TY - JOUR
T1 - Collaborative care for common mental disorders in low- and middle-income countries
T2 - A systematic review and meta-analysis
AU - Faisal, Mehreen Riaz
AU - Salam, Fakiha Tus
AU - Vidyasagaran, Aishwarya Lakshmi
AU - Carswell, Claire
AU - Naseri, Mohammad Wali
AU - Shinwari, Zalmai
AU - Fulbright, Helen
AU - Zavala, Gerardo A.
AU - Gilbody, Simon
AU - Siddiqi, Najma
N1 - © 2024 The Author(s)
PY - 2024/10/15
Y1 - 2024/10/15
N2 - Background: Low- and middle-income countries (LMICs) face high burden of common mental disorders (CMDs). Most of the evidence for the Collaborative Care (CC) model effectiveness comes from high-income countries (HICs) and may not generalise to LMICs. A systematic review was conducted to assess effectiveness of CC for CMDs in LMICs. Methods: We searched eight-databases, two trial registries (2011-November 2023). Randomised controlled trials (RCTs) of adults (≥18 years) with depression/anxiety diagnosis, reporting remission/change in symptom severity were eligible. Random effects meta-analyses were conducted for: short-(0–6 months), medium-(7–12 months), long-(13–24 months), and very long-term (≥25 months) follow-up. Quality was assessed with Cochrane RoB2 tool. PROSPERO registration: CRD42022380407. Results: Searches identified 7494 studies, 12 trials involving 13,531 participants were included; nine had low-risk of bias. CC was more effective than usual care for depression: dichotomous outcomes (short-term, 7 studies, relative risk (RR) 1.39, 95%CI 1.31, 1.48; medium-term, 6 studies, RR 1.35, 95%CI 1.28, 1.43); and continuous outcomes (short-term, 8 studies, standardised mean difference (SMD) −0.51, 95%CI −0.80, −0.23; medium-term, 8 studies, SMD −0.59, 95%CI −1.00, −0.17). CC was found to be effective at long-term (one study), but not at very long-term. Improvement in anxiety outcomes with CC (2 studies, 340 participants) reported up to 12-months; improvements in quality-of-life were not statistically significant (3 studies, 796 participants, SMD 0.62, 95%CI −0.10, 1.34). Limitations: Pooled estimates showed high heterogeneity. Conclusions: In LMICs, CC was more effective than usual care for improving depression outcomes at short and medium-term follow-up. A similar improvement was found for anxiety outcomes, but evidence is limited.
AB - Background: Low- and middle-income countries (LMICs) face high burden of common mental disorders (CMDs). Most of the evidence for the Collaborative Care (CC) model effectiveness comes from high-income countries (HICs) and may not generalise to LMICs. A systematic review was conducted to assess effectiveness of CC for CMDs in LMICs. Methods: We searched eight-databases, two trial registries (2011-November 2023). Randomised controlled trials (RCTs) of adults (≥18 years) with depression/anxiety diagnosis, reporting remission/change in symptom severity were eligible. Random effects meta-analyses were conducted for: short-(0–6 months), medium-(7–12 months), long-(13–24 months), and very long-term (≥25 months) follow-up. Quality was assessed with Cochrane RoB2 tool. PROSPERO registration: CRD42022380407. Results: Searches identified 7494 studies, 12 trials involving 13,531 participants were included; nine had low-risk of bias. CC was more effective than usual care for depression: dichotomous outcomes (short-term, 7 studies, relative risk (RR) 1.39, 95%CI 1.31, 1.48; medium-term, 6 studies, RR 1.35, 95%CI 1.28, 1.43); and continuous outcomes (short-term, 8 studies, standardised mean difference (SMD) −0.51, 95%CI −0.80, −0.23; medium-term, 8 studies, SMD −0.59, 95%CI −1.00, −0.17). CC was found to be effective at long-term (one study), but not at very long-term. Improvement in anxiety outcomes with CC (2 studies, 340 participants) reported up to 12-months; improvements in quality-of-life were not statistically significant (3 studies, 796 participants, SMD 0.62, 95%CI −0.10, 1.34). Limitations: Pooled estimates showed high heterogeneity. Conclusions: In LMICs, CC was more effective than usual care for improving depression outcomes at short and medium-term follow-up. A similar improvement was found for anxiety outcomes, but evidence is limited.
KW - Anxiety
KW - Collaborative care
KW - Depression
KW - Low- and middle-income countries
KW - Task-shifting
UR - http://www.scopus.com/inward/record.url?scp=85200118926&partnerID=8YFLogxK
U2 - 10.1016/j.jad.2024.07.086
DO - 10.1016/j.jad.2024.07.086
M3 - Review article
C2 - 39038620
SN - 0165-0327
VL - 363
SP - 595
EP - 608
JO - Journal of affective disorders
JF - Journal of affective disorders
ER -