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Annu Rev Clin Psychol. 2017 May 8;13:149-181. doi: 10.1146/annurev-clinpsy-032816-045217.

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

Author information

1
Sinai Health Network, Toronto, Ontario, Canada M5G 1X5.
2
Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada M5T 1R8; email: daisy.singla@sinaihealthsystem.ca.
3
Duke Global Health Institute, Department of Psychiatry, Duke University, Durham, North Carolina 27710; email: brandon.kohrt@duke.edu.
4
Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205; email: lmurra15@jhu.edu.
5
Sangath, Goa, India 403501; email: anand.arpita@gmail.com.
6
Department of Psychology, University of California, Los Angeles, California 90095; email: chorpita@ucla.edu.
7
Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts 02115; email: vikram.patel@hms.harvard.edu.
8
Centre for Chronic Conditions and Injuries, Public Health Foundation of India, Gurgaon India 122022.

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.

KEYWORDS:

common elements; global mental health; implementation processes; low- and middle-income countries; meta-analysis; psychological treatments; systematic review

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