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Cited by 575Mental Health Treatment and AccessGlobal Health Workforce IssuesHealth Policy Implementation Science

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

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van Ginneken, Nadja, Tharyan, Prathap, Lewin, Simon, Rao, Girish N, Meera, SM, Pian, Jessica, Chandrashekar, Sudha, Patel, Vikram·2013·Cochrane Database of Systematic Reviews
DOI 10.1002/14651858.cd009149.pub2
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Abstract

BACKGROUND: Many people with mental, neurological and substance-use disorders (MNS) do not receive health care. Non-specialist health workers (NSHWs) and other professionals with health roles (OPHRs) are a key strategy for closing the treatment gap. OBJECTIVES: To assess the effect of NSHWs and OPHRs delivering MNS interventions in primary and community health care in low- and middle-income countries. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (including the Cochrane Effective Practice and Organisation of Care (EPOC) Group Specialised Register) (searched 21 June 2012); MEDLINE, OvidSP; MEDLINE In Process & Other Non-Indexed Citations, OvidSP; EMBASE, OvidSP (searched 15 June 2012); CINAHL, EBSCOhost; PsycINFO, OvidSP (searched 18 and 19 June 2012); World Health Organization (WHO) Global Health Library (searched 29 June 2012); LILACS; the International Clinical Trials Registry Platform (WHO); OpenGrey; the metaRegister of Controlled Trials (searched 8 and 9 August 2012); Science Citation Index and Social Sciences Citation Index (ISI Web of Knowledge) (searched 2 October 2012) and reference lists, without language or date restrictions. We contacted authors for additional studies. SELECTION CRITERIA: Randomised and non-randomised controlled trials, controlled before-and-after studies and interrupted-time-series studies of NSHWs/OPHR-delivered interventions in primary/community health care in low- and middle-income countries, and intended to improve outcomes in people with MNS disorders and in their carers. We defined an NSHW as any professional health worker (e.g. doctors, nurses and social workers) or lay health worker without specialised training in MNS disorders. OPHRs included people outside the health sector (only teachers in this review). DATA COLLECTION AND ANALYSIS: Review authors double screened, double data-extracted and assessed risk of bias using standard formats. We grouped studies with similar interventions together. Where feasible, we combined data to obtain an overall estimate of effect. MAIN RESULTS: The 38 included studies were from seven low- and 15 middle-income countries. Twenty-two studies used lay health workers, and most addressed depression or post-traumatic stress disorder (PTSD). The review shows that the use of NSHWs, compared with usual healthcare services: 1. may increase the number of adults who recover from depression or anxiety, or both, two to six months after treatment (prevalence of depression: risk ratio (RR) 0.30, 95% confidence interval (CI) 0.14 to 0.64; low-quality evidence); 2. may slightly reduce symptoms for mothers with perinatal depression (severity of depressive symptoms: standardised mean difference (SMD) -0.42, 95% CI -0.58 to -0.26; low-quality evidence); 3. may slightly reduce the symptoms of adults with PTSD (severity of PTSD symptoms: SMD -0.36, 95% CI -0.67 to -0.05; low-quality evidence); 4. probably slightly improves the symptoms of people with dementia (severity of behavioural symptoms: SMD -0.26, 95% CI -0.60 to 0.08; moderate-quality evidence); 5. probably improves/slightly improves the mental well-being, burden and distress of carers of people with dementia (carer burden: SMD -0.50, 95% CI -0.84 to -0.15; moderate-quality evidence); 6. may decrease the amount of alcohol consumed by people with alcohol-use disorders (drinks/drinking day in last 7 to 30 days: mean difference -1.68, 95% CI -2.79 to -0.57); low-quality evidence).It is uncertain whether lay health workers or teachers reduce PTSD symptoms among children. There were insufficient data to draw conclusions about the cost-effectiveness of using NSHWs or teachers, or about their impact on people with other MNS conditions. In addition, very few studies measured adverse effects of NSHW-led care - such effects could impact on the appropriateness and quality of care. AUTHORS' CONCLUSIONS: Overall, NSHWs and teachers have some promising benefits in improving people's outcomes for general and perinatal depression, PTSD and alcohol-use disorders, and patient- and carer-outcomes for dementia. However, this evidence is mostly low or very low quality, and for some issues no evidence is available. Therefore, we cannot make conclusions about which specific NSHW-led interventions are more effective.

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  1. [19]19. Non-specialist health worker interventions for the care of mental, neurological and substance-abuse disorders in low-and middle- income countries (Review) Copyright © 2013 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. (Continued) 52 (mental health service? or mental health care or mental health- care or mental care).ti,ab 14,476 53 ((psychiatric or psychosocial) adj (service? or care or assistance or help or work)).ti,ab 8657 54 or/35-53 1,236,906 55 Developing Countries.sh,kf. 68,442 56 (Africa or Asia or Caribbean or West Indies or South America or Latin America or Central America).hw,kf,ti,ab,cp 58 ((developing or less* developed or under developed or under- developed or middle income or low* income or underserved or under served or deprived or pooror world)).ti,ab 47,759
  2. [24]24. impact.ti,ab. 394,702 (time series or time points).ti,ab. 50,864 ((pretest or pre test) and (posttest or post test)).ti,ab. 5274 (quasi experiment* or quasiexperiment*).ti,ab. 4655 ((multicenter or multicentre or multi center or multi centre) adj study).ti,ab 19,004 repeated measure*.ti,ab. 22,128 or/65-81 7,097,338 Animals/ 4,963,387 Humans/ 12,343,636 83 not (83 and 84) 3,640,602 82 not 85 5,374,334 34 and 54 and 64 and 86 3313 (diagnos* or detect* or case finding?).ti,ab. 2,673,184 34 and 54 and 64 and 88 1011 87 or 89 3662 "comment on".cm. 507,804 (systematic review or literature review).ti. 34,294 (editorial or comment or meta-analysis or news or review).pt 2,561,432 337
  3. [25]25. Non-specialist health worker interventions for the care of mental, neurological and substance-abuse disorders in low-and middle- income countries (Review) Copyright © 2013 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
  4. [30]30. Non-specialist health worker interventions for the care of mental, neurological and substance-abuse disorders in low-and middle- income countries (Review) Copyright © 2013 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. (Continued)
  5. [42]42. Non-specialist health worker interventions for the care of mental, neurological and substance-abuse disorders in low-and middle- income countries (Review) Copyright © 2013 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. (Continued) 45 (depression or anxiety or schizophrenia or psychoses or stress syndrome? or distress syndrome? or combat disorder? or war disorder? or pain disorder? or dementia or alzheimer or epilepsy or down syndrome or alcoholism or substance abuse or drug addict* or drug abus* or drug misuse or drug user?).ti,ab 642,797 46 (psychiatric adj (patient? or service? or care or assistance or help or work)).ti,ab 20,401 47 (mental health service? or mental health care or mental health- care or mental care).ti,ab 17,975 48 ((psychiatric or psychosocial) adj (service? or care or assistance or help or work)).ti,ab 11,075 49 or/32-48 1,785,107 50 Developing Country.sh. 69,992 51 (Africa or Asia or Caribbean or West Indies or South America or Latin America or Central America).hw,ti,ab,cp 53 ((developing or less* developed or under developed or under- developed or middle income or low* income or underserved or under served or deprived or or world)).ti,ab 54,293
  6. [46]46. impact.ti,ab. 504,137 ((pretest or pre test) and (posttest or post test)).ti,ab. 6116 (quasi experiment* or quasiexperiment*).ti,ab. 5334 ((multicenter or multicentre or multi center or multi centre) adj study).ti,ab 25,517 repeated measure*.ti,ab. 27,338 or/60-73 7,718,259 Nonhuman/ 3,853,444 74 not 75 5,951,391 31 and 49 and 59 and 76 4463 (diagnos* or detect* or case finding?).ti,ab. 3,181,233 31 and 49 and 59 and 78 1668 77 or 79 5101 (systematic review or literature review).ti. 41,493 "cochrane database of systematic reviews".jn. 3773 81 or 82 45,261 S25 TI ( (social or psychosocial) W0 (care or support) ) OR AB ( (social or psychosocial) W0 (care or support) ) 13,431 S24 TI ( "self help group" or "self help groups" or "support group" or "support groups" ) OR AB ( "self help group" or "self help groups" or "support group" or "support groups" ) 3318 S23 TI ( informal W0 (caregiver* or "care giver" or "care givers" or carer*) ) OR AB ( informal W0 (caregiver* or "care giver" or "care givers" or carer*) ) 1004 S22 TI ( nurs* N1 (auxiliary or auxiliaries) ) OR AB ( nurs* N1 (auxiliary or auxiliaries) ) 271
  7. [64]64. Non-specialist health worker interventions for the care of mental, neurological and substance-abuse disorders in low-and middle- income countries (Review) Copyright © 2013 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. (Continued)
  8. [77]77. Non-specialist health worker interventions for the care of mental, neurological and substance-abuse disorders in low-and middle- income countries (Review) Copyright © 2013 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. (Continued)
  9. [89]89. Non-specialist health worker interventions for the care of mental, neurological and substance-abuse disorders in low-and middle- income countries (Review) Copyright © 2013 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. (Continued) 47 (depression or anxiety or schizophrenia or psychoses or stress syndrome? or distress syndrome? or combat disorder? or war disorder? or pain disorder? or dementia or alzheimer or epilepsy or down syndrome or alcoholism or substance abuse or drug addict* or drug abus* or drug misuse or drug user?).ti,ab 391,381 48 (psychiatric adj (patient? or service? or care or assistance or help or work)).ti,ab 20,821 49 (mental health service? or mental health care or mental health- care or mental care).ti,ab 21234 50 ((psychiatric or psychosocial) adj (service? or care or assistance or help or work)).ti,ab 9123 51 or/33-50 839,743 52 Developing Countries.sh. 3138 53 (Africa or Asia or Caribbean or West Indies or South America or Latin America or Central America).hw,ti,ab 55 ((developing or less* developed or under developed or under- developed or middle income or low* income or underserved or under served or deprived ,ab 7959

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Authors
van Ginneken, N., Tharyan, P., Lewin, S., Rao, G. N., Meera, S., Pian, J., Chandrashekar, S., & Patel, V.
Affiliations
  • London School of Hygiene & Tropical Medicine; Centre for Global Mental Health; Keppel St London UK WC1E 7HT
  • Christian Medical College, Vellore (IN)
  • South African Medical Research Council (ZA)
  • National Institute of Mental Health and Neurosciences (IN)
  • Sangath (IN)
  • London School of Hygiene & Tropical Medicine (GB)
ORCID
Venue
Cochrane Database of Systematic Reviews
Publisher
Wiley
Published
2013-11-19
Issue
11
Pages
CD009149-CD009149
ISSN
  • 1361-6137 (ISSN-L)
  • 1465-1858
DOI
10.1002/14651858.cd009149.pub2
OpenAlex
W1500173045
Semantic Scholar
bc56b70fbd699b23026c37e788b4e7e31f079689
Cited by
575
References
396
Citations by year
2026: 20 · 2025: 32 · 2024: 36 · 2023: 42 · 2022: 50 · 2021: 77 · 2020: 49 · 2019: 68 · 2018: 48 · 2017: 39 · 2016: 49 · 2015: 39 · 2014: 24 · 2013: 1
FWCI
4.99
Type
journal article
Language
en
Update notices
new_version (2021-08-05)
Open access
Locations
  • Cochrane Database of Systematic Reviews (publishedVersion)
  • PubMed (publishedVersion)
  • LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
Funders
Wellcome Trust (100714, 091834)
Topics
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
  • Health Sciences › Health Professions › Emergency Medical Services › Global Health Workforce Issues
  • Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
Keywords
non-specialist health workers, lay health workers, mental, neurological and substance use disorders, primary care, community-based care, treatment gap, depression, post-traumatic stress disorder, substance use disorders, carer outcomes, low- and middle-income countries, health professions education, task shifting, mental health services, stigma reduction, help-seeking
MeSH terms
Adult, Allied Health Personnel, Anxiety, Mental Disorders, Child, Dementia, Depression, Developing Countries, Female, Humans, Male, Pregnancy, Stress Disorders, Post-Traumatic, Randomized Controlled Trials as Topic, Depression, Postpartum, Substance-Related Disorders, Alcohol-Related Disorders

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