World Health Organization's low‐intensity psychosocial interventions: a systematic review and meta‐analysis of the effects of Problem Management Plus andStep‐by‐Step

Abstract

Many societies have been recently exposed to humanitarian and health emergencies, which have resulted in a large number of people experiencing significant distress and being at risk to develop mental disorders such as depression, anxiety and post‐traumatic stress disorder. The World Health Organization has released a series of scalable psychosocial interventions for people impaired by distress in communities exposed to adversities. Prominent among these is a low‐intensity transdiagnostic psychosocial intervention, Problem Management Plus (PM+), and its digital adaptation Step‐by‐Step (SbS). This systematic review is the first to summarize the available evidence on the effects of PM+ and SbS. Up to March 8, 2023, five databases were searched for randomized controlled trials examining the effects of PM+ or SbS on distress indicators (i.e., general distress; anxiety, depressive or post‐traumatic stress disorder symptoms; functional impairment, self‐identified problems) and positive mental health outcomes (i.e., well‐being, quality of life, social support/relationships). We performed random‐effects multilevel meta‐analyses on standardized mean differences (SMDs) at post‐intervention and short‐term follow‐up assessments. Our search yielded 23 eligible studies, including 5,298 participants. We found a small to medium favorable effect on distress indicators (SMD=–0.45, 95% CI: –0.56 to –0.34) and a small beneficial effect on positive mental health outcomes (SMD=0.31, 95% CI: 0.14‐0.47), which both remained significant at follow‐up assessment and were robust in sensitivity analyses. However, our analyses pointed to substantial between‐study heterogeneity, which was only partially explained by moderators, and the certainty of evidence was very low across all outcomes. These results provide evidence for the effectiveness of PM+ and SbS in reducing distress indicators and promoting positive mental health in populations exposed to adversities, but a larger high‐quality evidence base is needed, as well as research on participant‐level moderators of the effects of these interventions, their suitability for stepped‐care programs, and their cost‐effectiveness.

Brief psychological interventions to improve mental health outcomes in refugee populations: A systematic review

“…Analysis of subgroups comprising studies conducted by trained psychologists and briefly trained lay persons found no significant difference in the effects of these interventions. Furthermore, psychological interventions conducted by lay persons had significant beneficial effects on PTSD symptoms, which is consistent with previous systematic reviews 21,22 . The effectiveness of these interventions may be attributed to the robustness of underlying therapeutic materials 18,19 .…”

“…This may be due to the lower rates of anxiety and depression compared to PTSD found in the refugee population 7 . Previous reviews have found similar findings in refugee populations 11,21,22,24 ; however, some only look at specific populations or single outcomes, or do not report the duration of interventional effects.…”

“…Studies were more likely to report PTSD compared to symptoms of depression and anxiety as compared to symptoms of PTSD. This may be due to the lower rates of anxiety and depression compared to PTSD found in the refugee population 7 Previous reviews have found similar findings in refugee populations11,21,22,24…”

“…Several studies reporting long-term follow-up were identified, and a post-hoc analysis of these outcomes was conducted. Follow-up durations were categorised into short-term (3-6 months) and long-term (7-12 months), in line with classifications used in similar systematic reviews 21,31 . No study extended long-term follow-up beyond 12 months.…”

“…There have been several recent systematic reviews looking at psychological interventions for refugees and asylum seekers. Two focus only on low-intensity, transdiagnostic interventions 21,22 ; one on psychological interventions in children 23 ; and one on psychosocial interventions for PTSD only in low- and middle-income countries 24 . To date, no systematic review has examined the effect of brief CBT-based interventions on varied outcomes of mental health symptoms.…”