TY - JOUR
T1 - Association of Task-Shared Psychological Interventions with Depression Outcomes in Low- and Middle-Income Countries
T2 - A Systematic Review and Individual Patient Data Meta-analysis
AU - Karyotaki, Eirini
AU - Araya, Ricardo
AU - Kessler, Ronald C.
AU - Waqas, Ahmed
AU - Bhana, Arvin
AU - Rahman, Atif
AU - Matsuzaka, Camila T.
AU - Miguel, Clara
AU - Lund, Crick
AU - Garman, Emily C.
AU - Nakimuli-Mpungu, Etheldreda
AU - Petersen, Inge
AU - Naslund, John A.
AU - Schneider, Marguerite
AU - Sikander, Siham
AU - Jordans, Mark J.D.
AU - Abas, Melanie
AU - Slade, Pauline
AU - Walters, Stephen
AU - Brugha, Traolach S.
AU - Furukawa, Toshi A.
AU - Amanvermez, Yagmur
AU - Mello, Marcelo F.
AU - Wainberg, Milton L.
AU - Cuijpers, Pim
AU - Patel, Vikram
N1 - Funding Information:
reported consultant fees from Datastat, Holmusk, RallyPoint Networks, and Sage Therapeutics and stock options from Mirah, PYM, and Roga Sciences during the conduct of the study. Dr Schneider reported a grant from the National Institute of Mental Health (NIMH) for the AFFIRM project during the conduct of the study. Dr Abas reported grants from NIMH during the conduct of the study. Dr Furukawa reported personal fees and/or grants from Mitsubishi-Tanabe, Shionogi, and Sony outside the submitted work; in addition, Dr Furukawa had a patent pending for 2018-177688 and a patent for copyrights licensed to Mitsubishi-Tanabe. Dr Wainberg reported grants from NIMH during the conduct of the study. No other disclosures were reported.
Funding Information:
Funding/Support: Dr Karyotaki was supported by the Netherlands Organization for Health Research and Development (019.182SG.001).
Publisher Copyright:
© 2022 American Medical Association. All rights reserved.
PY - 2022/5
Y1 - 2022/5
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=85127682044&partnerID=8YFLogxK
U2 - 10.1001/jamapsychiatry.2022.0301
DO - 10.1001/jamapsychiatry.2022.0301
M3 - Article
C2 - 35319740
AN - SCOPUS:85127682044
SN - 2168-622X
VL - 79
SP - 430
EP - 443
JO - JAMA Psychiatry
JF - JAMA Psychiatry
IS - 5
ER -
