在低收入和中等收入国家将心理预防干预措施与针对心理健康社会决定因素的干预措施相结合的有效性：一项系统评价和荟萃分析。
Effectiveness of combining psychological prevention interventions with interventions that address the social determinants of mental health in low- and middle-income countries: a systematic review and meta-analysis.
作者信息
Prina Eleonora, Bano Beatrice, Singh Rakesh, Albanese Emiliano, Trujillo Daniela, Sanguineti Maria Cecilia Dedios, Sorsdahl Katherine, Luitel Nagendra, Garman Emily, Purgato Marianna, Barbui Corrado, Jordans Mark, Lund Crick
机构信息
WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.
出版信息
BMJ Ment Health. 2025 May 26;28(1):e301573. doi: 10.1136/bmjment-2025-301573.
QUESTION
Task-shared preventive psychological interventions combined with interventions addressing social determinants of mental health may prevent common mental health conditions (CMHCs), particularly in low- and middle-income countries (LMICs). However, an evidence synthesis of their combination has not yet been investigated. We aimed to systematically assess the effectiveness of these combined interventions in LMICs.
STUDY SELECTION AND ANALYSIS
We searched Epistemonikos, CENTRAL, MEDLINE, Embase, PsycINFO, CINAHL, GIM, ClinicalTrials.gov and WHO ICTRP until 2 September 2024. Two reviewers independently abstracted the data and evaluated the risk of bias of included studies using the Cochrane Risk of Bias 2 tool. We performed random-effects meta-analyses to assess the primary outcome, which was the incidence of CMHCs, and rated the certainty of evidence using the Grading of Recommendations Assessment, Development, and Evaluation approach. The protocol was registered in PROSPERO (CRD42023451072).
FINDINGS
Of the 21 780 records identified from electronic sources, we included 31 randomised controlled trials from 21 LMICs involving 35 885 participants. Combined interventions were effective in reducing the incidence of depression and post-traumatic stress disorders at postintervention compared with control conditions for adults (risk ratio (RR) 0.82, 95% CI 0.73 to 0.93) and children (RR 0.70, 95% CI 0.49 to 0.99). At 7-24 months, we only found beneficial effects of combined interventions for depressive symptoms in children (standardised mean difference -0.41, 95% CI -0.63 to -0.18). No data were available on the incidence of anxiety.
CONCLUSIONS
Combined task-shared interventions are effective in mostly short-term prevention of CMHCs in LMICs. Combining strategies targeting social determinants with psychological prevention approaches offers a potential opportunity to reduce the global mental health burden. Future research should focus on key intervention components and head-to-head comparisons between different interventions and between their components.
PROSPERO REGISTRATION NUMBER
CRD42023451072.
问题
任务共享的预防性心理干预措施与针对心理健康社会决定因素的干预措施相结合，可能会预防常见心理健康问题（CMHCs），尤其是在低收入和中等收入国家（LMICs）。然而，尚未对它们的组合进行证据综合分析。我们旨在系统评估这些联合干预措施在低收入和中等收入国家的有效性。
研究选择与分析
我们检索了Epistemonikos、CENTRAL、MEDLINE、Embase、PsycINFO、CINAHL、GIM、ClinicalTrials.gov和WHO ICTRP，检索截止至2024年9月2日。两名 reviewers 独立提取数据，并使用Cochrane偏倚风险2工具评估纳入研究的偏倚风险。我们进行随机效应荟萃分析以评估主要结局，即CMHCs的发病率，并使用推荐分级评估、制定和评价方法对证据的确定性进行评级。该方案已在PROSPERO（CRD42023451072）注册。
结果
从电子来源识别出的21780条记录中，我们纳入了来自21个低收入和中等收入国家的31项随机对照试验，涉及35885名参与者。与对照条件相比，联合干预措施在干预后有效降低了成人（风险比（RR）0.82，95%CI 0.73至0.93）和儿童（RR 0.70，95%CI 0.49至0.99）的抑郁症和创伤后应激障碍发病率。在7至24个月时，我们仅发现联合干预措施对儿童抑郁症状有有益影响（标准化均差 -0.41，95%CI -0.63至 -0.18）。没有关于焦虑发病率的数据。
结论
联合任务共享干预措施在低收入和中等收入国家大多能有效短期预防常见心理健康问题。将针对社会决定因素的策略与心理预防方法相结合，为减轻全球心理健康负担提供了一个潜在机会。未来的研究应关注关键干预组成部分，以及不同干预措施及其组成部分之间的直接比较。
PROSPERO注册号：CRD42023451072。
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