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Cited by 913Mental Health Treatment and AccessHealth Policy Implementation SciencePsychotherapy Techniques and Applications

Psychological Treatments for the World: Lessons from Low- and Middle-Income Countries

Open access
Singla, Daisy R., Kohrt, Brandon A., Murray, Laura K., Anand, Arpita, Chorpita, Bruce F., Patel, Vikram·2017·Annual Review of Clinical Psychology
DOI 10.1146/annurev-clinpsy-032816-045217PMC PMC5506549
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Abstract

Common mental disorders, including depression, anxiety, and posttraumatic stress, are leading causes of disability worldwide. Treatment for these disorders is limited in low- and middle-income countries. This systematic review synthesizes the implementation processes and examines the effectiveness of psychological treatments for common mental disorders in adults delivered by nonspecialist providers in low- and middle-income countries. In total, 27 trials met the eligibility criteria; most treatments targeted depression or posttraumatic stress. Treatments were commonly delivered by community health workers or peers in primary care or community settings; they usually were delivered with fewer than 10 sessions over 2–3 months in an individual, face-to-face format. Treatments included common elements, such as nonspecific engagement and specific domains of behavioral, interpersonal, emotional, and cognitive elements. The pooled effect size was 0.49 (95% confidence interval = 0.36–0.62), favoring intervention conditions. Our review demonstrates that psychological treatments—comprising a parsimonious set of common elements and delivered by a low-cost, widely available human resource—have moderate to strong effects in reducing the burden of common mental disorders.

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Crossref · 10.1146/annurev-clinpsy-032816-045217

Cites

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Claims the paper makes

0 of 22 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    The five most commonly endorsed nonspecific elements were empathy (88.9%), collaboration (85.2%), active listening (77.8%), normalizing treatment or aspects of the illness (70.4%), and involving family members or a significant other (63.0%).

    “The five most commonly endorsed nonspecific elements were empathy (88.9%); collaboration (85.2%); active listening (77.8%); normalizing treatment or aspects of the illness (70.4%), or both; and involving family members or a significant other (63.0%).”
    Quote in the paperNot a substantial claim
  • Findingown data

    The nonspecific elements domain was significantly correlated with the specific element domains, except for the cognitive domain.

    “Similarly, the domain of nonspecific elements was significantly correlated with the specific element domains (r = 0.425–0.483, p < 0.01), with the exception of the cognitive element domain (r = 0.235, p = 0.240).”
    Quote in the paperNot a substantial claim
  • Findingown data

    The behavioral and cognitive element domains were significantly correlated.

    “We observed significant correlations between these domains, in particular between the behavioral and cognitive domains (r = 0.611, p < 0.001)”
    Quote in the paperNot a substantial claim
  • Findingnone given

    Most treatments in the review targeted depression or posttraumatic stress.

    “most treatments targeted depression or posttraumatic stress”
    Quote in the paperNot a substantial claim
  • Findingown data

    Treatments were commonly delivered by community health workers or peers in primary care or community settings.

    “Treatments were commonly delivered by community health workers or peers in primary care or community settings”
    Quote in the paperSubstantial claim
  • Classified as probably not a substantial claim. 32
  • May combine two claims. 46

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Among the eligible trials, 22 were individual randomized controlled trials and 5 were cluster randomized controlled trials.

    “Among these, 22 were individual RCTs and 5 were cluster randomized controlled trials.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    On average, treatments included 2.24 of 5 behavioral elements, 2.26 of 4 emotional elements, 1.71 of 3 interpersonal elements, and 1.74 of 6 cognitive elements.

    “On average, treatments comprised 2.24 out of 5 behavioral elements, 2.26 out of 4 emotional elements, 1.71 out of 3 interpersonal elements, and 1.74 out of 6 cognitive elements.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The coding of treatment elements from trial descriptions accurately reflects the treatments as delivered.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Participants were most likely recruited from primary health-care settings, notably maternal and reproductive services (n=12), followed by community settings (n=8), and participants' homes (n=6).

    “Trial participants were most likely to be recruited from primary health-care settings, notably those providing maternal and reproductive services (n = 12), followed by community settings (n = 8), and participants’ homes (n = 6).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    The average age of participants was 33.9 years (95% confidence interval 31.1-36.9).

    “The average age of participants was 33.9 years (95% CI = 31.1–36.9).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    The median sample size including intervention and control arms was 194 participants, with a range of 15 to 1,961.

    “The median sample size inclusive of intervention and control arms was 194 participants (range = 15 to 1,961).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The five most commonly used specific elements were eliciting or identifying social support (85.2%), engaging in problem-solving (80.8%), identifying or eliciting affect (76.9%), linking affect to events (76.9%), and identifying thoughts (63.0%).

    “The five most commonly used specific elements were eliciting or identifying social support (85.2%); engaging in problem-solving (80.8%); identifying or eliciting affect (76.9%), or both; linking affect to events (76.9%); and identifying thoughts (63.0%).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Excluding the largest and smallest trials, the average sample size was 219 participants, with a range of 49-798.

    “Excluding the outliers of the largest and smallest trials (Patel et al. 2010, n = 1,961; Hirani et al. 2010a, n = 15), the average sample size for the trials was 219 participants (range = 49–798).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Patel et al. 2010

      Not checked in the free run.

    • cites Hirani et al. 2010a

      Not checked in the free run.

  • May combine two claims.

    Findingown data

    Across the reviewed treatments, the mean number of nonspecific elements used was 5.22 out of 9, and the mean number of specific elements was 7.81 out of 18.

    “Overall, treatments included an average of 5.22 out of 9 nonspecific elements and 7.81 out of 18 specific elements.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The coding of treatment elements from trial descriptions accurately reflects the treatments as delivered.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Of 25 authors contacted, 21 (84%) completed the online survey used to distill treatment components.

    “Among the 25 authors who were contacted to enter their treatment data, 21 (84%) completed the online survey used to distill treatment components.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The most frequently used in-session techniques were psychoeducation, providing direct suggestions, assigning homework, giving praise, and goal setting.

    “The most common in-session techniques used were psychoeducation (85.2%), providing direct suggestions (59.2%), assigning homework (59.2%), giving praise (55.6%), and goal setting (55.6%).”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The coding of treatment elements from trial descriptions accurately reflects the treatments as delivered.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    The least commonly used nonspecific element was case management (18.5%).

    “The least commonly used nonspecific element was case management (18.5%).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    The final taxonomy includes 18 specific elements in four domains, 9 nonspecific engagement elements, and 12 in-session techniques.

    “resulting in the current taxonomy, which includes 18 specific elements in four domains (behavioral, interpersonal, cognitive, and emotional); 9 nonspecific engagement elements; and 12 in-session techniques (Figure 1).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The most commonly used treatment class was psychoeducation, followed by problem-solving, cognitive behavioral therapy, and behavioral activation or interpersonal psychotherapy.

    “The most commonly used treatment class was psychoeducation (33.3%), followed by problem-solving (23.1%), cognitive behavioral therapy (17.9%), and behavioral activation or interpersonal psychotherapy (12.8%).”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The authors' self-reported treatment classes are accurate.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Almost half of the trials took place among urban populations, with the remainder equally distributed among rural and semiurban populations.

    “Almost half of the trials took place among urban populations, with the remainder equally distributed among rural and semiurban populations.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The trials were conducted in 17 countries, most commonly in sub-Saharan Africa (n=7, including 2 in Uganda), East Asia (n=6, including 5 from China or Taiwan), South Asia (n=5, including 3 from Pakistan), and 3 each from Chile and Iraq.

    “The trials were conducted in 17 countries, most commonly in sub-Saharan Africa (n = 7, including 2 in Uganda), East Asia (n = 6, including 5 from China or Taiwan), South Asia (n = 5, including 3 from Pakistan) and 3 each from Chile and Iraq.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The target population in most trials was primary care attendees (77.8%), followed by torture survivors (14.8%), persons living with HIV (7.4%), and refugees (7.4%).

    “The target population in most trials was primary care attendees (77.8%), followed by torture survivors (14.8%), persons living with HIV (7.4%), and refugees (7.4%).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The majority of trials (62.9%) targeted only women, and almost half of those women were mothers in the pre- or postnatal phase.

    “The majority of trials (62.9%) targeted only women, almost half of whom were mothers in the pre- or postnatal phase.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    At least one behavioral, interpersonal, and emotional element was used in 23 trials (85%), and at least one cognitive element was used in 20 trials (74.1%).

    “At least one behavioral, interpersonal, and emotional element was used in 23 trials (85%); at least one cognitive element was used in 20 trials (74.1%).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    The final review included 25 articles, which reported 27 trials.

    “our final review included 25 articles, which included 27 trials (two articles included data on two trials).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Supervision format was reported by 15 trials; all conducted supervision in person, and almost half supplemented it with telephone or Skype.

    “The format for supervision was reported by 15 trials. All trials conducted supervision in person, and almost half of these supplemented this supervision with telephone (46.7%) or Skype (40.0%) support.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The 27 included trials are representative of all psychological treatments delivered by nonspecialist providers in low- and middle-income countries.

  • May combine two claims.

    Findingown data

    The majority of trials exclusively used an individual format; 37.0% used group formats, and 11.1% used both.

    “The majority of trials exclusively used an individual (51.9%) format; 37.0% used group formats; 11.1% used both.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The 27 included trials are representative of all psychological treatments delivered by nonspecialist providers in low- and middle-income countries.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    In all trials, treatment was delivered face to face; two trials also used the telephone.

    “In all trials, treatment was delivered face to face; two (7.4%) also used the telephone.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The 27 included trials are representative of all psychological treatments delivered by nonspecialist providers in low- and middle-income countries.

  • May combine two claims.

    Findingown data

    Overall, training lasted a mean of 78.82 hours; when one outlier was excluded, the mean was 53.80 hours.

    “Overall, training lasted a mean of 78.82 hours (95% CI = 21.81–135.84); it lasted a mean of 53.80 hours (95% CI = 31.72–75.84) when the one outlier (Patel et al. 2010) was excluded”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Patel et al. 2010

      Not checked in the free run.

    • Rests on an assumption: The 27 included trials are representative of all psychological treatments delivered by nonspecialist providers in low- and middle-income countries.

  • Classified as probably not a substantial claim.

    Findingown data

    The review highlights a gap in reporting on relevant implementation processes.

    “Our review also highlights the gap in reporting on relevant implementation processes.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Mental health specialists had diverse roles, most commonly during trial evaluation, followed by training and supervising nonspecialist providers.

    “Mental health specialists had diverse roles in these treatments, most commonly during trial evaluation (100%), followed by training and supervising NSPs (66.7%),”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The 27 included trials are representative of all psychological treatments delivered by nonspecialist providers in low- and middle-income countries.

  • May combine two claims.

    Findingown data

    Twenty-three trials reported the proportion of individuals who completed the entire or a significant amount of the psychological treatment, with a mean of 79.6%.

    “A total of 23 trials reported the proportion of individuals who completed the entire or a significant amount of the psychological treatment (mean = 79.6% participants).”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The 27 included trials are representative of all psychological treatments delivered by nonspecialist providers in low- and middle-income countries.

  • May combine two claims.

    Findingown data

    Almost three-quarters of trials reported using a manualized treatment strategy; 65% used a phase- or session-specific sequence, and 40% used booster sessions.

    “Almost three-quarters of trials (n = 18) reported using a manualized treatment strategy; 65% of trials used a phase- or session-specific sequence; and 40% used booster sessions.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The 27 included trials are representative of all psychological treatments delivered by nonspecialist providers in low- and middle-income countries.

  • May combine two claims.

    Findingown data

    About half of the trials described a rationale for selecting nonspecialist providers; the most common rationale was that providers were close to and had frequent contact with the target community.

    “The rationale for selecting a given NSP was described by about half of the trials (n = 13): The most common rationale was that the NSPs were close to and had frequent contact with the target community (46.2%);”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The 27 included trials are representative of all psychological treatments delivered by nonspecialist providers in low- and middle-income countries.

  • May combine two claims.

    Findingown data

    The review identified 27 trials that met eligibility criteria, with 35 primary and secondary outcomes.

    “We identified 27 trials that met our eligibility criteria, with 35 primary and secondary outcomes.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The 27 included trials are representative of all psychological treatments delivered by nonspecialist providers in low- and middle-income countries.

  • May combine two claims.

    Findingown data

    The second regression model explained 46.3% of the variance in trial effectiveness, with the strongest associations for interpersonal, emotional, and nonspecific elements.

    “This model was more robust (F = 3.62, p = 0.016) and the five domains explained 46.3% of the variance (R2) in trial effectiveness. The strongest associations were observed for the interpersonal elements (β = 0.442, p = 0.029), emotional elements (β = 0.415, p = 0.046), and nonspecific (engagement) elements (β = 0.409, p = 0.052).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Exploratory analyses showed that trial effect size was significantly related to the summed score of all specific elements and to the summed score of nonspecific elements.

    “Exploratory analyses showed that the trial effect size was significantly related to the summed score of the number of all specific elements (Pearson’s r=0.383, p=0.048) and nonspecific elements (r = 0.474, p = 0.012).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Only two trials reported an economic evaluation of their psychological treatments, and only one reported on mediators of treatment effectiveness.

    “Only two trials (Araya et al. 2006, Buttorff et al. 2012) reported an economic evaluation of their psychological treatments, and only one reported on mediators of the treatment’s effectiveness (Singla et al. 2015).”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites Araya et al. 2006

      Not checked in the free run.

    • cites Buttorff et al. 2012

      Not checked in the free run.

    • cites Singla et al. 2015

      Not checked in the free run.

  • May combine two claims.

    Findingown data

    Other frequently used nonspecialist providers were peers or individuals recruited from the same community, nurses, and midwives.

    “The other frequently used personnel were peers or individuals specifically recruited for the trial from the same community (29.6%), nurses (18.5%), and midwives (14.8%).”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The 27 included trials are representative of all psychological treatments delivered by nonspecialist providers in low- and middle-income countries.

  • May combine two claims.

    Findingown data

    Mean treatment duration was 10.19 weeks; when four outliers were excluded, it was 9.05 weeks.

    “When all 26 trials were included, the mean duration was 10.19 weeks (95% CI = 6.92 to 13.51); when the four outliers were excluded, treatment duration was 9.05 weeks (95% CI = 7.43 to 10.58)”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The 27 included trials are representative of all psychological treatments delivered by nonspecialist providers in low- and middle-income countries.

  • May combine two claims.

    Findingown data

    Training methods were reported by 18 trials; the majority used a mixed methods approach, while others reported only didactics.

    “Training methods were reported by 18 trials. The majority of programs (77.8%) used a mixed methods approach to train NSPs; others reported only using didactics.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The 27 included trials are representative of all psychological treatments delivered by nonspecialist providers in low- and middle-income countries.

  • May combine two claims.

    Findingown data

    No trials reported conducting a formal evaluation of nonspecialist provider competency or providing certification.

    “No trials reported conducting a formal evaluation to examine the competency of NSPs, or whether certification was provided.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The 27 included trials are representative of all psychological treatments delivered by nonspecialist providers in low- and middle-income countries.

  • May combine two claims.

    Findingown data

    The standardized mean difference for the 24 primary outcomes was 0.49, favoring the intervention, with substantial heterogeneity (I2 = 83%).

    “The SMD for the 24 primary outcomes was 0.49 (95% CI = 0.36–0.62), favoring the intervention with the inconsistency measure I2 = 83%, suggesting substantial heterogeneity among trials”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The effect sizes from the included trials are not substantially biased by publication bias or selective reporting.

  • May combine two claims.

    Findingown data

    Half of the treatments were delivered in the community, 38.4% at primary care centers, and 26.9% in homes.

    “Half of the treatments were delivered in the community (50.0%)—for example in schools, at community meetings, and outdoors; 38.4% were delivered at primary care centers; and 26.9% were delivered in homes.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The 27 included trials are representative of all psychological treatments delivered by nonspecialist providers in low- and middle-income countries.

  • May combine two claims.

    Findingown data

    The review found an unexpected gap: limited utilization of indigenous elements, with mindfulness not used by any of the trials.

    “An unexpected gap in the literature was the limited utilization of indigenous elements. For example, mindfulness, a practice rooted in South and East Asian culture, was not used by any of the trials.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The 27 included trials are representative of all psychological treatments delivered by nonspecialist providers in low- and middle-income countries.

  • May combine two claims.

    Findingown data

    Two-thirds of the selected trials targeted only women, and many focused on perinatal common mental disorders.

    “Two-thirds of the selected trials targeted only women, and many focused on perinatal CMDs.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The 27 included trials are representative of all psychological treatments delivered by nonspecialist providers in low- and middle-income countries.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Supervision was most often conducted weekly, with some trials using ad hoc supervision when required or monthly supervision.

    “Supervision was most often conducted weekly (76.5%); in other trials, ad hoc supervision was conducted when required (17.6%) or supervision occurred monthly (5.9%).”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The 27 included trials are representative of all psychological treatments delivered by nonspecialist providers in low- and middle-income countries.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The review protocol was registered with PROSPERO under CRD42016029451.

    “The protocol was developed following the procedures outlined in the Cochrane handbook for systematic reviews (Higgins et al. 2011) and registered with PROSPERO (the international prospective register of systematic reviews; CRD42016029451).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Higgins et al. 2011

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Two researchers and two research assistants independently identified eligible articles by screening titles and abstracts.

    “Two researchers (D.R.S. and B.A.K.) and two research assistants independently identified eligible articles by systematically screening titles and abstracts to determine whether an article met the eligibility criteria.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Premisenone given

    No review exists of the implementation processes or common elements used when delivering psychological treatment to adults in low- and middle-income countries.

    “Despite the growing evidence that testifies to the success of psychological treatments in the global context, there is no review of relevant implementation processes or the common elements utilized when delivering psychological treatment to adults in LMICs.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    Outliers were identified and, when applicable, analyses were repeated without them.

    “Outliers were identified and, when applicable, analyses were repeated without these outliers.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    For trials whose authors did not respond, two researchers independently coded the same article with high interrater reliability, with an intraclass correlation of 0.90.

    “Finally, for those trials in which the authors did not respond, two researchers independently coded the same article with high interrater reliability (ICC = 0.90).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Each abstract deemed ineligible was screened by a second researcher and, if necessary, by a third researcher to reach final consensus.

    “Each abstract that was deemed ineligible was screened by the second researcher and, if necessary, by a third researcher (V.P.) to reach a final consensus.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    Eligible articles were distributed among researchers and full-text screened, and articles deemed ineligible at this stage were verified by two additional researchers.

    “Next, eligible articles were distributed among the researchers (D.R.S., B.A.K., L.K.M., and A.A.) and the full-text was screened. At this stage, articles that were deemed ineligible were verified by two additional researchers.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    The systematic review and meta-analysis was conducted in accordance with PRISMA guidelines.

    “We conducted a systematic review and meta-analysis in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines (Moher et al. 2009).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Moher et al. 2009

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In low- and middle-income countries, intervention coverage for common mental disorders is estimated at 7% to 28%, producing a treatment gap of up to 93%.

    “This is particularly true in LMICs, where intervention coverage for CMDs is estimated at 7% to 28%, resulting in a treatment gap of up to 93% (Chisholm et al. 2016).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Chisholm et al. 2016

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    Four rounds of pilot testing were conducted, and interrater reliability was estimated using an intraclass correlation.

    “Four rounds of pilot testing followed, whereby four researchers independently coded two or more eligible trials to test and iteratively adapt the existing taxonomy. During this phase, interrater reliability was estimated using an intraclass correlation (ICC).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The final round of coding showed high agreement among coders, with an intraclass correlation of 0.77-0.85.

    “Our final round of coding indicated a high degree of agreement among coders (ICC = 0.77–0.85).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Common mental disorders, which include depression, anxiety, and posttraumatic stress, are among the leading causes of disability globally.

    “Common mental disorders, including depression, anxiety, and posttraumatic stress, are leading causes of disability worldwide.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Whiteford et al. 2013

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    The World Health Organization's mhGAP recommends psychological treatments as first-line treatment for common mental disorders.

    “the World Health Organization’s (WHO’s) Mental Health Gap Action Program (mhGAP; WHO 2015) recommends psychological treatments as first-line treatment for CMDs”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites WHO 2015

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Study design and conductcitation

    A random-effects analysis was used because heterogeneity was expected from the presence of cluster randomized controlled trials.

    “We employed a random-effects analysis because we expected heterogeneity arising from the presence of cluster randomized controlled trials for which the random-effects model is the method of choice (Hayes & Moulton 2009).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Hayes & Moulton 2009

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The completeness and face validity of the list of elements and their organization was confirmed by trial authors and experts in psychological treatment.

    “The completeness and face validity of the list of elements and their organization was confirmed by trial authors and experts in psychological treatment.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    The taxonomy showed modest to good internal consistency within domains, strong interrater reliability, and covered both nonspecific and domain-specific elements.

    “The taxonomy we developed showed modest to good internal consistency within domains, strong interrater reliability, and covered both nonspecific and domain-specific elements.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The coding of treatment elements from trial descriptions accurately reflects the treatments as delivered.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    None of the independent variables in either regression model showed evidence of multicollinearity.

    “None of the independent variables in either model showed evidence of multicollinearity (VIF < 2).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    These innovations share a number of key treatment components and implementation processes, including types of elements and techniques, training and supervision formats, and number of sessions and duration.

    “These innovations share a number of key treatment components and implementation processes, including the types of elements and techniques, the training and supervision formats for NSPs, and the number of sessions and duration during which the treatment is delivered.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The 27 included trials are representative of all psychological treatments delivered by nonspecialist providers in low- and middle-income countries.

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    The findings point to using relatively simpler treatment protocols as the basis for more widely disseminating empirically supported psychological treatments.

    “Our findings point to using relatively simpler treatment protocols as the basis for more widely disseminating empirically supported psychological treatments.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

    Interpretationreasoning

    The findings indicate a need to expand orthodox definitions of who is considered a mental health-care provider, what constitutes a psychological treatment, and where treatments can be delivered.

    “Therefore, our findings strongly indicate the need to expand the orthodox definitions of who is considered a mental health-care provider, what constitutes a psychological treatment, and where treatments can be delivered.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    These common implementation processes could act as a blueprint for scaling up these psychological treatments globally.

    “These common implementation processes could act as a blueprint for scaling-up these psychological treatments, not just in the LMICs from where our evidence base was generated but globally, with implications for the science of the dissemination of such treatments.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    The subgroup of trials that reported on training and supervision processes showed a continuing reliance on orthodox, face-to-face methods delivered by experts, which is a significant barrier to scale-up.

    “The subgroup of trials that reported on these processes showed a continuing reliance on orthodox, face-to-face methods for training and supervision delivered by experts, which, although reported to be critical to changing behavior in therapy (Beidas et al. 2014), is a significant barrier to scale-up (Fairburn & Patel 2014).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites Beidas et al. 2014

      Not checked in the free run.

    • cites Fairburn & Patel 2014

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Significant barriers to wider adoption of nonspecialist-provider-delivered psychological treatments include the need for ongoing structured supervision and adequate training and compensation.

    “Thus, there are significant barriers to the wider adoption of such NSP-delivered psychological treatments, including the need for ongoing, structured supervision and adequate training and compensation (Mendenhall et al. 2014).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Mendenhall et al. 2014

      Not checked in the free run.

64 of 64

  • The paper relies on this without support.

    There will never be enough mental health professionals to deliver psychological treatment in any country.

    “The rationale for the principle of involving NSPs is that it is extremely unlikely that there will ever be sufficient mental health professionals to deliver psychological treatment in any country; thus, dissemination hinges on delivery by NSPs.”

  • The paper relies on this without support.

    Psychological treatments rely on expensive but scarce mental health professionals for delivery.

    “Additionally, these psychological treatments rely on expensive but scarce mental health professionals for delivery.”

  • The paper relies on this without support.

    The vast majority of people with common mental disorders in low- and middle-income countries will seek treatment through primary health-care or other community platforms.

    “Moving to real-world, LMIC-based settings, in which the vast majority of individuals with CMDs will pursue treatment options through primary health-care or other community platforms, requires psychological treatments to be delivered by nonspecialist providers (NSPs; i.e., through task sharing) and addresses explanatory models distinct from those of mental health practitioners.”

  • The paper relies on this without support.

    The 27 included trials are representative of all psychological treatments delivered by nonspecialist providers in low- and middle-income countries.

    “We identified 27 trials that met our eligibility criteria, with 35 primary and secondary outcomes.”

  • The paper relies on this without support.

    The effect sizes from the included trials are not substantially biased by publication bias or selective reporting.

    “The SMD for the 24 primary outcomes was 0.49 (95% CI = 0.36–0.62), favoring the intervention with the inconsistency measure I2 = 83%”

  • The paper relies on this without support.

    The coding of treatment elements from trial descriptions accurately reflects the treatments as delivered.

    “We measured the internal consistency of the taxonomy by using Cronbach’s α”

  • The paper relies on this without support.

    The authors' self-reported treatment classes are accurate.

    “When asked, most authors (63%) indicated they used more than one class of treatments”
7 of 7

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

  • Specific-element domain averages exceed the stated overall average

    Minor

    The four specific-element domain averages sum to 7.95, not the stated overall average of 7.81 specific elements per treatment. The gap is larger than rounding to two decimal places can explain.

    Reported 7.81 · recomputed 7.95

1 of 1

Cites

Flagged first, then by citations

Research works printed but not linked: 18

  1. Cochrane Collab. 2014. Review Manager 5 (RevMan 5): version 5.3.http://tech.cochrane.org/revman
  2. England MJ, 2015, Psychosocial Interventions for Mental and Substance Use Disorders: A Framework for Establishing Evidence-Based Standards
  3. Fritsch R, 2007, Rev. Med. Chil, 135, 587
  4. Gul A, 2004, J. Pak. Med. Assoc, 54, 549
  5. Hirani SS, 2010, South. Online J. Nurs. Res., 10, 6
  6. Kazdin AE, 2016, Clin. Psychol., 23, 201
  7. Milani HS, 2015, Int. J. Fertil. Steril., 9, 247
  8. Naeem S, 2003, J. Pak. Med. Assoc, 53, 388
  9. PracticeWise., 2015, Psychosocial and combined treatments coding manual
  10. SAS Institute Inc., 2011, SAS/STAT 9.3
  11. van Ginneken N, 2013, Cochrane Database Syst. Rev., 19, CD009149
  12. van't Hof E, 2011, Afr. J. Psychiatry, 14, 200
  13. Verdeli H, 2003, World Psychiatry, 2, 114
  14. Weiss WM, 2016, Torture, 26, 17
  15. WHO (World Health Organ.)., 2014, Low-Intensity Psychological Interventions for People in Communities Affected by Adversity: A New Area of Mental Health and Psychosocial Work at WHO
  16. WHO (World Health Organ.)., 2014, Preventing Suicide: A Global Imperative
  17. WHO (World Health Organ.)., 2015, mhGAP Humanitarian Intervention Guide (mhGAP-HIG): Clinical Management of Mental, Neurological and Substance Use Conditions in Humanitarian Emergencies.
  18. World Bank Group., 2015, World Bank Country and Data Groups

Cited by

Sorted by citations

Related

Authors
Singla, D. R., Kohrt, B. A., Murray, L. K., Anand, A., Chorpita, B. F., & Patel, V.
Affiliations
  • University of Toronto (CA)
  • Duke University (US)
  • Johns Hopkins University (US)
  • Sangath (IN)
  • University of California, Los Angeles (US)
  • Harvard University (US)
ORCID
Venue
Annual Review of Clinical Psychology
Publisher
Annual Reviews
Published
2017-05-08
Volume
13
Issue
1
Pages
149-181
ISSN
  • 1548-5943 (ISSN-L)
  • 1548-5951
DOI
10.1146/annurev-clinpsy-032816-045217
PMC
PMC5506549
OpenAlex
W2404531844
Cited by
913
References
112
Citations by year
2026: 90 · 2025: 77 · 2024: 118 · 2023: 109 · 2022: 128 · 2021: 182 · 2020: 87 · 2019: 76 · 2018: 32 · 2017: 14
FWCI
9.00
Type
journal article
Language
en
Open access
Locations
  • Annual Review of Clinical Psychology (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
  • eScholarship (California Digital Library) (submittedVersion)
Funders
  • Wellcome Trust (106919, 106919/Z/15)
  • National Institute of Mental Health (K01MH104310, U19MH095687)
Topics
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
  • Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
  • Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
Keywords
psychological intervention, common mental disorders, depression, anxiety, post-traumatic stress disorder, low- and middle-income countries, community health workers, peer-mediated intervention, primary care, brief intervention, treatment effectiveness, implementation process
MeSH terms
Mental Disorders, Developing Countries, Humans, Mental Health, Psychotherapy, Global Health

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-06.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-06.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

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