Primary‐level worker interventions for the care of people living with mental disorders and distress in low‐ and middle‐income countries

Recovery from CMDs ‐ intermediate term (1 to 6 months post intervention) Recovery defined by HDRS < 8a; SRQ‐20 ≤ 7b (RR > 1 denotes greater likelihood of recovery)

Prevalence of CMDs ‐ intermediate term (1 to 6 months post intervention) Diagnosis defined by SRQ‐20 > 7b; PHQ‐9 ≥ 11d (RR < 1 denotes lower prevalence compared to control)

Severity of CMD symptoms (including anxiety and depression) ‐ intermediate term (1 to 6 months post intervention) Measured by PHQ‐9a,d,f; SRQ‐20b (higher score, higher severity)

Quality of life ‐ intermediate term (1 to 6 months post intervention) Measured by EQ‐5D (higher score = better quality of life)

Functional impairment/disability ‐ intermediate term (1 to 6 months post intervention) Measured by WHODAS 2.0 (higher score = higher disability)

Service utilisation (1 to 6 months post intervention)

Adverse events RR < 1 indicates lower risk of adverse eventsÂ

Recovery from CMD ‐ intermediate term (1 to 6 months post intervention) Recovery defined by GDS ≤ 11a; HDRS < 7b; HDRS < 8c; PHQ‐9 < 6d; PHQ‐9 < 5 or 50% reduction from baselinee (RR > 1 denotes greater likelihood of recovery)

Prevalence of CMD ‐ intermediate term (1 to 6 months post intervention) Diagnosis defined by presence of ICD‐10 diagnosis on CIS‐Rg; prevalence defined by [Total number ‐ number recovered (recovery defined by HDRS < 8)]c (RR < 1 denotes lower prev...

CMD symptoms ‐ intermediate term (1 to 6 months post intervention) Measured by change in CIS‐Rg; GHQ‐12i; HDRSc; PHQ‐9e,j,k scores from baseline (greater decline = greater improvement)

Quality of life ‐ intermediate term (1 to 6 months post intervention) EQ‐5Di; SF‐36c,m; WHOQOL‐BREFe,j,n (higher score = better quality of life)

Functional impairment ‐ intermediate term (1 to 6 months post intervention) WHODAS 2.0e,g,i,j,k (higher score = higher disability)

Service utilisation ‐ referral to mental health team ‐ long term (7 to 12 months post intervention)Â

Adverse events ‐ deathÂ

Recovery from depression ‐ intermediate term (1 to 6 months post intervention) Recovery defined by Edinburgh Postnatal Depression Scale ≤ 5a; PHQ‐9 < 5b,c; absence of major depression based on DSM‐IV criteriad (RR > 1 denotes greater likelihood of...

Prevalence of perinatal depression (1 to 6 months post intervention)

Severity of depression symptoms ‐ intermediate term (1 to 6 months post intervention) Edinburgh Postnatal Depression Scalea; Hamilton Depression Rating Scaled,f; PHQ‐9b,c (higher score = higher severity)

Quality of life (1 to 6 months post intervention)Â

Functional impairment ‐ intermediate term (1 to 6 months post intervention) Global assessment of functioning scale, WHODAS (higher score = higher functional impairment)

Service utilisation ‐ maternal or child hospitalisations ‐ intermediate term (1 to 6 months post intervention)

Adverse events (1 to 6 months post intervention)

Depression recovery ‐ intermediate term (1 to 6 months post intervention)

Disease prevalence (1 to 6 months post intervention)

Depression symptoms ‐ intermediate term (1 to 6 months post intervention) Edinburgh Postnatal Depression Scale score (higher score = higher severity)

Quality of life ‐ intermediate term (1 to 6 months post intervention) SF‐36 social functioning (higher score = higher quality of life)

Functional impairment ‐ intermediate term (1 to 6 months post intervention)

Service utilisation ‐ intermediate term (1 to 6 months post intervention) Mean number of medical consultations

Adverse events (7 to 24 months post intervention)

Recovery from PTSD (1 to 6 months post intervention)

Prevalence of PTSD ‐ intermediate term (1 to 6 months) Diagnosis defined by fulfilment of PTSD diagnostic criteria using the PCL‐5a; fulfilment of DSM‐IV PTSD diagnostic criteria using the CIDIb (RR < 1 denotes lower prevalence compared to control)

PTS symptoms ‐ intermediate term (1 to 6 months post intervention) PCL‐5a,d,e; PCL‐6f; Post‐traumatic Stress Diagnostic Scaleb (higher score = higher severity)

Depression symptoms ‐ intermediate term (1 to 6 months post intervention) GHQ‐12a; PHQ‐9d,e,f; self‐reporting questionnaireh (higher score = higher severity)

Quality of life ‐ intermediate term (1 to 6 months post intervention) PSYCHLOPS (higher score = poorer outcome)

Functional impairment ‐ intermediate term (1 to 6 months post intervention) WHODAS (higher score = more severity impairment)

Service utilisation ‐ hospital admissions (1 to 6 months post intervention) Â

Adverse events

Recovery from PTSD

Prevalence of adults with probable PTSD (1 to 6 months post intervention) Diagnosis defined by HTQ ≥ 1.75 (RR > 1 denotes lower prevalence compared to control)

Prevalence of adults with probable depression or anxiety (1 to 6 months post intervention) Diagnosis defined by HSCL‐25 ≥ 1.75 (RR > 1 denotes lower prevalence compared to control)

PTS symptoms (1 to 6 months post intervention) Harvard Trauma Questionnaire (higher score = higher severity)

Depression symptoms (1 to 6 months post intervention) Hopkins Symptom Checklist ‐ depression (higher score = higher severity)

Quality of life

Functional impairment (1 to 6 months post intervention) Locally developed functional impairment scale (higher score = higher functional impairment)

Service utilisation

Adverse events (RR > 1 denotes greater risk of harm)

Clinical recovery ‐ harmful or hazardous alcohol use (1 to 6 months post intervention)

Prevalence of methamphetamine use (1 to 6 months post intervention) (RR < 1 denotes lower prevalence compared to control)

Clinical symptoms ‐ alcohol use (1 to 6 months post intervention) ‐ risk of hazardous or harmful alcohol use

Clinical symptoms ‐ alcohol and substance use (1 to 6 months post intervention)

Quality of life

Functional impairment (1 to 6 months post intervention)

Service utilisation ‐ unplanned hospitalisations (1 to 6 months post intervention) (RR < 1 denotes lower risk)

Adverse events ‐ deaths (RR < 1 denotes lower risk)

Clinical recovery ‐ harmful or hazardous alcohol use (1 to 6 months post intervention)

Prevalence of cannabis use (1 to 6 months post intervention) (RR < 1 denotes lower prevalence compared to control)

Clinical symptoms ‐ risk of harmful or hazardous drinking (1 to 6 months post intervention)

Clinical symptoms ‐ overall risk of harmful or hazardous alcohol and substance use (1 to 6 months post intervention)

Quality of life (1 to 6 months post intervention)

Functional impairmentÂ

Service utilisation (1 to 6 months post intervention) ‐ incidence of visits to primary care centres due to alcohol consumption (RR > 1 denotes greater risk)

Adverse events (1 to 6 months post intervention) ‐ incidence of alcohol‐related consequences ‐ accidents (RR > 1 denotes greater risk)

Clinical recovery ‐ harmful or dependent alcohol use (1 to 6 months post intervention) Defined by AUDIT score < 8 (RR > 1 denotes higher likelihood of recovery)

Prevalence of alcohol dependence (1 to 6 months post intervention)

Clinical symptoms ‐ alcohol use (1 to 6 months post intervention)

Clinical symptoms ‐ depression (1 to 6 months post intervention)

Quality of life

Functional impairment (1 to 6 months post intervention)

Service utilisation ‐ Unplanned hospitalisation in past 12 months (RR > 1 denotes higher risk of hospitalisation)

Adverse events ‐ death in past 12 months (RR > 1 denotes higher risk of death)

Clinical recovery

Prevalence of morphine use

Clinical symptoms ‐ alcohol use (< 1 month post intervention)

Clinical symptoms ‐ drug use (< 1 month post intervention) ‐ heroin

Quality of life (< 1 month post intervention) ‐ social functioning

Functional impairment

Service utilisation

Adverse events

Recovery from severe mental disorders

Prevalence of severe mental disorders

Schizophrenia symptoms severity ‐ immediately post intervention Assessed by BPRSa; PANSSb (Chatterjee 2014) (higher scores = greater symptom severity)

Caregiver burden symptom severity ‐ immediately post intervention Assessed by Burden Assessment Schedule (higher scores = higher burden)

Quality of life

Functional impairment ‐ immediately post intervention Assessed by IDEASb; SDSSa (lower scores = less functional impairment)

Service utilisation ‐ hospitalisation during intervention (RR > 1 denotes greater risk)Â

Adverse events ‐ death from suicide during intervention (RR > 1 denotes greater risk)Â

Clinical recovery from severe mental disorder (immediately post intervention) Defined by BPRS decreased by ≥ 80% (RR > 1 denotes greater likelihood of recovery)

Relapse of severe mental disorder (immediately post intervention) Defined by re‐appearance of symptoms or worsening of symptoms necessitating adjustment of medicationa; Li 2002; based on 1 item scoring ≥ 5 or 2 items scoring ≥ 4 in items 4, 7, 11,...

Prevalence of severe mental disorder

Schizophrenia symptoms severity (immediately post intervention)

Depression symptom severity (immediately post intervention)

Quality of life (immediately post intervention)

Functional impairment ‐ immediately post intervention

Service utilisation ‐ hospital re‐admission (during intervention) (RR > 1 denotes greater risk)

Adverse eventsÂ

Clinical illness recovery

Disease prevalence

Severity of behavioural symptoms (patient) (1 to 6 months post intervention)Measured using the behavioural symptom scale (NPI‐S) (high score = greater severity)

Severity of mental distress (carer) (1 to 6 months post intervention) Neuropsychiatric Interview for dementia (higher score = better quality of life)

Quality of life (patient) (1 to 6 months post intervention) DEMQOL (higher score = better quality of life)

Quality of life (carer) (1 to 6 months post intervention) WHOQOL‐BREF (higher score = better quality of life)

Functional impairment (patient) (1 to 6 months post intervention) EASI (higher score = higher impairment in activities of daily living)

Service utilisation ‐ home visits by LHW and psychiatrist (during intervention)

Adverse events ‐ number of deaths (during intervention) Â

Depression or PTSD recovery

Disease prevalence

Depression symptoms (1 to 6 months post intervention) Depression self‐rating scale (higher score = higher severity)

PTS symptoms (1 to 6 months post intervention) Child post‐traumatic stress scale (higher score = higher severity)

Quality of life

Functional impairment (1 to 6 months post intervention) Locally developed functional scale (higher score = higher impairment)

Service utilisation

Adverse events (during intervention)

Recovery from probable PTSD in children (< 1 month post intervention) Defined by number of participants whose CRIES‐13 score was above cutoff for diagnosis of PTSD at baseline ‐ number of participants whose CRIES‐13 score was above cutoff for the ...

Prevalence of PTSD

PTS symptoms (1 to 6 months post intervention) Harvard Trauma Questionnairec; PTSD‐RId; UCLA PTSD indexe (higher score = higher severity)

Depression symptoms (1 to 6 months post intervention) Beck Depression Inventorye; Oxford Measure of Psychosocial Adjustmentd (higher score = higher severity)

Quality of life

Functional impairment (1 to 6 months post intervention) Child diagnostic interview schedulee; WHODAS IId (higher score = higher functional impairment)

Service utilisation

Adverse events (during intervention)Â