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- Title
Association of Task-Shared Psychological Interventions With Depression Outcomes in Low- and Middle-Income Countries: A Systematic Review and Individual Patient Data Meta-analysis.
- Authors
Karyotaki, Eirini; Araya, Ricardo; Kessler, Ronald C.; Waqas, Ahmed; Bhana, Arvin; Rahman, Atif; Matsuzaka, Camila T.; Miguel, Clara; Lund, Crick; Garman, Emily C.; Nakimuli-Mpungu, Etheldreda; Petersen, Inge; Naslund, John A.; Schneider, Marguerite; Sikander, Siham; Jordans, Mark J. D.; Abas, Melanie; Slade, Pauline; Walters, Stephen; Brugha, Traolach S.
- Abstract
This systematic review and meta-analysis examines data for the outcomes and moderators of task-shared psychological interventions associated with depression in low- and middle-income countries. Key Points: Question: What are the depression outcomes and moderators associated with task-shared psychological interventions, ie, those delivered by nonspecialist workers, in low- and middle-income countries (LMICs)? Findings: This systematic review and individual patient data meta-analysis showed that task-shared psychological interventions were associated with significantly larger reduction in depression severity and enhanced response and remission rates compared with control conditions. These outcomes were associated with the presence of psychomotor symptoms, while no other significant associations were identified. Meaning: The present findings underscore the need for scaling up interventions that use task sharing to reduce the burden of depression in LMICs. Importance: Task sharing, the training of nonspecialist workers with no formal experience in counseling, is a promising strategy for addressing the large gap in treatment for depression in low- and middle-income countries (LMICs). Objective: To examine the outcomes and moderators of task-shared psychological interventions associated with depression severity, response, and remission. Data Sources: Systematic literature searches in PubMed, Embase, PsycINFO, and Cochrane Library up to January 1, 2021. Study Selection: Randomized clinical trials (RCTs) of task-shared psychological interventions compared with control conditions for adults with depressive symptoms in LMICs were included. Data Extraction and Synthesis: Two researchers independently reviewed the titles, abstracts, and full text of articles from an existing generic meta-analytic database that includes all RCTs on psychotherapy for depression. A systematic review and individual patient data (IPD) meta-analysis was used to estimate the outcomes of task-shared psychological interventions across patient characteristics using mixed-effects models. Procedures for abstracting data and assessing data quality and validity followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guideline. Main Outcomes and Measures: Primary outcome was reduction in depression symptom severity measured by the 9-item Patient Health Questionnaire (PHQ-9). Response and remission rates were also estimated. Results: Of 13 eligible trials, 11 (4145 participants) contributed IPD. Task-shared psychological interventions were associated with a greater decrease in depressive symptom severity than control conditions (Hedges g, 0.32; 95% CI, –0.26 to –0.38). Participants in the intervention groups had a higher chance of responding (odds ratio, 2.11; 95% CI, 1.60 to 2.80) and remitting (odds ratio, 1.87; 95% CI, 1.20 to 1.99). The presence of psychomotor symptoms was significantly associated with the outcomes of task-shared psychological interventions (β [SE], –1.21 [0.39]; P =.002). No other significant associations were identified. Heterogeneity among the trials with IPD was 74% (95% CI, 53%-86%). Conclusions and Relevance: In this meta-analysis of IPD, task-shared psychological interventions were associated with a larger reduction in depressive symptom severity and a greater chance of response and remission than control conditions. These findings show potential for the use of task-sharing of psychological interventions across different groups of patients with depression. Further research would help identify which people are most likely to benefit and strengthen larger-scale implementation of this strategy to address the burden of depression in LMICs.
- Publication
JAMA Psychiatry, 2022, Vol 79, Issue 5, p430
- ISSN
2168-622X
- Publication type
Article
- DOI
10.1001/jamapsychiatry.2022.0301