Cochrane · systematic review · CD009149
Primary‐level worker interventions for the care of people living with mental disorders and distress in low‐ and middle‐income countries
van Ginneken, N, Chin, WY, Lim, YC, et al. · Cochrane Database of Systematic Reviews · 2021 · Cochrane Library
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
119
current version
GRADE rated
89
No studies
30
Included studies
NR
No studies 30 · 25.2%Ungraded 0 · 0%Very low 50 · 42%Low 29 · 24.4%Moderate 10 · 8.4%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Current version onlyLay health worker‐led psychological interventions compared to usual care in treating common mental disorders in adults in low‐ and middle‐income countries
Population: adults with common mental disorders (CMDs)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
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) Lay health worker‐led psychological interventions vs usual care | RR 1.29 [1.06, 1.56] | 2 studies · 308 participants | Low Downgraded: imprecision, inconsistency, indirectness |
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) Lay health worker‐led psychological interventions vs usual care | RR 0.42 [0.18, 0.96] | 2 studies · 479 participants | Low Downgraded: imprecision, inconsistency, indirectness |
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) Lay health worker‐led psychological interventions vs usual care | no estimate extracted | 4 studies · 798 participants | Low Downgraded: imprecision, inconsistency, indirectness |
Quality of life ‐ intermediate term (1 to 6 months post intervention) Measured by EQ‐5D (higher score = better quality of life) Lay health worker‐led psychological interventions vs usual care | no estimate extracted | 1 study · 521 participants | Low Downgraded: imprecision, inconsistency, indirectness |
Functional impairment/disability ‐ intermediate term (1 to 6 months post intervention) Measured by WHODAS 2.0 (higher score = higher disability) Lay health worker‐led psychological interventions vs usual care | no estimate extracted | 3 studies · 1399 participants | Low Downgraded: imprecision, inconsistency, indirectness |
Service utilisation (1 to 6 months post intervention) Lay health worker‐led psychological interventions vs usual care | RR 0.43 [0.11, 1.66] | 1 study · 493 participants | Very low Downgraded: imprecision, inconsistency, indirectness |
Adverse events RR < 1 indicates lower risk of adverse events Lay health worker‐led psychological interventions vs usual care | no estimate extracted | 2 studies · 1014 participants | Low Downgraded: imprecision, inconsistency, indirectness |
Primary‐level worker‐led collaborative care compared to usual care in treating common mental disorders (CMDs) in adults in low‐ and middle‐income countries
Population: adults with common mental disorders
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
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) Primary‐level worker‐led collaborative care vs usual care | RR 2.26 [1.5, 3.43] | 5 studies · 804 participants | Low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
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... Primary‐level worker‐led collaborative care vs usual care | RR 0.57 [0.32, 1.01] | 2 studies · 2820 participants | Low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
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) Primary‐level worker‐led collaborative care vs usual care | no estimate extracted | 6 studies · 4419 participants | Low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
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) Primary‐level worker‐led collaborative care vs usual care | no estimate extracted | 6 studies · 2199 participants | Low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Functional impairment ‐ intermediate term (1 to 6 months post intervention) WHODAS 2.0e,g,i,j,k (higher score = higher disability) Primary‐level worker‐led collaborative care vs usual care | no estimate extracted | 5 studies · 4216 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Service utilisation ‐ referral to mental health team ‐ long term (7 to 12 months post intervention)Â Primary‐level worker‐led collaborative care vs usual care | RR 0.46 [0.33, 0.64] | 1 study · 907 participants | Low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Adverse events ‐ death Primary‐level worker‐led collaborative care vs usual care | RR 0.63 [0.38, 1.06] | 5 studies · 5300 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Lay health worker‐led psychosocial interventions compared to enhanced usual care for treating perinatal depression in low‐ and middle‐income countries
Population: women with perinatal depression
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
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... Lay health worker‐led psychosocial interventions vs enhanced usual care | RR 1.29 [1.08, 1.54] | 4 studies · 1243 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Prevalence of perinatal depression (1 to 6 months post intervention) Lay health worker‐led psychosocial interventions vs enhanced usual care | no estimate extracted | NR | No studies |
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) Lay health worker‐led psychosocial interventions vs enhanced usual care | no estimate extracted | 5 studies · 1989 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency |
Quality of life (1 to 6 months post intervention)Â Lay health worker‐led psychosocial interventions vs enhanced usual care | no estimate extracted | NR | No studies |
Functional impairment ‐ intermediate term (1 to 6 months post intervention) Global assessment of functioning scale, WHODAS (higher score = higher functional impairment) Lay health worker‐led psychosocial interventions vs enhanced usual care | no estimate extracted | 4 studies · 1856 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Service utilisation ‐ maternal or child hospitalisations ‐ intermediate term (1 to 6 months post intervention) Lay health worker‐led psychosocial interventions vs enhanced usual care | RR 1.12 [0.6, 2.06] | 2 studies · 850 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Adverse events (1 to 6 months post intervention) Lay health worker‐led psychosocial interventions vs enhanced usual care | no estimate extracted | 4 studies · 1205 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Primary health professional‐led collaborative care interventions compared to usual or enhanced care in treating perinatal depression in low‐ and middle‐income countries
Population: women with perinatal depression
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Depression recovery ‐ intermediate term (1 to 6 months post intervention) Primary health professional‐led collaborative care interventions vs usual or enhanced care | no estimate extracted | NR | No studies |
Disease prevalence (1 to 6 months post intervention) Primary health professional‐led collaborative care interventions vs usual or enhanced care | no estimate extracted | NR | No studies |
Depression symptoms ‐ intermediate term (1 to 6 months post intervention) Edinburgh Postnatal Depression Scale score (higher score = higher severity) Primary health professional‐led collaborative care interventions vs usual or enhanced care | no estimate extracted | 1 study · 230 participants | Very low Downgraded: imprecision, indirectness |
Quality of life ‐ intermediate term (1 to 6 months post intervention) SF‐36 social functioning (higher score = higher quality of life) Primary health professional‐led collaborative care interventions vs usual or enhanced care | MD 3.5 | 1 study · 230 participants | Very low Downgraded: imprecision, indirectness |
Functional impairment ‐ intermediate term (1 to 6 months post intervention) Primary health professional‐led collaborative care interventions vs usual or enhanced care | no estimate extracted | NR | No studies |
Service utilisation ‐ intermediate term (1 to 6 months post intervention) Mean number of medical consultations Primary health professional‐led collaborative care interventions vs usual or enhanced care | no estimate extracted | 1 study · 230 participants | Very low Downgraded: imprecision, indirectness |
Adverse events (7 to 24 months post intervention) Primary health professional‐led collaborative care interventions vs usual or enhanced care | no estimate extracted | 1 study · 686 participants | Very low Downgraded: imprecision, indirectness |
Lay health worker‐led psychological interventions compared to usual care in treating adults with post‐traumatic stress or common mental disorders in humanitarian settings in low‐ and middle‐income countries
Population: adults with post‐traumatic stress and CMDs
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Recovery from PTSD (1 to 6 months post intervention) Lay health worker‐led psychological interventions vs usual care | no estimate extracted | NR | No studies |
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) Lay health worker‐led psychological interventions vs usual care | RR 0.77 [0.3, 2] | 2 studies · 380 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
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) Lay health worker‐led psychological interventions vs usual care | no estimate extracted | 5 studies · 2045 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Depression symptoms ‐ intermediate term (1 to 6 months post intervention) GHQ‐12a; PHQ‐9d,e,f; self‐reporting questionnaireh (higher score = higher severity) Lay health worker‐led psychological interventions vs usual care | no estimate extracted | 5 studies · 1986 participants | Low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Quality of life ‐ intermediate term (1 to 6 months post intervention) PSYCHLOPS (higher score = poorer outcome) Lay health worker‐led psychological interventions vs usual care | no estimate extracted | 4 studies · 1918 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Functional impairment ‐ intermediate term (1 to 6 months post intervention) WHODAS (higher score = more severity impairment) Lay health worker‐led psychological interventions vs usual care | no estimate extracted | 4 studies · 1914 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Service utilisation ‐ hospital admissions (1 to 6 months post intervention) Â Lay health worker‐led psychological interventions vs usual care | RR 1.13 [0.53, 2.34] | 1 study · 319 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Adverse events Lay health worker‐led psychological interventions vs usual care | no estimate extracted | 5 studies · 1701 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Primary health professional‐led psychological interventions compared to usual or no care for treating adults with post‐traumatic stress or common mental disorders in humanitarian settings in low‐ and middle‐income countries
Population: adults with post‐traumatic stress or common mental disorders
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Recovery from PTSD Primary health professional‐led psychological interventions vs usual or no care | no estimate extracted | NR | No studies |
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) Primary health professional‐led psychological interventions vs usual or no care | RR 5.5 [2.5, 12.1] | 1 study · 313 participants | Low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
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) Primary health professional‐led psychological interventions vs usual or no care | RR 4.6 [2.1, 10.08] | 1 study · 313 participants | Low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
PTS symptoms (1 to 6 months post intervention) Harvard Trauma Questionnaire (higher score = higher severity) Primary health professional‐led psychological interventions vs usual or no care | no estimate extracted | 2 studies · 680 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Depression symptoms (1 to 6 months post intervention) Hopkins Symptom Checklist ‐ depression (higher score = higher severity) Primary health professional‐led psychological interventions vs usual or no care | no estimate extracted | 2 studies · 680 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Quality of life Primary health professional‐led psychological interventions vs usual or no care | no estimate extracted | NR | No studies |
Functional impairment (1 to 6 months post intervention) Locally developed functional impairment scale (higher score = higher functional impairment) Primary health professional‐led psychological interventions vs usual or no care | no estimate extracted | 2 studies · 680 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Service utilisation Primary health professional‐led psychological interventions vs usual or no care | no estimate extracted | 5 studies · 1572 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Adverse events (RR > 1 denotes greater risk of harm) Primary health professional‐led psychological interventions vs usual or no care | RR 2.22 [0.23, 21.34] | 4 studies · 1242 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Lay health worker‐led interventions for adult patients with harmful or hazardous alcohol or substance use compared to enhanced usual care in low‐ and middle‐income countries
Population: adult patients with harmful or hazardous alcohol or substance use
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Clinical recovery ‐ harmful or hazardous alcohol use (1 to 6 months post intervention) Lay health worker‐led interventions for adult patients with harmful or hazardous alcohol or substance use vs enhanced usual care | RR 1.28 [0.94, 1.74] | 4 studies · 872 participants | Low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Prevalence of methamphetamine use (1 to 6 months post intervention) (RR < 1 denotes lower prevalence compared to control) Lay health worker‐led interventions for adult patients with harmful or hazardous alcohol or substance use vs enhanced usual care | RR 1.01 [0.91, 1.13] | 1 study · 882 participants | Low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Clinical symptoms ‐ alcohol use (1 to 6 months post intervention) ‐ risk of hazardous or harmful alcohol use Lay health worker‐led interventions for adult patients with harmful or hazardous alcohol or substance use vs enhanced usual care | no estimate extracted | 3 studies · 667 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Clinical symptoms ‐ alcohol and substance use (1 to 6 months post intervention) Lay health worker‐led interventions for adult patients with harmful or hazardous alcohol or substance use vs enhanced usual care | no estimate extracted | 2 studies · 540 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Quality of life Lay health worker‐led interventions for adult patients with harmful or hazardous alcohol or substance use vs enhanced usual care | no estimate extracted | NR | No studies |
Functional impairment (1 to 6 months post intervention) Lay health worker‐led interventions for adult patients with harmful or hazardous alcohol or substance use vs enhanced usual care | no estimate extracted | 2 studies · 498 participants | Low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Service utilisation ‐ unplanned hospitalisations (1 to 6 months post intervention) (RR < 1 denotes lower risk) Lay health worker‐led interventions for adult patients with harmful or hazardous alcohol or substance use vs enhanced usual care | RR 0.9 [0.29, 2.72] | 1 study · 336 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Adverse events ‐ deaths (RR < 1 denotes lower risk) Lay health worker‐led interventions for adult patients with harmful or hazardous alcohol or substance use vs enhanced usual care | RR 0.34 [0.1, 1.18] | 3 studies · 1025 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Primary health professional‐ and community professional‐led interventions compared to enhanced usual care for adult patients with harmful or hazardous alcohol or substance use in low‐ and middle‐income countries
Population: adult patients with harmful or hazardous alcohol or substance use
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Clinical recovery ‐ harmful or hazardous alcohol use (1 to 6 months post intervention) Primary health professional‐ and community professional‐led interventions vs enhanced usual care | RR 0.93 [0.77, 1.12] | 3 studies · 1075 participants | Moderate Downgraded: imprecision, indirectness |
Prevalence of cannabis use (1 to 6 months post intervention) (RR < 1 denotes lower prevalence compared to control) Primary health professional‐ and community professional‐led interventions vs enhanced usual care | RR 1.1 [0.67, 1.8] | 1 study · 152 participants | Very low Downgraded: imprecision, indirectness |
Clinical symptoms ‐ risk of harmful or hazardous drinking (1 to 6 months post intervention) Primary health professional‐ and community professional‐led interventions vs enhanced usual care | no estimate extracted | 3 studies · 1075 participants | Low Downgraded: imprecision, indirectness |
Clinical symptoms ‐ overall risk of harmful or hazardous alcohol and substance use (1 to 6 months post intervention) Primary health professional‐ and community professional‐led interventions vs enhanced usual care | no estimate extracted | 2 studies · 705 participants | Moderate Downgraded: imprecision, indirectness |
Quality of life (1 to 6 months post intervention) Primary health professional‐ and community professional‐led interventions vs enhanced usual care | MD 0 | 1 study · 560 participants | Moderate Downgraded: imprecision, indirectness |
Functional impairment Primary health professional‐ and community professional‐led interventions vs enhanced usual care | no estimate extracted | NR | No studies |
Service utilisation (1 to 6 months post intervention) ‐ incidence of visits to primary care centres due to alcohol consumption (RR > 1 denotes greater risk) Primary health professional‐ and community professional‐led interventions vs enhanced usual care | RR 0 [0.01, 2.5] | 1 study · 107 participants | Very low Downgraded: imprecision, indirectness |
Adverse events (1 to 6 months post intervention) ‐ incidence of alcohol‐related consequences ‐ accidents (RR > 1 denotes greater risk) Primary health professional‐ and community professional‐led interventions vs enhanced usual care | RR 0.23 [0.03, 1.97] | 1 study · 107 participants | Very low Downgraded: imprecision, indirectness |
Lay health worker‐led interventions compared to enhanced usual care for adult patients with alcohol dependence in low‐ and middle‐income countries
Population: adult patients with alcohol dependence
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
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) Lay health worker‐led interventions vs enhanced usual care | RR 1.87 [0.9, 3.9] | 1 study · 121 participants | Very low Downgraded: imprecision, indirectness |
Prevalence of alcohol dependence (1 to 6 months post intervention) Lay health worker‐led interventions vs enhanced usual care | no estimate extracted | NR | No studies |
Clinical symptoms ‐ alcohol use (1 to 6 months post intervention) Lay health worker‐led interventions vs enhanced usual care | no estimate extracted | 1 study · 121 participants | Very low Downgraded: imprecision, indirectness |
Clinical symptoms ‐ depression (1 to 6 months post intervention) Lay health worker‐led interventions vs enhanced usual care | no estimate extracted | 1 study · 121 participants | Very low Downgraded: imprecision, indirectness |
Quality of life Lay health worker‐led interventions vs enhanced usual care | no estimate extracted | NR | No studies |
Functional impairment (1 to 6 months post intervention) Lay health worker‐led interventions vs enhanced usual care | no estimate extracted | 1 study · 121 participants | Very low Downgraded: imprecision, indirectness |
Service utilisation ‐ Unplanned hospitalisation in past 12 months (RR > 1 denotes higher risk of hospitalisation) Lay health worker‐led interventions vs enhanced usual care | RR 0.7 [0.26, 1.88] | 1 study · 112 participants | Very low Downgraded: imprecision, indirectness |
Adverse events ‐ death in past 12 months (RR > 1 denotes higher risk of death) Lay health worker‐led interventions vs enhanced usual care | RR 0.32 [0.01, 7.7] | 1 study · 135 participants | Very low Downgraded: imprecision, indirectness |
Primary health professional‐ and community professional‐led interventions compared to enhanced usual care for adult patients with substance dependence in low‐ and middle‐income countries
Population: adult patients with substance dependence
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Clinical recovery Primary health professional‐ and community professional‐led interventions vs enhanced usual care | no estimate extracted | NR | No studies |
Prevalence of morphine use Primary health professional‐ and community professional‐led interventions vs enhanced usual care | RR 1.06 [0.63, 1.8] | 1 study · 173 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Clinical symptoms ‐ alcohol use (< 1 month post intervention) Primary health professional‐ and community professional‐led interventions vs enhanced usual care | MD 0.1 | 1 study · 155 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Clinical symptoms ‐ drug use (< 1 month post intervention) ‐ heroin Primary health professional‐ and community professional‐led interventions vs enhanced usual care | no estimate extracted | 1 study · 155 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Quality of life (< 1 month post intervention) ‐ social functioning Primary health professional‐ and community professional‐led interventions vs enhanced usual care | 48.36 [41.8, 54.92] | 1 study · 155 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Functional impairment Primary health professional‐ and community professional‐led interventions vs enhanced usual care | no estimate extracted | NR | No studies |
Service utilisation Primary health professional‐ and community professional‐led interventions vs enhanced usual care | no estimate extracted | NR | No studies |
Adverse events Primary health professional‐ and community professional‐led interventions vs enhanced usual care | no estimate extracted | NR | No studies |
Lay health worker‐ compared to specialist‐led care for people with severe mental disorder in low‐ and middle‐income countries
Population: people with severe mental disorder
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Recovery from severe mental disorders Lay health worker‐ vs specialist‐led care | no estimate extracted | NR | No studies |
Prevalence of severe mental disorders Lay health worker‐ vs specialist‐led care | no estimate extracted | NR | No studies |
Schizophrenia symptoms severity ‐ immediately post intervention Assessed by BPRSa; PANSSb (Chatterjee 2014) (higher scores = greater symptom severity) Lay health worker‐ vs specialist‐led care | no estimate extracted | 2 studies · 364 participants | Very low Downgraded: imprecision, inconsistency, indirectness |
Caregiver burden symptom severity ‐ immediately post intervention Assessed by Burden Assessment Schedule (higher scores = higher burden) Lay health worker‐ vs specialist‐led care | no estimate extracted | 1 study · 253 participants | Low Downgraded: imprecision, inconsistency, indirectness |
Quality of life Lay health worker‐ vs specialist‐led care | no estimate extracted | NR | No studies |
Functional impairment ‐ immediately post intervention Assessed by IDEASb; SDSSa (lower scores = less functional impairment) Lay health worker‐ vs specialist‐led care | no estimate extracted | 2 studies · 364 participants | Very low Downgraded: imprecision, inconsistency, indirectness |
Service utilisation ‐ hospitalisation during intervention (RR > 1 denotes greater risk)Â Lay health worker‐ vs specialist‐led care | RR 8.64 [1.17, 63.92] | 1 study · 282 participants | Very low Downgraded: imprecision, inconsistency, indirectness |
Adverse events ‐ death from suicide during intervention (RR > 1 denotes greater risk)Â Lay health worker‐ vs specialist‐led care | RR 0.51 [0.03, 8.03] | 1 study · 282 participants | Very low Downgraded: imprecision, inconsistency, indirectness |
Primary health professional‐led or collaborative care compared to specialist‐led care for people with severe mental disorder in low‐ and middle‐income countries
Population: people with severe mental disorder
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Clinical recovery from severe mental disorder (immediately post intervention) Defined by BPRS decreased by ≥ 80% (RR > 1 denotes greater likelihood of recovery) Primary health professional‐led or collaborative care vs specialist‐led care | RR 1.08 [0.81, 1.44] | 1 study · 76 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
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,... Primary health professional‐led or collaborative care vs specialist‐led care | RR 0.3 [0.16, 0.55] | 4 studies · 492 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Prevalence of severe mental disorder Primary health professional‐led or collaborative care vs specialist‐led care | no estimate extracted | NR | No studies |
Schizophrenia symptoms severity (immediately post intervention) Primary health professional‐led or collaborative care vs specialist‐led care | no estimate extracted | 6 studies · 836 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Depression symptom severity (immediately post intervention) Primary health professional‐led or collaborative care vs specialist‐led care | no estimate extracted | 2 studies · 270 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Quality of life (immediately post intervention) Primary health professional‐led or collaborative care vs specialist‐led care | no estimate extracted | 3 studies · 536 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Functional impairment ‐ immediately post intervention Primary health professional‐led or collaborative care vs specialist‐led care | no estimate extracted | 7 studies · 874 participants | Low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Service utilisation ‐ hospital re‐admission (during intervention) (RR > 1 denotes greater risk) Primary health professional‐led or collaborative care vs specialist‐led care | RR 0.6 [0.28, 1.28] | 3 studies · 441 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Adverse events Primary health professional‐led or collaborative care vs specialist‐led care | no estimate extracted | NR | No studies |
Primary health professionals and lay health workers compared with usual care in improving dementia patients' and carers' outcomes in low‐ and middle‐income countries
Population: people with dementia and their carers
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Clinical illness recovery Primary health professionals and lay health workers vs usual care | no estimate extracted | NR | No studies |
Disease prevalence Primary health professionals and lay health workers vs usual care | no estimate extracted | NR | No studies |
Severity of behavioural symptoms (patient) (1 to 6 months post intervention)Measured using the behavioural symptom scale (NPI‐S) (high score = greater severity) Primary health professionals and lay health workers vs usual care | no estimate extracted | 2 studies · 134 participants | Low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Severity of mental distress (carer) (1 to 6 months post intervention) Neuropsychiatric Interview for dementia (higher score = better quality of life) Primary health professionals and lay health workers vs usual care | no estimate extracted | 2 studies · 134 participants | Low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Quality of life (patient) (1 to 6 months post intervention) DEMQOL (higher score = better quality of life) Primary health professionals and lay health workers vs usual care | no estimate extracted | 1 study · 53 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Quality of life (carer) (1 to 6 months post intervention) WHOQOL‐BREF (higher score = better quality of life) Primary health professionals and lay health workers vs usual care | no estimate extracted | 1 study · 53 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Functional impairment (patient) (1 to 6 months post intervention) EASI (higher score = higher impairment in activities of daily living) Primary health professionals and lay health workers vs usual care | no estimate extracted | 1 study · 81 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Service utilisation ‐ home visits by LHW and psychiatrist (during intervention) Primary health professionals and lay health workers vs usual care | no estimate extracted | 1 study · 81 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Adverse events ‐ number of deaths (during intervention) Â Primary health professionals and lay health workers vs usual care | no estimate extracted | 2 studies · 141 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Lay health worker‐led psychosocial interventions vs usual or no care in treating children with post‐traumatic stress and common mental disorders in humanitarian settings in low‐ and middle‐income countries
Population: children/adolescents with post‐traumatic stress and related depressive/anxiety symptoms
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Depression or PTSD recovery Lay health worker‐led psychosocial interventions vs usual or no care | no estimate extracted | NR | No studies |
Disease prevalence Lay health worker‐led psychosocial interventions vs usual or no care | no estimate extracted | NR | No studies |
Depression symptoms (1 to 6 months post intervention) Depression self‐rating scale (higher score = higher severity) Lay health worker‐led psychosocial interventions vs usual or no care | no estimate extracted | 3 studies · 1092 participants | Moderate Downgraded: imprecision, inconsistency, indirectness |
PTS symptoms (1 to 6 months post intervention) Child post‐traumatic stress scale (higher score = higher severity) Lay health worker‐led psychosocial interventions vs usual or no care | no estimate extracted | 3 studies · 1090 participants | Low Downgraded: imprecision, inconsistency, indirectness |
Quality of life Lay health worker‐led psychosocial interventions vs usual or no care | no estimate extracted | NR | No studies |
Functional impairment (1 to 6 months post intervention) Locally developed functional scale (higher score = higher impairment) Lay health worker‐led psychosocial interventions vs usual or no care | no estimate extracted | 3 studies · 1092 participants | Moderate Downgraded: imprecision, inconsistency, indirectness |
Service utilisation Lay health worker‐led psychosocial interventions vs usual or no care | no estimate extracted | NR | No studies |
Adverse events (during intervention) Lay health worker‐led psychosocial interventions vs usual or no care | no estimate extracted | 3 studies · 809 participants | Low Downgraded: imprecision, inconsistency, indirectness |
Community professional‐led interventions vs no care in treating children with post‐traumatic stress and common mental disorders in humanitarian settings in low‐ and middle‐income countries
Population: children/adolescents with post‐traumatic stress and related depressive/anxiety symptoms
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
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 ... Community professional‐led interventions vs no care | RR 3.93 [1.31, 11.8] | 1 study · 78 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Prevalence of PTSD Community professional‐led interventions vs no care | no estimate extracted | NR | No studies |
PTS symptoms (1 to 6 months post intervention) Harvard Trauma Questionnairec; PTSD‐RId; UCLA PTSD indexe (higher score = higher severity) Community professional‐led interventions vs no care | no estimate extracted | 3 studies · 679 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Depression symptoms (1 to 6 months post intervention) Beck Depression Inventorye; Oxford Measure of Psychosocial Adjustmentd (higher score = higher severity) Community professional‐led interventions vs no care | no estimate extracted | 2 studies · 602 participants | Low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Quality of life Community professional‐led interventions vs no care | no estimate extracted | NR | No studies |
Functional impairment (1 to 6 months post intervention) Child diagnostic interview schedulee; WHODAS IId (higher score = higher functional impairment) Community professional‐led interventions vs no care | no estimate extracted | 2 studies · 602 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Service utilisation Community professional‐led interventions vs no care | no estimate extracted | NR | No studies |
Adverse events (during intervention)Â Community professional‐led interventions vs no care | no estimate extracted | 3 studies · 180 participants | Low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
NSHW‐led psychological interventions compared with usual care in treating depression in adults in low‐ and middle‐income countries (RCTs)
Population: Adults with depression
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Prevalence of depression (adults), short term (0‐8 weeks) measured using various depression rating scales1 NSHW‐led psychological interventions vs usual care | no estimate extracted | 3 studies · 1082 participants | Low Downgraded: risk of bias, inconsistency |
Collaborative care model (NSHWs plus specialist) compared with usual care in treating common mental disorders in adults in low‐ and middle‐income countries (RCTs)
Population: Adults (≥ 18 years) with CMDs (includes anxiety or depression, or both)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Prevalence of CMDs, short term (2‐6 months) measured using various CMD/depression rating scales1 Collaborative care model (NSHWs plus specialist) vs usual care | no estimate extracted | 3 studies · 2380 participants | Low Downgraded: risk of bias, inconsistency |
NSHWs compared with usual care for treating maternal depression (RCTs)
Population: Adult women with maternal depression
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Severity of symptoms of perinatal depression, (short and medium term: 0‐12 months) measured using various depression rating scales1 NSHWs vs usual care | no estimate extracted | 4 studies · 1213 participants | Low Downgraded: risk of bias, imprecision |
NSHWs compared with specialists in treating depression in adults in low‐ and middle‐income countries (CBAs)
Population: Adults with depression
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Severity of depression, short term (0‐56 days) measured using HDRS NSHWs vs specialists | no estimate extracted | 1 study · 768 participants | Very low Downgraded: risk of bias |
NSHW‐led psychological interventions compared with usual care in treating adults with PTSD (NRCT)
Population: Adults with PTSD
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Severity of PTSD symptoms in LHW/teacher‐led psychological interventions (trauma counselling, workshop with psychoeducation, mother intervention) in the short term (2 weeks to 6 months) measured using various PTSD symptom scales1 NSHW‐led psychological interventions vs usual care | no estimate extracted | 3 studies · 223 participants | Low Downgraded: risk of bias, imprecision |
NSHWs compared with usual care in improving dementia patients' and carers' outcomes in low‐ and middle‐income countries (RCTs)
Population: People with dementia and their carers
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Severity of patient behavioural problems, short term (6 months) measured using the behavioural symptom scale (NPI‐S) NSHWs vs usual care | no estimate extracted | 2 studies · 134 participants | Moderate Downgraded: risk of bias, imprecision |
NSHW‐led brief alcohol interventions compared with usual care for adults with alcohol‐use disorders (RCTs)
Population: People with alcohol‐use disorders
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Amount of alcohol consumed, short term (3‐6 months) measured using the number of drinks/drinking day (in past week to 30 days) NSHW‐led brief alcohol interventions vs usual care | no estimate extracted | 2 studies · 167 participants | Low Downgraded: risk of bias, imprecision |
NSHWs/OPHRs compared with usual care in conducting interventions for children with post‐traumatic stress disorder and depression (RCTs)
Population: Children/adolescents with PTSD and related depressive/anxiety symptoms
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Severity of PTSD symptoms in LHW/teacher‐led interventions, short term (1‐6 months) measured using various PTSD severity of symptom scales1 NSHWs/OPHRs vs usual care | no estimate extracted | 3 studies · 298 participants | Very low Downgraded: risk of bias, inconsistency |