Common mental disorders, including depression, anxiety, and posttraumatic stress, are leading causes of disability worldwide. Treatment for these disorders is limited in low- and middle-income countries. This systematic review synthesizes the implementation processes and examines the effectiveness of psychological treatments for common mental disorders in adults delivered by nonspecialist providers in low- and middle-income countries. In total, 27 trials met the eligibility criteria; most treatments targeted depression or posttraumatic stress. Treatments were commonly delivered by community health workers or peers in primary care or community settings; they usually were delivered with fewer than 10 sessions over 2-3 months in an individual, face-to-face format. Treatments included common elements, such as nonspecific engagement and specific domains of behavioral, interpersonal, emotional, and cognitive elements. The pooled effect size was 0.49 (95% confidence interval = 0.36-0.62), favoring intervention conditions. Our review demonstrates that psychological treatments-comprising a parsimonious set of common elements and delivered by a low-cost, widely available human resource-have moderate to strong effects in reducing the burden of common mental disorders.

Psychological Treatments for the World: Lessons from Low- and Middle-Income Countries

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(11)61094-5.pdf

Mental health and psychosocial support in humanitarian settings: Linking practice and research

Background: In developing countries, most people with mental, neurological and substance-abuse (MNS) disorders do not receive adequate care mainly because of a lack of mental health professionals. Non-specialist health workers, but also other professionals with health roles, such as teachers, may therefore have an important role to play in delivering MNS health care. Researchers in The Cochrane Collaboration carried out a review of the effects of using non-specialist health workers or other professionals with health roles to help people with MNS disorders in developing countries. After searching for all relevant studies in scientific databases, they found 38 studies published before October 2012. Their findings are summarised below. What is a non-specialist health worker? Any type of health worker (like a doctor, nurse or lay health worker) who is not a specialist in mental health or neurology but who may have had some training in these fields. We also looked at teachers, as they can be particularly important in the care of children and youths. What the research says: The studies in this review were from 22 developing countries. In most studies, lay health workers delivered the mental health care, and addressed depression or anxiety (or both), or post-traumatic stress disorder. The review shows that the use of non-specialist health workers, compared with usual healthcare services: Â· may increase the number of adults who recover from depression or anxiety (or both) two to six months after treatment; Â· may slightly reduce symptoms formothers with depression; Â· may slightly reduce the symptoms of adults with post-traumatic stress disorder (non-specialists and teachers were used in one study); Â· probably slightly improves the symptoms of people with dementia; Â· probably improves/slightly improves the mental well-being, burden and distress of carers of people with dementia; Â· may decrease the quantity of alcohol consumed by problem drinkers. It is uncertain whether lay health workers or teachers reducepost-traumatic stress disorder symptoms among children. There were too few studies to draw any conclusions about the cost-effectiveness of using non-specialist health workers or teachers, or about their impact on people with other MNS conditions such as epilepsy, schizophrenia, and alcohol and drug abuse problems. In addition, very few studies measured unintended consequences of non-specialist health worker-led care - such effects could impact on the appropriateness and quality of care. Quality of the evidence: Overall, non-specialist health workers and teachers have some promising benefits in improving people's outcomes for general and perinatal depression, post-traumatic stress disorder and alcohol-use disorders, and patient and carer outcomes for dementia. However, this evidence is of low or very low quality in some areas, and for some issues no evidence is available. Therefore, we cannot make conclusions about which specific interventions using non-specialist health workers to help people with MNS disorders are more effective.

/pdf/non-specialist-health-worker-interventions-for-the-care-of-4p2djvvv9r.pdf

Non-specialist health worker interventions for the care of mental, neurological and substance-abuse disorders in low- and middle-income countries.

Purpose: This systematic review examines research and practical applications of the World Health Organization Disability Assessment Schedule (WHODAS 2.0) as a basis for establishing specific criter...

World Health Organization disability assessment schedule 2.0: An international systematic review

https://dukespace.lib.duke.edu/dspace/bitstream/handle/10161/10953/Kaiser%20et%20al_2015_SocialScienceMedicine_Thinking%20Too%20Much%20Systematic%20Review.pdf?sequence=1

“Thinking too much”: A systematic review of a common idiom of distress

War and conflict have consequences on the mental health of individuals and entire communities and the communities in Aceh, Indonesia, having experienced more than 30 years of armed conflict, are no exception. This study presents results from an evaluation of a non-specific mental health group counseling program among adults affected by conflict. Interventions such as these need to be evaluated to further the limited empirical evidence base for efficacious community-based treatments for improving the mental health and psychosocial problems in humanitarian settings. A total of 589 adults were screened using a locally validated measure of mental health and functioning. Of all, 420 (71%) met the study inclusion criteria of elevated symptom levels and functional impairment: 214 and 206 in three intervention and three control villages, respectively. Intervention participants met weekly for eight sessions in groups of eight to ten adults. Following completion of treatment, 175 (85%) controls and 158 (74%) intervention participants were re-assessed. Regression analyses compared pre- and post-intervention scale scores. We did not find an intervention effect for reducing the burden of depression and anxiety symptoms when compared with the control sample. Impact on functioning was mixed and there was an increase in use of positive coping strategies. The lack of mental health impact may be because the mental health problems and dysfunction were not due to disorder, but were normal responses to struggles of daily living experienced by this community and not addressed by the intervention.

A controlled trial of problem-solving counseling for war-affected adults in Aceh, Indonesia.

This research describes the development and findings of a literature review and analysis meant to inform the international torture and trauma treatment community. The review focuses on interventions that have been used among populations affected by torture, based on a review of journals indexed in commonly used search engines. Work on the review began in September 2008 and continued to be updated until March 2014. In total, 88 studies of interventions for torture victims were identified. Studies ranged from randomized controlled trials utilizing evidence-based treatments to case studies employing non-structured, supportive therapies. Based on the results of the analysis, we have included recommendations for interventions that demonstrate effectiveness in treating survivors of torture and other systematic violence who suffer from PTSD, depression, and anxiety.  Priorities for mental health research for survivors of torture and other systematic violence are also recommended.

https://tidsskrift.dk/torture-journal/article/download/108061/157487

Maya Nadison

Papers

A controlled trial of problem-solving counseling for war-affected adults in Aceh, Indonesia.

Mental health interventions and priorities for research for adult survivors of torture and systematic violence: a review of the literature.