Department of Clinical Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam, the Netherlands.
Center for Global Mental Health and Primary Care Research, Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.
JAMA Psychiatry. 2022 May 1;79(5):430-443. doi: 10.1001/jamapsychiatry.2022.0301.
Task sharing, the training of nonspecialist workers with no formal experience in counseling, is a promising strategy for addressing the large gap in treatment for depression in low- and middle-income countries (LMICs).
To examine the outcomes and moderators of task-shared psychological interventions associated with depression severity, response, and remission.
Systematic literature searches in PubMed, Embase, PsycINFO, and Cochrane Library up to January 1, 2021.
Randomized clinical trials (RCTs) of task-shared psychological interventions compared with control conditions for adults with depressive symptoms in LMICs were included.
Two researchers independently reviewed the titles, abstracts, and full text of articles from an existing generic meta-analytic database that includes all RCTs on psychotherapy for depression. A systematic review and individual patient data (IPD) meta-analysis was used to estimate the outcomes of task-shared psychological interventions across patient characteristics using mixed-effects models. Procedures for abstracting data and assessing data quality and validity followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guideline.
Primary outcome was reduction in depression symptom severity measured by the 9-item Patient Health Questionnaire (PHQ-9). Response and remission rates were also estimated.
Of 13 eligible trials, 11 (4145 participants) contributed IPD. Task-shared psychological interventions were associated with a greater decrease in depressive symptom severity than control conditions (Hedges g, 0.32; 95% CI, -0.26 to -0.38). Participants in the intervention groups had a higher chance of responding (odds ratio, 2.11; 95% CI, 1.60 to 2.80) and remitting (odds ratio, 1.87; 95% CI, 1.20 to 1.99). The presence of psychomotor symptoms was significantly associated with the outcomes of task-shared psychological interventions (β [SE], -1.21 [0.39]; P = .002). No other significant associations were identified. Heterogeneity among the trials with IPD was 74% (95% CI, 53%-86%).
In this meta-analysis of IPD, task-shared psychological interventions were associated with a larger reduction in depressive symptom severity and a greater chance of response and remission than control conditions. These findings show potential for the use of task-sharing of psychological interventions across different groups of patients with depression. Further research would help identify which people are most likely to benefit and strengthen larger-scale implementation of this strategy to address the burden of depression in LMICs.
任务分担，即培训没有咨询方面正式经验的非专业人员，是解决中低收入国家（LMIC）治疗抑郁症方面巨大差距的一种很有前景的策略。
研究与抑郁症严重程度、反应和缓解相关的任务分担心理干预的结果和调节因素。
对 PubMed、Embase、PsycINFO 和 Cochrane Library 进行了系统的文献检索，截至 2021 年 1 月 1 日。
包括在 LMIC 中针对有抑郁症状的成年人进行的任务分担心理干预与对照条件的随机临床试验（RCT）。
两名研究人员独立审查了现有通用元分析数据库中包含所有抑郁症心理治疗 RCT 的文章的标题、摘要和全文。使用混合效应模型，对任务分担心理干预在患者特征方面的结果进行了系统评价和个体患者数据（IPD）元分析。数据提取和评估数据质量和有效性的程序遵循系统评价和荟萃分析报告指南的首选报告项目。
主要结果是通过 9 项患者健康问卷（PHQ-9）测量的抑郁症状严重程度的降低。还估计了反应和缓解率。
在 13 项合格试验中，有 11 项（4145 名参与者）提供了 IPD。任务分担心理干预与对照条件相比，抑郁症状严重程度的降低更为明显（Hedges g，0.32；95%CI，-0.26 至-0.38）。干预组的参与者更有可能做出反应（优势比，2.11；95%CI，1.60 至 2.80）和缓解（优势比，1.87；95%CI，1.20 至 1.99）。精神运动症状的存在与任务分担心理干预的结果显著相关（β[SE]，-1.21[0.39]；P=0.002）。没有发现其他显著的关联。具有 IPD 的试验之间的异质性为 74%（95%CI，53%-86%）。
在这项 IPD 的荟萃分析中，任务分担心理干预与抑郁症状严重程度的更大降低以及反应和缓解的更大机会相关，而与对照条件相比。这些发现表明，在不同的抑郁症患者群体中使用心理干预的任务分担具有潜力。进一步的研究将有助于确定哪些人最有可能受益，并加强这一策略的大规模实施，以解决中低收入国家的抑郁症负担。
