Background
Community‐based primary‐level workers (PWs) are an important strategy for addressing gaps in mental health service delivery in low‐ and middle‐income countries.
Objectives
To evaluate the effectiveness of PW‐led treatments for persons with mental health symptoms in LMICs, compared to usual care.
Search methods
MEDLINE, Embase, CENTRAL, ClinicalTrials.gov, ICTRP, reference lists (to 20 June 2019).
Selection criteria
Randomised trials of PW‐led or collaborative‐care interventions treating people with mental health symptoms or their carers in LMICs.
PWs included: primary health professionals (PHPs), lay health workers (LHWs), community non‐health professionals (CPs).
Data collection and analysis
Seven conditions were identified apriori and analysed by disorder and PW examining recovery, prevalence, symptom change, quality‐of‐life (QOL), functioning, service use (SU), and adverse events (AEs).
Risk ratios (RRs) were used for dichotomous outcomes; mean difference (MDs), standardised mean differences (SMDs), or mean change differences (MCDs) for continuous outcomes.
For SMDs, 0.20 to 0.49 represented small, 0.50 to 0.79 moderate, and ≥0.80 large clinical effects.
Analysis timepoints: T1 (<1 month), T2 (1‐6 months), T3 ( >6 months) post‐intervention.
Main results
Description of studies
95 trials (72 new since 2013) from 30 LMICs (25 trials from 13 LICs).
Risk of bias
Most common: detection bias, attrition bias (efficacy), insufficient protection against contamination.
Intervention effects
*Unless indicated, comparisons were usual care at T2.
“Probably”, “may”, or “uncertain” indicates "moderate", "low," or "very low" certainty evidence.
Adults with common mental disorders (CMDs)
LHW‐led interventions
a. may increase recovery (2 trials, 308 participants; RR 1.29, 95%CI 1.06 to 1.56);
b. may reduce prevalence (2 trials, 479 participants; RR 0.42, 95%CI 0.18 to 0.96);
c. may reduce symptoms (4 trials, 798 participants; SMD ‐0.59, 95%CI ‐1.01 to ‐0.16);
d. may improve QOL (1 trial, 521 participants; SMD 0.51, 95%CI 0.34 to 0.69);
e. may slightly reduce functional impairment (3 trials, 1399 participants; SMD ‐0.47, 95%CI ‐0.8 to ‐0.15);
f. may reduce AEs (risk of suicide ideation/attempts);
g. may have uncertain effects on SU.
Collaborative‐care
a. may increase recovery (5 trials, 804 participants; RR 2.26, 95%CI 1.50 to 3.43);
b. may reduce prevalence although the actual effect range indicates it may have little‐or‐no effect (2 trials, 2820 participants; RR 0.57, 95%CI 0.32 to 1.01);
c. may slightly red...
