Intervention Review

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

  1. Nadja van Ginneken1,2,*,
  2. Prathap Tharyan3,
  3. Simon Lewin4,5,
  4. Girish N Rao6,
  5. SM Meera2,
  6. Jessica Pian7,
  7. Sudha Chandrashekar7,8,
  8. Vikram Patel1,2

Editorial Group: Cochrane Effective Practice and Organisation of Care Group

Published Online: 19 NOV 2013

Assessed as up-to-date: 2 OCT 2012

DOI: 10.1002/14651858.CD009149.pub2


How to Cite

van Ginneken N, Tharyan P, Lewin S, Rao GN, Meera SM, Pian J, Chandrashekar S, Patel V. Non-specialist health worker interventions for the care of mental, neurological and substance-abuse disorders in low- and middle-income countries. Cochrane Database of Systematic Reviews 2013, Issue 11. Art. No.: CD009149. DOI: 10.1002/14651858.CD009149.pub2.

Author Information

  1. 1

    London School of Hygiene & Tropical Medicine, Centre for Global Mental Health, London, UK

  2. 2

    Sangath, Goa, India

  3. 3

    Christian Medical College, South Asian Cochrane Network & Centre, Prof. BV Moses & ICMR Advanced Centre for Research & Training in Evidence Informed Health Care, Vellore, Tamil Nadu, India

  4. 4

    Norwegian Knowledge Centre for the Health Services, Global Health Unit, Oslo, Norway

  5. 5

    Medical Research Council of South Africa, Health Systems Research Unit, Tygerberg, South Africa

  6. 6

    National Institute of Mental Health and Neuro Sciences, Department of Epidemiology, Bangalore, Karnataka, India

  7. 7

    London School of Hygiene & Tropical Medicine, London, UK

  8. 8

    St. Johns Research Institute, Bangalore, India

*Nadja van Ginneken, Centre for Global Mental Health, London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT, UK. nadja.vanginneken@lshtm.ac.uk. nvanginneken@yahoo.co.uk.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 19 NOV 2013

SEARCH

[Figure 1]
Figure 1. Study flow diagram.
[Figure 2]
Figure 2. Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
[Figure 3]
Figure 3. Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
[Figure 4]
Figure 4. Forest plot of comparison: 1 NSHW-led psychological interventions versus usual care in treating CMDs in adults (RCTs), outcome: 1.1 Prevalence of depression (adults) (completers).
[Figure 5]
Figure 5. Forest plot of comparison: 1 NSHW-led psychological interventions versus usual care in treating common mental disorders in adults (RCTs), outcome: 1.6 Severity of common mental disorder symptoms (includes anxiety and depression).
[Figure 6]
Figure 6. Forest plot of comparison: 2 Collaborative care model (NSHWs plus specialist) versus usual care in treating common mental disorders (CMD) (RCTs), outcome: 2.1 Prevalence of common mental disorders (CMDs - includes anxiety and depression) (completers combined) all facilities and in public and private facilities.
[Figure 7]
Figure 7. Forest plot of comparison: 2 Collaborative care model (NSHWs plus specialist) versus usual care in treating common mental disorders (RCTs), outcome: 2.2 Severity of symptoms of common mental disorders (completers combined) in all facilities and in public and private facilities.
[Figure 8]
Figure 8. Forest plot of comparison: 3 NSHWs versus usual care in treating maternal depression (RCTs), outcome: 3.1 Severity of symptoms in treating maternal depression.
[Figure 9]
Figure 9. Forest plot of comparison: 5 NSHW-led psychological interventions versus usual care in treating adults with post-traumatic stress disorder (RCT and NRCT), outcome: 5.1 Prevalence of post-traumatic stress disorder (PTSD).
[Figure 10]
Figure 10. Forest plot of comparison: 5 NSHW-led psychological interventions versus usual care in treating adults with PTSD (RCT and NRCT), outcome: 5.2 Severity of PTSD symptoms (N = completers).
[Figure 11]
Figure 11. Forest plot of comparison: 6 NSHWs versus usual care in improving dementia patients' and carers' outcomes (RCTs), outcome: 6.1 Severity of behavioural problem (patient).
[Figure 12]
Figure 12. Forest plot of comparison: 6 NSHWs versus usual care in improving dementia patients' and carers' outcomes (RCTs), outcome: 6.5 Carer burden.
[Figure 13]
Figure 13. Forest plot of comparison: 7 NSHW-led brief alcohol interventions versus usual care for adults with alcohol-use disorders (RCTs), outcome: 7.1 Amount of alcohol consumed (MD).
[Figure 14]
Figure 14. Forest plot of comparison: 9 NSHWs/OPHRs versus usual care in conducting interventions for children with PTSD (RCTs), outcome: 9.3 Severity of PTSD symptoms - teacher-led interventions (children) (MDs).
[Analysis 1.1]
Analysis 1.1. Comparison 1 NSHW-led psychological interventions versus usual care in treating common mental disorders in adults (RCTs), Outcome 1 Prevalence of depression (completers).
[Analysis 1.2]
Analysis 1.2. Comparison 1 NSHW-led psychological interventions versus usual care in treating common mental disorders in adults (RCTs), Outcome 2 Prevalence of depression (ITT sensitivity analysis - assumption non-completers depressed).
[Analysis 1.3]
Analysis 1.3. Comparison 1 NSHW-led psychological interventions versus usual care in treating common mental disorders in adults (RCTs), Outcome 3 Prevalence of depression (ITT sensitivity analysis - assumption non-completers not depressed).
[Analysis 1.4]
Analysis 1.4. Comparison 1 NSHW-led psychological interventions versus usual care in treating common mental disorders in adults (RCTs), Outcome 4 Prevalence of depression (ITT sensitivity analysis - worse-case scenario intervention group depressed; control group not depressed).
[Analysis 1.5]
Analysis 1.5. Comparison 1 NSHW-led psychological interventions versus usual care in treating common mental disorders in adults (RCTs), Outcome 5 Prevalence of depression (ITT sensitivity analysis - best-case scenario: intervention group not depressed; control group all depressed).
[Analysis 1.6]
Analysis 1.6. Comparison 1 NSHW-led psychological interventions versus usual care in treating common mental disorders in adults (RCTs), Outcome 6 Severity of common mental disorder symptoms (includes anxiety and depression).
[Analysis 1.7]
Analysis 1.7. Comparison 1 NSHW-led psychological interventions versus usual care in treating common mental disorders in adults (RCTs), Outcome 7 Functional impairment/disability in common mental disorders.
[Analysis 2.1]
Analysis 2.1. Comparison 2 Collaborative care model (NSHWs plus specialist) versus usual care in treating common mental disorders (RCTs), Outcome 1 Prevalence of common mental disorders (CMDs - includes anxiety and depression) (completers-combined) all facilities and in public and private facilities.
[Analysis 2.2]
Analysis 2.2. Comparison 2 Collaborative care model (NSHWs plus specialist) versus usual care in treating common mental disorders (RCTs), Outcome 2 Severity of symptoms of CMDs (completers-combined) in all facilities and in public and private facilities.
[Analysis 2.3]
Analysis 2.3. Comparison 2 Collaborative care model (NSHWs plus specialist) versus usual care in treating common mental disorders (RCTs), Outcome 3 Functional impairment/disability in CMD (completers- combined) all facilities and in public and private facilities (SMD).
[Analysis 2.4]
Analysis 2.4. Comparison 2 Collaborative care model (NSHWs plus specialist) versus usual care in treating common mental disorders (RCTs), Outcome 4 Suicide attempt for those with CMDs all facilities and in public/private facilities (completers).
[Analysis 2.5]
Analysis 2.5. Comparison 2 Collaborative care model (NSHWs plus specialist) versus usual care in treating common mental disorders (RCTs), Outcome 5 Prevalence of CMDs (only Patel - sensitivity analysis (SA)) (completers) all facilities and in public and private facilities.
[Analysis 2.6]
Analysis 2.6. Comparison 2 Collaborative care model (NSHWs plus specialist) versus usual care in treating common mental disorders (RCTs), Outcome 6 Severity of symptoms in CMD (only Patel and Jenkins (SA)) in all facilities and in public and private facilities.
[Analysis 2.7]
Analysis 2.7. Comparison 2 Collaborative care model (NSHWs plus specialist) versus usual care in treating common mental disorders (RCTs), Outcome 7 Prevalence of depression (completers) (SA) all facilities and in public and private facilities.
[Analysis 2.8]
Analysis 2.8. Comparison 2 Collaborative care model (NSHWs plus specialist) versus usual care in treating common mental disorders (RCTs), Outcome 8 Severity of symptoms of depression (SA) in all facilities and in public and private facilities.
[Analysis 2.9]
Analysis 2.9. Comparison 2 Collaborative care model (NSHWs plus specialist) versus usual care in treating common mental disorders (RCTs), Outcome 9 Functional impairment/disability in CMD (SA) all facilities and in public and private facilities (SMD).
[Analysis 2.10]
Analysis 2.10. Comparison 2 Collaborative care model (NSHWs plus specialist) versus usual care in treating common mental disorders (RCTs), Outcome 10 Functional impairment/disability in CMD (SA) all facilities and in public and private facilities (MD).
[Analysis 2.11]
Analysis 2.11. Comparison 2 Collaborative care model (NSHWs plus specialist) versus usual care in treating common mental disorders (RCTs), Outcome 11 Functional impairment/disability in depression (SA) all facilities and in public and private facilities.
[Analysis 3.1]
Analysis 3.1. Comparison 3 NSHWs versus usual care in treating maternal depression (RCTs), Outcome 1 Severity of symptoms in treating maternal depression.
[Analysis 4.1]
Analysis 4.1. Comparison 4 NSHWs versus specialists in treating depression in adults (controlled before-and-after studies), Outcome 1 Severity of depression short term (2 months post intervention).
[Analysis 4.2]
Analysis 4.2. Comparison 4 NSHWs versus specialists in treating depression in adults (controlled before-and-after studies), Outcome 2 Frequency of adverse events.
[Analysis 4.3]
Analysis 4.3. Comparison 4 NSHWs versus specialists in treating depression in adults (controlled before-and-after studies), Outcome 3 Number of days spent in hospital.
[Analysis 4.4]
Analysis 4.4. Comparison 4 NSHWs versus specialists in treating depression in adults (controlled before-and-after studies), Outcome 4 Number of days spent on sick leave.
[Analysis 5.1]
Analysis 5.1. Comparison 5 NSHW-led psychological interventions versus usual care in treating adults with post-traumatic stress disorder (RCT and NRCT), Outcome 1 Prevalence of post-traumatic stress disorder (PTSD).
[Analysis 5.2]
Analysis 5.2. Comparison 5 NSHW-led psychological interventions versus usual care in treating adults with post-traumatic stress disorder (RCT and NRCT), Outcome 2 Severity of PTSD symptoms.
[Analysis 5.3]
Analysis 5.3. Comparison 5 NSHW-led psychological interventions versus usual care in treating adults with post-traumatic stress disorder (RCT and NRCT), Outcome 3 Severity of depression.
[Analysis 6.1]
Analysis 6.1. Comparison 6 NSHWs versus usual care in improving dementia patients' and carers' outcomes (RCTs), Outcome 1 Severity of behavioural problem (patient).
[Analysis 6.2]
Analysis 6.2. Comparison 6 NSHWs versus usual care in improving dementia patients' and carers' outcomes (RCTs), Outcome 2 Patient functional ability.
[Analysis 6.3]
Analysis 6.3. Comparison 6 NSHWs versus usual care in improving dementia patients' and carers' outcomes (RCTs), Outcome 3 Patient quality of life.
[Analysis 6.4]
Analysis 6.4. Comparison 6 NSHWs versus usual care in improving dementia patients' and carers' outcomes (RCTs), Outcome 4 Carer mental health status.
[Analysis 6.5]
Analysis 6.5. Comparison 6 NSHWs versus usual care in improving dementia patients' and carers' outcomes (RCTs), Outcome 5 Carer burden.
[Analysis 6.6]
Analysis 6.6. Comparison 6 NSHWs versus usual care in improving dementia patients' and carers' outcomes (RCTs), Outcome 6 Carer distress.
[Analysis 6.7]
Analysis 6.7. Comparison 6 NSHWs versus usual care in improving dementia patients' and carers' outcomes (RCTs), Outcome 7 Carer quality of life.
[Analysis 7.1]
Analysis 7.1. Comparison 7 NSHW-led brief alcohol interventions versus usual care for adults with alcohol-use disorders (RCTs), Outcome 1 Amount of alcohol consumed (MD).
[Analysis 7.2]
Analysis 7.2. Comparison 7 NSHW-led brief alcohol interventions versus usual care for adults with alcohol-use disorders (RCTs), Outcome 2 Frequency of binge drinking.
[Analysis 7.3]
Analysis 7.3. Comparison 7 NSHW-led brief alcohol interventions versus usual care for adults with alcohol-use disorders (RCTs), Outcome 3 Adverse consequences.
[Analysis 8.1]
Analysis 8.1. Comparison 8 NSHWs/OPHRs versus usual care in conducting interventions for children with post-traumatic stress and depression (RCTs), Outcome 1 Severity of PTSD symptoms - teacher/LHW-led interventions (SMDs).
[Analysis 8.2]
Analysis 8.2. Comparison 8 NSHWs/OPHRs versus usual care in conducting interventions for children with post-traumatic stress and depression (RCTs), Outcome 2 Severity of PTSD symptoms - classroom-based LHW interventions (MCDs).
[Analysis 8.3]
Analysis 8.3. Comparison 8 NSHWs/OPHRs versus usual care in conducting interventions for children with post-traumatic stress and depression (RCTs), Outcome 3 Severity of PTSD symptoms - classroom-based LHW interventions - boys/girls.
[Analysis 8.4]
Analysis 8.4. Comparison 8 NSHWs/OPHRs versus usual care in conducting interventions for children with post-traumatic stress and depression (RCTs), Outcome 4 Severity of depressive symptoms - teacher/LHW-led interventions (SMDs).
[Analysis 8.5]
Analysis 8.5. Comparison 8 NSHWs/OPHRs versus usual care in conducting interventions for children with post-traumatic stress and depression (RCTs), Outcome 5 Severity of depressive symptoms - classroom-based LHW interventions (MCDs).
[Analysis 8.6]
Analysis 8.6. Comparison 8 NSHWs/OPHRs versus usual care in conducting interventions for children with post-traumatic stress and depression (RCTs), Outcome 6 Severity of depressive symptoms (MCDs) Tol 2012 boys/girls.
[Analysis 8.7]
Analysis 8.7. Comparison 8 NSHWs/OPHRs versus usual care in conducting interventions for children with post-traumatic stress and depression (RCTs), Outcome 7 Severity of anxiety symptoms - classroom-based intervention (within 6 months post intervention).
[Analysis 8.8]
Analysis 8.8. Comparison 8 NSHWs/OPHRs versus usual care in conducting interventions for children with post-traumatic stress and depression (RCTs), Outcome 8 Severity of anxiety symptoms - classroom-based intervention - boys/girls.
[Analysis 8.9]
Analysis 8.9. Comparison 8 NSHWs/OPHRs versus usual care in conducting interventions for children with post-traumatic stress and depression (RCTs), Outcome 9 Functional impairment teacher/LHW-led interventions.
[Analysis 8.10]
Analysis 8.10. Comparison 8 NSHWs/OPHRs versus usual care in conducting interventions for children with post-traumatic stress and depression (RCTs), Outcome 10 Functional impairment LHW-led - classroom-based intervention.
[Analysis 8.11]
Analysis 8.11. Comparison 8 NSHWs/OPHRs versus usual care in conducting interventions for children with post-traumatic stress and depression (RCTs), Outcome 11 Functional impairment - classroom-based LHW intervention - boys/girls.