Primary-level worker interventions for people living with mental health disorders or distress in low- and middle-income countries
Citation: Van Ginneken N, Chin W, Lim Y, et al. Primary-level worker interventions for the care of people living with mental disorders and distress in low- and middle-income countries. Cochrane Database of Systematic Reviews. 2021;(8):CD009149. Podcast available in EN.
Language: Abstract available in EN / ES / FR / KO. Plain language summary available in EN / ES / FR / JA / KO / MS / ZH. Full text available in EN.
Free to view: Yes.
Funding sources: Norwegian Agency for Development Cooperation (Norad); Indian Council of Medical Research; Wellcome Trust, UK; and UKaid (Department of International Development), UK.
What is this? Community based healthcare delivered by primary-level workers is becoming a preferred approach to increase access to public health services, especially for people with mental health disorders in low- and middle-income countries (LMICs). This may help with the development of resilient health systems.
In this Cochrane review, the authors searched for randomised trials of mental health treatments delivered by trained primary-level workers to people with mental distress or mental health disorders in LMICs. They did not restrict their searches by date or language of publication and did the search on 20 August 2020. They included 67 individual randomised trials and 28 cluster randomised trials. They also identified an additional 50 ongoing studies and 16 articles which are awaiting assessment. Audio podcasts are available here[https://www.cochrane.org/podcasts/10.1002/14651858.CD009149.pub3].
What works: Interventions from lay healthcare workers may increase recovery, decrease the number of people with depression or anxiety, improve day-to-day functioning, improve quality of life and reduce the risk of suicidal thoughts.
In women with depression related to pregnancy and childbirth, treatments from lay healthcare workers may increase recovery, possibly reduce symptoms of depression and slightly improve day-to-day functioning.
In adults with dementia, interventions led by primary-level workers may reduce carers’ mental distress.
Interventions led by lay healthcare workers may help recuperation from harmful/hazardous alcohol use and substance abuse in adults.
What doesn’t work: Nothing noted.
What is uncertain: The effects of interventions led by lay healthcare workers on service use, adverse events, symptoms of post-traumatic stress disorder in adults and quality of life in adults with dementia are uncertain.
Implications: The authors of the review concluded that the included studies suggest that primary‐level workers delivering interventions for the care of individuals with mental health disorders and distress have some impact on patient outcomes, although most of the evidence is of low certainty. They stated that there is a need to develop a comprehensive typology for primary-level workers and the interventions they provide, which would help policy makers and future researchers to develop more standardised and comparable interventions and situations.
Other considerations: The authors of the review discussed their findings in the context of place of residence, occupation and gender/sex.
This summary was prepared by Ana Pizarro and edited and finalized by Mike Clarke.