Implementation outcomes and strategies for depression interventions in low- and middle-income countries: a systematic review

Wagenaar, Bradley H.; Hammett, Wilson H; Jackson, Courtney B.; Atkins, Dana L.; Belus, Jennifer M.; Kemp, Christopher G.

doi:10.1017/gmh.2020.1

Cited by 31 publications

(29 citation statements)

References 134 publications

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“…• Shortage of staff and required clinical skills • Only 15% of countries met all criteria for integrating mental health into primary care in 2020 83 • Insufficient perceived need 79,80,82,93 and population mental health literacy 92 • Stigma and discrimination, which reduce help-seeking 94 • Poor quality treatment [79][80][81][82] • Poor adherence with and negative attitude towards treatment 93,95 • Insufficient evidence about effective scale implementation of treatment [96][97][98] • Insufficient involvement of service users and families in treatment 83,99,100 and setting policy at local and government level 101…”

Section: Causes Of Mental Disorder Treatment Gapmentioning

confidence: 99%

Public mental health: required actions to address implementation failure in the context of COVID-19

Campion

Javed

Lund

et al. 2022

The Lancet Psychiatry

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Mental disorders account for at least 18% of global disease burden, and the associated annual global costs are projected to be US$6 trillion by 2030. Evidence-based, cost-effective public mental health (PMH) interventions exist to prevent mental disorders from arising, prevent associated impacts of mental disorders (including through treatment), and promote mental wellbeing and resilience. However, only a small proportion of people with mental disorders receive minimally adequate treatment. Compared with treatment, there is even less coverage of interventions to prevent the associated impacts of mental disorders, prevent mental disorders from arising, or promote mental wellbeing and resilience. This implementation failure breaches the right to health, has increased during the COVID-19 pandemic, and results in preventable suffering, broad impacts, and associated economic costs. In this Health Policy paper, we outline specific actions to improve the coverage of PMH interventions, including PMH needs assessments, collaborative advocacy and leadership, PMH practice to inform policy and implementation, training and improvement of population literacy, settings-based and integrated approaches, use of digital technology, maximising existing resources, focus on high-return interventions, human rights approaches, legislation, and implementation research. Increased interest in PMH in populations and governments since the onset of the COVID-19 pandemic supports these actions. Improved implementation of PMH interventions can result in broad health, social, and economic impacts, even in the short-term, which support the achievement of a range of policy objectives, sustainable economic development, and recovery.

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Section: Causes Of Mental Disorder Treatment Gapmentioning

confidence: 99%

Public mental health: required actions to address implementation failure in the context of COVID-19

Campion

Javed

Lund

et al. 2022

The Lancet Psychiatry

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“…These challenges will require the continuous control and implementation of the corresponding reporting and analytical pathways ( 36 ). Thus, these analyses should be based on high-quality pragmatic designs and focus on later-stage implementation outcomes ( 37 ). A suggested way of reporting is the usage of validated indicators that describe referral processes and their cofactors ( 38 ).…”

Section: Discussionmentioning

confidence: 99%

Availability and Accessibility of Primary Care for the Remote, Rural, and Poor Population of Indonesia

Wenang

Schaefers

Afdal³

et al. 2021

Front. Public Health

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Background: Adopting Universal Health Coverage for implementation of a national health insurance system [Jaminan Kesehatan Nasional (JKN)/Badan Penyelenggara Jaminan Sosial or the Indonesian National Social Health Insurance Scheme (BPJS)] targets the 255 million population of Indonesia. The availability, accessibility, and acceptance of healthcare services are the most important challenges during implementation. Referral behavior and the utilization of primary care structures for underserved (rural/remote regions) populations are key guiding elements. In this study, we provided the first assessment of BPJS implementation and its resulting implications for healthcare delivery based on the entire insurance dataset for the initial period of implementation, specifically focusing on poor and remote populations.Methods: Demographic, economic, and healthcare infrastructure information was obtained from public resources. Data about the JKN membership structure, performance information, and reimbursement were provided by the BPJS national head office. For analysis, an ANOVA was used to compare reimbursement indexes for primary healthcare (PHC) and advanced healthcare (AHC). The usage of primary care resources was analyzed by comparing clustered provinces and utilization indices differentiating poor [Penerima Bantuan Iur (PBI) membership] and non-poor populations (non-PBI). Factorial and canonical discrimination analyses were applied to identify the determinants of PHC structures.Results: Remote regions cover 27.8% of districts/municipalities. The distribution of the poor population and PBI members were highly correlated (r2 > 0.8; p < 0.001). Three clusters of provinces [remote high-poor (N = 13), remote low-poor (N = 15), non-remote (N = 5)] were identified. A discrimination analysis enabled the >82% correct cluster classification of infrastructure and human resources of health (HRH)-related factors. Standardized HRH (nurses and general practitioners [GP]) availability showed significant differences between clusters (p < 0.01), whereas the availability of hospital beds was weakly correlated. The usage of PHC was ~2-fold of AHC, while non-PBI members utilized AHC 4- to 5-fold more frequently than PBI members. Referral indices (r2 = 0.94; p < 0.001) for PBI, non-PBI, and AHC utilization rates (r2 = 0.53; p < 0.001) were highly correlated.Conclusion: Human resources of health availability were intensively related to the extent of the remote population but not the numbers of the poor population. The access points of PHC were mainly used by the poor population and in remote regions, whereas other population groups (non-PBI and non-Remote) preferred direct access to AHC. Guiding referral and the utilization of primary care will be key success factors for the effective and efficient usage of available healthcare infrastructures and the achievement of universal health coverage in Indonesia. The short-term development of JKN was recommended, with a focus on guiding referral behavior, especially in remote regions and for non-PBI members.

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“…We used mixed-effects longitudinal regression analysis to examine the relationship between level of treatment exposure (measured as number of clinical visits) and magnitude of change in ZLDSI score from enrollment to endline, defined as the last date for which patients were recorded as receiving care. In the absence of a comparison group, this constitutes a longitudinal extension of pre-post treatment analysis that is common in the empirical literature (Adams et al ., 2015 ; Bernstein et al ., 2016 ; Wagenaar et al ., 2020 ). Due to the use of routinely collected data for this study and based on the observed efficacy of antidepressant and behavioral therapy, the research team deemed that a comparison group deprived of treatment would not be acceptable within the health system and would be considered to lack equipoise.…”

Section: Methodsmentioning

confidence: 99%

Evaluating clinical outcomes of routinely delivered task-shared care for depression in rural Haiti

et al. 2021

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Background There is a growing literature in support of the effectiveness of task-shared mental health interventions in resource-limited settings globally. However, despite evidence that effect sizes are greater in research studies than actual care, the literature is sparse on the impact of such interventions as delivered in routine care. In this paper, we examine the clinical outcomes of routine depression care in a task-shared mental health system established in rural Haiti by the international health care organization Partners In Health, in collaboration with the Haitian Ministry of Health, following the 2010 earthquake. Methods For patients seeking depression care betw|een January 2016 and December 2019, we conducted mixed-effects longitudinal regression to quantify the effect of depression visit dose on symptoms, incorporating interaction effects to examine the relationship between baseline severity and dose. Results 306 patients attended 2052 visits. Each visit was associated with an average reduction of 1.11 in depression score (range 0–39), controlling for sex, age, and days in treatment (95% CI −1.478 to −0.91; p < 0.001). Patients with more severe symptoms experienced greater improvement as a function of visits (p = 0.04). Psychotherapy was provided less frequently and medication more often than expected for patients with moderate symptoms. Conclusions Our findings support the potential positive impact of scaling up routine mental health services in low- and middle-income countries, despite greater than expected variability in service provision, as well as the importance of understanding potential barriers and facilitators to care as they occur in resource-limited settings.

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Implementation outcomes and strategies for depression interventions in low- and middle-income countries: a systematic review

Cited by 31 publications

References 134 publications

Public mental health: required actions to address implementation failure in the context of COVID-19

Public mental health: required actions to address implementation failure in the context of COVID-19

Availability and Accessibility of Primary Care for the Remote, Rural, and Poor Population of Indonesia

Evaluating clinical outcomes of routinely delivered task-shared care for depression in rural Haiti

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