Paraprofessionals for anxiety and depressive disorders

Abstract

Background The established mental health care system does not have the resources to meet the extensive need for care of those with anxiety and depressive disorders. Paraprofessionals partially replacing professionals may be cost-effective. Objectives To investigate the effectiveness of any kind of psychological treatment for anxiety and depressive disorders performed by paraprofessionals. To examine whether the results apply to clinically significant disorders. Search methods CCDANCTR-Studies, EMBASE (ExerptaMedica), MEDLINE, PsycINFO, all years published using the key words: para-/paraprofessional, non-/nonprofessional, rand*, psy*; peer; volunt*; citation lists of articles reviewing the subject and included studies; correspondence with authors of controlled studies, and review reports on the subject. Selection criteria Randomised controlled trials that used symptom measures, and compared the effects of treatments given by paraprofessionals (paid or voluntary, unqualified with respect to the psychological treatment) with treatments given by professionals, and with waiting list or placebo condition. Data collection and analysis The standard mean difference was used to pool continuous data, and odds ratios were used to pool dichotomous data, using a random effects model. The generic inverse variance method was used for combining continuous and dichotomous data. The effect of low quality studies and the use of self-rated versus observer-rated measures were tested. Subgroup analyses were performed for differences between depression and anxiety diagnosis, paraprofessionals with/without professional background, group/individual intervention, length of follow-up and gender (post-hoc subgroup analysis).

Meta‐Analysis of the Effects of Peer‐Administered Psychosocial Interventions on Symptoms of Depression

“…These services are different from PAIs in that paraprofessional therapists typically need not have personal experience with the problems they are treating; their effectiveness, however, is relevant to the study of PAIs because it speaks to whether people with little or no prior training as mental health providers may be able to effectively deliver psychosocial treatments. Den Boer et al (2005) meta-analyzed controlled studies of paraprofessional treatments for anxiety and depression. They found that the outcomes achieved by paraprofessionals delivering a variety of cognitive-behavioral and supportive interventions were not statistically different from those achieved by mental health professionals and were significantly better than waitlist and placebo control conditions.…”

The therapist–client relationship, computerized self‐help and active therapy ingredients

“…There is indeed much evidence to support this notion. For example, in a recent meta-analysis, den Boer, Wiersma, Russo and van den Bosch (2005) found that paraprofessionals such as volunteers, graduate students, ex-clients, and members of self-help organizations, were as effective in treating anxiety and depression as professionals; the results could not be attributed to poor study methodology, and differences between professionals and paraprofessionals failed to appear even at long term follow up. The evidence strongly indicates that untrained 'paraprofessionals' are as effective as, if not more effective than, professionals who have had extensive training and experience and who hold high levels of formal qualifi cations.…”

A telephonic-based trial to reduce depressive symptoms among Latina breast cancer survivors

“…Furthermore, most mental health interventions are delivered by professional facilitators (e.g., nurses and social workers), and few are implemented by trained paraprofessional behavioral interventionist or lay health workers . Paraprofessionals are often socioculturally competent as they are ethnically, culturally, linguistically, and experientially similar to the target patient or study population .…”