Scaling-up treatment of depression and anxiety: a global return on investment analysis

Chisholm, Dan; Sweeny, Kim; Sheehan, Peter; Rasmussen, Bruce; Smit, Filip; Cuijpers, Pim; Saxena, Shekhar

doi:10.1016/s2215-0366(16)30024-4

Cited by 965 publications

(664 citation statements)

References 28 publications

(54 reference statements)

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“…It has been argued recently that an investment in mental health care in low-and middle-income countries has considerable economic support 5 . Because we found no indication that the effects are associated with the treatment format, it would be possible to introduce low intensity interventions as a first line treatment, because these are easier and cheaper to implement than high intensity ones.…”

Section: Discussionmentioning

confidence: 99%

“…production losses and health and social care expenditures, have been estimated at US$2.5 trillion in 2010 worldwide [5][6][7] , and these costs are expected to grow to US$6.0 trillion by 2030 8 .…”

mentioning

confidence: 99%

“…However, most people with a depressive disorder do not receive treatment, especially in lowand middle-income countries, where only between 7 and 21% of patients are treated 5 . If patients get treatment, this typically consists of pharmacotherapy, while the majority of patients prefer psychotherapies 9 .…”

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confidence: 99%

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Psychotherapies for depression in low‐ and middle‐income countries: a meta‐analysis

et al. 2018

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Most psychotherapies for depression have been developed in high-income Western countries of North America, Europe and Australia. A growing number of randomized trials have examined the effects of these treatments in non-Western countries. We conducted a meta-analysis of these studies to examine whether these psychotherapies are effective and to compare their effects between studies from Western and nonWestern countries. We conducted systematic searches in bibliographical databases and included 253 randomized controlled trials, of which 32 were conducted in non-Western countries. The effects of psychotherapies in non-Western countries were large (g51.10; 95% CI: 0.91-1.30), with high heterogeneity (I 2 590; 95% CI: 87-92). After adjustment for publication bias, the effect size dropped to g50.73 (95% CI: 0.51-0.96). Subgroup analyses did not indicate that adaptation to the local situation was associated with the effect size. Comparisons with the studies in Western countries showed that the effects of the therapies were significantly larger in non-Western countries, also after adjusting for characteristics of the participants, the treatments and the studies. These larger effect sizes in non-Western countries may reflect true differences indicating that therapies are indeed more effective; or may be explained by the care-as-usual control conditions in non-Western countries, often indicating that no care was available; or may be the result of the relative low quality of many trials in the field. This study suggests that psychotherapies that were developed in Western countries may or may not be more effective in non-Western countries, but they are probably no less effective and can therefore also be used in these latter countries.

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Section: Discussionmentioning

confidence: 99%

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Psychotherapies for depression in low‐ and middle‐income countries: a meta‐analysis

et al. 2018

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“…The World Health Organization (WHO) currently places a strong focus on improving mental health treatment. The prevalence of mental illness continues to rise [91,92], both in the developed world and in areas of high instability that lack the infrastructure to deal with the increased need for treatment [91]. In low-income countries, 75% of the population does not have access to needed treatment and even in high-income countries, there are many barriers to accessing treatment [93].…”

Section: Implications For Internet-based Mental Health Interventionsmentioning

confidence: 99%

Improving the Efficacy of Cognitive Training for Digital Mental Health Interventions Through Avatar Customization: Crowdsourced Quasi-Experimental Study (Preprint)

Birk¹,

Mandryk²

2018

Preprint

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Background: The success of Internet-based mental health interventions in practice -i.e., in-the-wild -depends on the uptake and retention of the application and the user's focused attention in the moment of use. Incorporating game-based motivational design into digital interventions delivered in-the-wild has been shown to increase uptake and retention in Internet-based training; however, there are outstanding questions about the potential of game-based motivational strategies to increase engagement with a task in the moment of use, and -as a result -improve intervention efficacy without accompanying increases in treatment exposure. Objective: Designers of Internet-based interventions need to know whether game-based motivational design strategies can increase in-the-moment engagement and thus improve intervention efficacy. We investigate the effects of one motivational design strategy (avatar customization) in an example mental health intervention (computerized cognitive training for attention bias modification). Methods: We assigned 317 participants to either a customized avatar or an assigned avatar condition. After measuring state-anxiety (STAI), we randomly assigned half of the participants in each condition to either an attentional retraining condition (ABMT) or a control condition. After training, participants were exposed to a Negative Mood Induction using images with strong negative valance (IAPS), after which we measured state-anxiety again. Results: Avatar customization improved treatment efficacy, evidenced as decreased posttraining state-anxiety when controlling for baseline state-anxiety, for those who trained attention bias modification; however, those who did not train experienced decreased resilience to the negative mood induction (F 1,252 =6.86, P=.009, η p

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“…With depression currently affecting some 350 million individuals worldwide (WHO 2016), the estimated financial burden of these conditions up until 2030 is more than £100 billion (Chisholm et al 2016). As such, there is a crucial need for developing cost-effective, stand-alone or adjunctive treatments.…”

Section: Introductionmentioning

confidence: 99%

Acute and repetitive fronto-cerebellar tDCS stimulation improves mood in non-depressed participants

et al. 2017

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second-daily (n = 21). In a second experiment, we separately investigated the influence of reversed polarity upon these same measures, in response to acute stimulation (n = 23) and repeated stimulation (n = 11). We observed a systematic elevation of mood in both active conditions following single and repeated tDCS, the latter of which displayed a progressive elevation of mood from baseline. No mood change was noted in response to either single or repeated stimulation in the sham condition. Frontocerebellar tDCS stimulation advantageously influences mood in healthy participants, with an accumulative and potentiated effect following successive stimulations. The possibility that frontocerebellar stimulation may provide a novel therapeutic adjunctive or pre-emptive intervention in stress-related disorders and mood-related psychopathologies should be considered.

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Scaling-up treatment of depression and anxiety: a global return on investment analysis

Abstract: Grand Challenges Canada.

Cited by 965 publications

References 28 publications

Psychotherapies for depression in low‐ and middle‐income countries: a meta‐analysis

Psychotherapies for depression in low‐ and middle‐income countries: a meta‐analysis

Improving the Efficacy of Cognitive Training for Digital Mental Health Interventions Through Avatar Customization: Crowdsourced Quasi-Experimental Study (Preprint)

Acute and repetitive fronto-cerebellar tDCS stimulation improves mood in non-depressed participants

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