Effectiveness and implementation of psychological interventions for depression in people with non-communicable diseases in South Asia: Systematic review and meta-analysis

Abstract

We evaluate the effectiveness of psychological interventions for depression in people with NCDs in South Asia and explore the individual, organizational, and policy-level barriers and facilitators for the implementation and scaling up of these interventions. Eight databases (and local web pages) were searched in May 2022. We conducted random effects models to evaluate the pooled effect of psychological interventions on depression in people with NCDs. We extracted the individual, organizational, and policy level barriers and facilitators. We found five randomized control trials, nine qualitative studies, and 35 policy documents that fitted the inclusion criteria. The pooled standardized mean difference in depression comparing psychological interventions with usual care was −2.31 (95% CI, −4.16 to −0.45; p = .015, I 2 = 96.0%). We found barriers and facilitators to intervention delivery, mental health appears in the policy agenda in Bangladesh and Pakistan. However, there is a lack of policies relating to training in mental health for NCD health providers and a lack of integration of mental health care with NCD care. All of the psychological interventions reported to be effective in treating depression in this population. There are important delivery and policy barriers to the implementation and scaling up of psychological interventions for people with NCDs.

Effectiveness and cost-effectiveness of a culturally tailored Behavioural Activation intervention (DiaDeM) for treating Depression in Type 2 Diabetes: Protocol for a parallel arm, multi-country, randomised controlled trial in South Asia

“…Published literature from South Asian settings estimates the prevalence of diabetes to be as high as 26% [9], with at least a quarter of such individuals also having co-morbid depression [10,11]. Psychological therapies are increasingly being recognised for their relevance to the treatment of common mental disorders in people with diabetes, particularly because of their consideration of the wider psychosocial aspects of illness, and they have proven to be effective to reduce depressive symptoms in people with NCDs in LMICs [12]. Behavioural activation (BA) is a type of psychological treatment, recognised for its parsimony, portability across cultures and efficiency of training.…”