Usher Institute, University of Edinburgh, Teviot Place, Edinburgh, Scotland.
Department of Clinical and Health Psychology, School of Health in Social Sciences, University of Edinburgh, Teviot Place, Edinburgh, Scotland.
J Glob Health. 2022 Jun 11;12:04049. doi: 10.7189/jogh.12.04049.
Depression commonly co-exists with human immunodeficiency virus (HIV), but in low- and middle-income countries (LMICs), where the HIV burden is greatest, mental health resources are limited. These settings may benefit from psychosocial interventions delivered to people living with HIV/AIDS (PLWH) by non-mental health specialists. We aimed to systematically review randomised controlled trials (RCTs) that investigated the effectiveness of psychosocial interventions delivered by non-mental health specialists to prevent depression in PLWH in LMICs.
We used a comprehensive electronic search strategy to identify RCTs of any stage, including pilot studies, which reported on the effectiveness of a psychosocial intervention on depression among adults living with HIV/AIDS in a LMIC setting. Screening, study selection and data extraction was completed independently by two authors. We assessed risk of bias using the Cochrane risk of bias (RoB) tool and performed a narrative synthesis.
We identified 3431 studies, from which we included 15 studies corresponding to 14 RCTs and a total of 3997 PLWH. Eleven studies were parallel RCTs, one was a stepped-wedged RCT, one was a full factorial RCT, one was a three-arm RCT and four were pilot studies. Studies were generally small, with eight including depression as a primary outcome. All but four trials included men and women and most studies followed participants for less than one year. Twelve trials had at least one domain in which there was a high risk of bias, with the remaining two trials having at least one domain of concern, due to lack of reporting of items. In 12 studies people in the intervention arm had statistically significantly (P < 0.05) lower or more reduced depressive symptom scores, or were less likely to have major depression, at final follow-up than people in the control group.
Psychosocial interventions delivered by non-specialist mental health workers may be effective in preventing or reducing depression in PLWH in LMICs. However, existing studies are small with a relatively short follow-up period and have methodological limitations. Future trials should address these shortcomings, establish whether intervention effects are clinically meaningful and investigate cost-effectiveness.
抑郁症常与人类免疫缺陷病毒（HIV）共存，但在中低收入国家（LMICs），HIV 负担最重，精神卫生资源有限。这些环境可能受益于非精神卫生专家向艾滋病毒/艾滋病感染者（PLWH）提供的心理社会干预。我们旨在系统地审查随机对照试验（RCTs），这些试验调查了非精神卫生专家提供的心理社会干预在预防 LMICs 中 PLWH 抑郁方面的有效性。
我们使用全面的电子搜索策略来确定任何阶段的 RCTs，包括试点研究，这些研究报告了在 LMIC 环境中，对成年人进行 HIV 感染的心理社会干预对抑郁的有效性。两名作者独立进行了筛选、研究选择和数据提取。我们使用 Cochrane 风险偏倚（RoB）工具评估了风险偏倚，并进行了叙述性综合。
我们确定了 3431 项研究，从中纳入了 15 项研究，对应 14 项 RCT 和总共 3997 名 PLWH。11 项研究为平行 RCT，1 项为阶梯式 RCT，1 项为完全因子 RCT，1 项为三臂 RCT，4 项为试点研究。这些研究通常规模较小，其中 8 项将抑郁作为主要结局。除了四项试验外，所有试验都包括了男性和女性，大多数研究的随访时间都不到一年。12 项试验至少有一个领域存在高风险偏倚，其余两项试验由于缺乏对项目的报告，存在至少一个关注领域。在 12 项研究中，干预组的人在最终随访时，抑郁症状评分显著（P<0.05）降低或更多降低，或者不太可能患有重度抑郁症，比对照组的人。
非专业精神卫生工作者提供的心理社会干预可能在预防或减轻 LMICs 中 PLWH 的抑郁方面有效。然而，现有的研究规模较小，随访时间相对较短，且存在方法学上的局限性。未来的试验应解决这些缺陷，确定干预效果是否具有临床意义，并研究成本效益。
