Singla Daisy R, Kohrt Brandon A, Murray Laura K, Anand Arpita, Chorpita Bruce F, Patel Vikram
Sinai Health Network, Toronto, Ontario, Canada M5G 1X5.
Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada M5T 1R8; email:
Annu Rev Clin Psychol. 2017 May 8;13:149-181. doi: 10.1146/annurev-clinpsy-032816-045217.
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.
常见精神障碍，包括抑郁症、焦虑症和创伤后应激障碍，是全球致残的主要原因。在低收入和中等收入国家，这些障碍的治疗方法有限。本系统评价综合了实施过程，并考察了低收入和中等收入国家非专科医疗服务提供者为成年人常见精神障碍提供的心理治疗的有效性。共有27项试验符合纳入标准；大多数治疗针对的是抑郁症或创伤后应激障碍。治疗通常由社区卫生工作者或同伴在初级保健或社区环境中提供；通常以个体面对面的形式在2至3个月内进行少于10次的治疗。治疗包括一些常见要素，如非特异性参与以及行为、人际、情感和认知要素的特定领域。合并效应量为0.49（95%置信区间=0.36-0.62），支持干预组。我们的评价表明，由一套简约的常见要素组成、由低成本且广泛可得的人力资源提供的心理治疗，在减轻常见精神障碍负担方面具有中度到强效的效果。
