Health Service and Population Research, King's College London Institute of Psychiatry Psychology and Neuroscience, London, UK
Département des sciences de la santé communautaire, Université de Sherbrooke, Sherbrooke, Canada.
Evid Based Ment Health. 2022 Dec;25(e1):e1-e7. doi: 10.1136/ebmental-2021-300401. Epub 2022 Apr 26.
The WHO's Mental Health Gap Action Programme Intervention Guide (mhGAP-IG) has been widely used in low and middle-income countries. We reviewed literature describing interventions and training programmes beyond the mhGAP-IG, in primary healthcare (PHC) and community-based healthcare (CBH).
We searched studies excluded from our updated mhGAP-IG systematic review, and included in other relevant systematic reviews, for evidence and experience of initiatives integrating mental health into PHC and CBH. Our 24 November 2020 mhGAP-IG search encompassed MEDLINE, Embase, PsycINFO, Web of Knowledge, Scopus, CINAHL, LILACS, ScieELO, Cochrane, PubMed databases, 3ie and Google Scholar. Although heterogeneity prevented meta-analysis, we descriptively summarised the evidence-base.
Out of 1827 results, we identified 208 relevant records. They described randomised controlled trials of mental health interventions (98 studies, n=55 523 participants), non-randomised studies measuring clinical outcomes (22 studies, n=7405), training outcomes (36 studies, n=12 280) and implementation outcomes (21 studies, n=1090), plus descriptive accounts (18 studies, n=2526), baseline surveys and exploratory studies (6 studies, n=17 093) and commentaries (7 studies). Most (40%) were conducted in the African region, region of the Americas (16%), and South-East Asia (13%). Randomised and non-randomised studies reported improved symptoms, substance use, functioning, parenting and child outcomes. Non-randomised studies reported improved clinical knowledge, confidence and skills following training.
The literature beyond the mhGAP-IG is extensive and shares common findings. Future priorities are less-studied regions, interventions for severe mental illness, exploring ways that mhGAP-IG and alternative approaches complement each other in different contexts and scaling-up mental health integration.PROSPERO registration numberCRD42017068459.
世界卫生组织的《精神卫生差距行动规划干预指南》（mhGAP-IG）已在中低收入国家广泛使用。我们回顾了描述 mhGAP-IG 以外的初级卫生保健（PHC）和社区卫生保健（CBH）中精神卫生干预措施和培训方案的文献。
我们搜索了从我们更新的 mhGAP-IG 系统评价中排除的研究，并纳入了其他相关系统评价，以获取将精神卫生纳入 PHC 和 CBH 的举措的证据和经验。我们于 2020 年 11 月 24 日对 mhGAP-IG 进行了搜索，涵盖了 MEDLINE、Embase、PsycINFO、Web of Knowledge、Scopus、CINAHL、LILACS、ScieELO、Cochrane、PubMed 数据库、3ie 和 Google Scholar。尽管异质性妨碍了荟萃分析，但我们对证据基础进行了描述性总结。
在 1827 项结果中，我们确定了 208 份相关记录。它们描述了精神卫生干预措施的随机对照试验（98 项研究，n=55523 名参与者）、测量临床结局的非随机研究（22 项研究，n=7405）、培训结局（36 项研究，n=12280）和实施结局（21 项研究，n=1090），以及描述性报告（18 项研究，n=2526）、基线调查和探索性研究（6 项研究，n=17093）和评论（7 项研究）。大多数（40%）研究在非洲地区、美洲地区（16%）和东南亚（13%）进行。随机和非随机研究报告了症状、物质使用、功能、育儿和儿童结局的改善。非随机研究报告了培训后临床知识、信心和技能的提高。
mhGAP-IG 以外的文献广泛存在，并具有共同的发现。未来的优先事项是研究较少的地区、严重精神疾病的干预措施，探索 mhGAP-IG 和替代方法在不同背景下相互补充的方式，以及扩大精神卫生一体化。
PROSPERO 注册号：CRD42017068459。
