Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Italy.
Global Program Expert Group on Mental Health and Psychosocial Support, SOS Children's Villages, Milan, Italy.
Int J Soc Psychiatry. 2023 Nov;69(7):1578-1591. doi: 10.1177/00207640231174451. Epub 2023 May 15.
to assess the efficacy of psychosocial interventions delivered through task-sharing approaches for preventing perinatal common mental disorders among women in low- and middle-income countries.
We conducted a systematic review of randomized controlled trials following a prespecified protocol registered in the Open Science Framework (osf.io/qt4y3). We searched MEDLINE, Web of Science, PsycINFO, and Cochrane Central Register of Controlled Trials (CENTRAL) through June 2022. Two reviewers independently extracted the data and evaluated the risk of bias of included studies using the Cochrane risk of bias tool. We performed random-effects meta-analyses and rated the certainty of evidence using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach.
We included 23 studies with 24,442 participants. At post-intervention, task-shared psychosocial interventions, were effective in preventing the development of mental disorders in general (RR 0.57, 95% CI [0.35, 0.91]), and specifically depression (RR 0.51, 95% CI [0.35, 0.75]), but not anxiety disorders (RR 0.46, 95% CI [0.06, 3.33]). Similarly, psychosocial interventions reduced psychological distress (SMD -1.32, 95% CI [-2.28, -0.35]), and depressive symptoms (SMD -0.50, 95% CI [-0.80, -0.16]), and increased parenting self-efficacy (SMD -0.76, 95% CI [-1.13, -0.38]) and social support (SMD -0.72, 95% CI [-1.22, -0.22]). No effect was detected for anxiety symptoms at post-intervention. At follow-up the beneficial effects of interventions progressively decreased.
Psychosocial interventions delivered through the task-sharing modality are effective in preventing perinatal common mental disorders and fostering positive mental health among women in low- and middle-income countries. However, our findings are tentative, due to the low number of preventative intervention strategies considering outcomes as the incidence of mental disorders, especially in the long-term. This evidence supports calls to implement and scale up psychosocial prevention interventions for perinatal common mental disorders in low- and middle-income countries.
评估通过任务分担方法提供的心理社会干预措施预防中低收入国家妇女围产期常见精神障碍的效果。
我们按照预先设定的方案在开放科学框架（osf.io/qt4y3）中进行了系统评价。我们通过 6 月检索了 MEDLINE、Web of Science、PsycINFO 和 Cochrane 对照试验中心注册库（CENTRAL）。两名审查员独立提取数据，并使用 Cochrane 偏倚风险工具评估纳入研究的偏倚风险。我们进行了随机效应荟萃分析，并使用推荐评估、制定与评价（GRADE）方法对证据质量进行评级。
我们纳入了 23 项研究，共 24442 名参与者。在干预后，任务分担的心理社会干预措施在预防一般精神障碍（RR 0.57，95%CI [0.35, 0.91]）和特定的抑郁障碍（RR 0.51，95%CI [0.35, 0.75]）方面是有效的，但在预防焦虑障碍方面无效（RR 0.46，95%CI [0.06, 3.33]）。同样，心理社会干预措施降低了心理困扰（SMD -1.32，95%CI [-2.28, -0.35]）、抑郁症状（SMD -0.50，95%CI [-0.80, -0.16]），并增加了育儿自我效能感（SMD -0.76，95%CI [-1.13, -0.38]）和社会支持（SMD -0.72，95%CI [-1.22, -0.22]）。干预后对焦虑症状没有影响。随访时，干预的有益效果逐渐减弱。
通过任务分担模式提供的心理社会干预措施在预防中低收入国家妇女围产期常见精神障碍和促进其心理健康方面是有效的。然而，由于预防干预策略的数量较少，考虑到精神障碍的发生率，特别是在长期内，我们的发现是不确定的。这一证据支持了在中低收入国家实施和扩大围产期常见精神障碍心理预防干预的呼吁。
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