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

Background Community-based primary-level workers (PWs) are an important strategy for addressing gaps in mental health service delivery in low- and middle-income countries. Objectives To evaluate the e)ectiveness of PW-led treatments for persons with mental health symptoms in LMICs, compared to usual care. Search methods MEDLINE, Embase, CENTRAL, ClinicalTrials.gov, ICTRP, reference lists (to 20 June 2019). Selection criteria Randomised trials of PW-led or collaborative-care interventions treating people with mental health symptoms or their carers in LMICs. PWs included: primary health professionals (PHPs), lay health workers (LHWs), community non-health professionals (CPs). Data collection and analysis Seven conditions were identified apriori and analysed by disorder and PW examining recovery, prevalence, symptom change, quality-oflife (QOL), functioning, service use (SU), and adverse events (AEs). Risk ratios (RRs) were used for dichotomous outcomes; mean di)erence (MDs), standardised mean di)erences (SMDs), or mean change di)erences (MCDs) for continuous outcomes. For SMDs, 0.20 to 0.49 represented small, 0.50 to 0.79 moderate, and O0.80 large clinical e)ects. Analysis timepoints: T1 (<1 month), T2 (1-6 months), T3 ( >6 months) post-intervention. Main results Description of studies 95 trials (72 new since 2013) from 30 LMICs (25 trials from 13 LICs). Risk of bias Most common: detection bias, attrition bias (e)icacy), insu)icient protection against contamination. Intervention e ects *Unless indicated, comparisons were usual care at T2. Probably, may, or uncertain indicates moderate, low, or very low certainty evidence.

Automated summary

This study aimed to evaluate the effectiveness of primary-level workers in treating individuals with mental health symptoms in low- and middle-income countries. The results suggest that this intervention may have a moderate impact on improving patients’ quality of life, functioning, and service use.