Task-sharing psychosocial interventions for the prevention of common mental disorders in the perinatal period in low- and middle-income countries: A systematic review and meta-analysis

Abstract

Aim: to assess the efficacy of psychosocial interventions delivered through task-sharing approaches for preventing perinatal common mental disorders among women in low- and middle-income countries. Methods: We conducted a systematic review of randomized controlled trials following a prespecified protocol registered in the Open Science Framework (osf.io/qt4y3). We searched MEDLINE, Web of Science, PsycINFO, and Cochrane Central Register of Controlled Trials (CENTRAL) through June 2022. Two reviewers independently extracted the data and evaluated the risk of bias of included studies using the Cochrane risk of bias tool. We performed random-effects meta-analyses and rated the certainty of evidence using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. Results: We included 23 studies with 24,442 participants. At post-intervention, task-shared psychosocial interventions, were effective in preventing the development of mental disorders in general (RR 0.57, 95% CI [0.35, 0.91]), and specifically depression (RR 0.51, 95% CI [0.35, 0.75]), but not anxiety disorders (RR 0.46, 95% CI [0.06, 3.33]). Similarly, psychosocial interventions reduced psychological distress (SMD −1.32, 95% CI [−2.28, −0.35]), and depressive symptoms (SMD −0.50, 95% CI [−0.80, −0.16]), and increased parenting self-efficacy (SMD −0.76, 95% CI [−1.13, −0.38]) and social support (SMD −0.72, 95% CI [−1.22, −0.22]). No effect was detected for anxiety symptoms at post-intervention. At follow-up the beneficial effects of interventions progressively decreased. Conclusions: Psychosocial interventions delivered through the task-sharing modality are effective in preventing perinatal common mental disorders and fostering positive mental health among women in low- and middle-income countries. However, our findings are tentative, due to the low number of preventative intervention strategies considering outcomes as the incidence of mental disorders, especially in the long-term. This evidence supports calls to implement and scale up psychosocial prevention interventions for perinatal common mental disorders in low- and middle-income countries.

Acceptability and Feasibility of Maternal Mental Health Assessment When Managing Small, Nutritionally At-Risk Infants Aged < 6 Months: A Key Informant Interview Study

“…Although MMH specialist staff may be a valuable investment, many participants felt that MMH specialists are not necessary at all stages of care pathways for effective implementation of MMH assessments. This is consistent with other evidence that task-shifting to more generalist staff can be effective [40]. To further boost the chances of success, there is also a need for ongoing staff training and for better grassroots-level training for health professional qualifications.…”

“…Solid governance is vital for strong MMH care systems in a country or region, and our study is not unique in highlighting that policy makers and programme specialists need to be more aware of mental health issues and improved governance needs to be set up to facilitate effective and safe services [39]. There are numerous, well-documented ways forward, including task-shifting, which could help strengthen services in the short and medium terms [40].…”

“…This is important for programme design and funding, as without budgeting for specialist input, MMH screening may not always be safely implemented. Some existing studies examine the positive effects of task-sharing and supervision of lay staff in delivering MMH interventions [40]. These data focus on wide-ranging interventions rather than MMH screening/assessment alone, but they do clearly show that there is scope to better utilise staff skill sets and invest in adequate training and supervision of lay staff to implement MMH screening.…”

Effectiveness of combining prevention psychological interventions with interventions that address the social determinants of mental health in low and middle-income countries: protocol of a systematic review and meta-analysis

“…Common mental health conditions (CMHCs), defined here as depression, anxiety and post-traumatic stress disorder (PTSD), are highly prevalent in low and middle-income countries (LMICs) and exert a significant contribution to the global burden of disease and disability. [1][2][3][4] The WHO estimates that the prevalence of CMHCs in conflict settings is at 22%, 5 which is notably, around five times higher than the general population.…”