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Cited by 115Digital Mental Health InterventionsMental Health Treatment and AccessPosttraumatic Stress Disorder Research

World Health Organization's low‐intensity psychosocial interventions: a systematic review and meta‐analysis of the effects of Problem Management Plus and Step‐by‐Step

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Schäfer, Sarah K., Thomas, Lea M., Lindner, Saskia, Lieb, Klaus·2023·World Psychiatry
DOI 10.1002/wps.21129PMC PMC10503931
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Abstract

Many societies have been recently exposed to humanitarian and health emergencies, which have resulted in a large number of people experiencing significant distress and being at risk to develop mental disorders such as depression, anxiety and post‐traumatic stress disorder. The World Health Organization has released a series of scalable psychosocial interventions for people impaired by distress in communities exposed to adversities. Prominent among these is a low‐intensity transdiagnostic psychosocial intervention, Problem Management Plus (PM+), and its digital adaptation Step‐by‐Step (SbS). This systematic review is the first to summarize the available evidence on the effects of PM+ and SbS. Up to March 8, 2023, five databases were searched for randomized controlled trials examining the effects of PM+ or SbS on distress indicators (i.e., general distress; anxiety, depressive or post‐traumatic stress disorder symptoms; functional impairment, self‐identified problems) and positive mental health outcomes (i.e., well‐being, quality of life, social support/relationships). We performed random‐effects multilevel meta‐analyses on standardized mean differences (SMDs) at post‐intervention and short‐term follow‐up assessments. Our search yielded 23 eligible studies, including 5,298 participants. We found a small to medium favorable effect on distress indicators (SMD=–0.45, 95% CI: –0.56 to –0.34) and a small beneficial effect on positive mental health outcomes (SMD=0.31, 95% CI: 0.14‐0.47), which both remained significant at follow‐up assessment and were robust in sensitivity analyses. However, our analyses pointed to substantial between‐study heterogeneity, which was only partially explained by moderators, and the certainty of evidence was very low across all outcomes. These results provide evidence for the effectiveness of PM+ and SbS in reducing distress indicators and promoting positive mental health in populations exposed to adversities, but a larger high‐quality evidence base is needed, as well as research on participant‐level moderators of the effects of these interventions, their suitability for stepped‐care programs, and their cost‐effectiveness.

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  • PM+ has proven particularly effective in reducing symptoms of anxiety, depression, and general distress in settings affected by significant adversity, including conflict-affected regions or under-resourced settings.

    “It has proven to be particularly effective in reducing the symptoms of anxiety, depression, and general distress in settings affected by significant adversity, including conflict-affected regions or under-resourced settings [16].”

    From A Digital Tool (Technology-Assisted Problem Management Plus) for Lay Health Workers to Address Common Mental Health Disorders: Co-production and Usability Study in Pakistan (2025) · cites this paper as [16]

    The Effects at post-intervention section reports reductions in anxiety, depressive symptoms, and general distress for PM+ and Step-by-Step combined; the Discussion places these interventions in populations exposed to adversity. But the paper does not establish that PM+ is particularly effective in conflict-affected or under-resourced settings, and the Abstract rates the certainty of evidence as very low. “Proven particularly effective” overstates those findings. (LLM, conf=0.85)

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Authors
Schäfer, S. K., Thomas, L. M., Lindner, S., & Lieb, K.
Affiliations
  • Leibniz Institute for Resilience Research (DE)
  • Johannes Gutenberg University Mainz (DE)
ORCID
Venue
World Psychiatry
Publisher
Wiley
Published
2023-09-15
Volume
22
Issue
3
Pages
449-462
ISSN
  • 1723-8617 (ISSN-L)
  • 2051-5545
DOI
10.1002/wps.21129
PMC
PMC10503931
OpenAlex
W4386765452
Cited by
115
References
54
Citations by year
2026: 33 · 2025: 39 · 2024: 36 · 2023: 7
FWCI
3.88
Type
journal article
Language
en
Open access
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations
  • World Psychiatry (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • Informationszentrum Lebenswissenschaften (ZB MED) (submittedVersion)
Topics
  • Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
  • Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
Keywords
Problem Management Plus, transdiagnostic treatment, digital mental health interventions, distress, depression, anxiety, post-traumatic stress disorder, positive mental health, quality of life, social support, humanitarian crisis, World Health Organization

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