs or a past history of dependence; and (6) had no obvious hallucinations or complaints.…”

“…Some studies have found that an increased number of hospitalizations for persons living with schizophrenia increased the psychological burden on relatives (4). The provision of antipsychotic drugs alone cannot meet the economic, social, and psychological needs of persons living with schizophrenia (5). Clinical researchers believe that the treatment of schizophrenia requires drugs combined with psychological interventions (6).…”