Raghuram Harikeerthan, Rajguru Akanksha Jayant, Pathiyil Mythili Menon, Brahmbhatt Aakrushi, Bhan Anant, Spagnolo Jessica, Naslund John A
Sangath, Bhopal, India.
AIIMS, New Delhi, India.
Int J Ment Health Syst. 2025 Jul 2;19(1):20. doi: 10.1186/s13033-025-00671-z.
Low- and middle-income countries (LMICs) allocate a disproportionately small fraction of their healthcare budgets to mental health, leading to a treatment gap exceeding 75%. To address this disparity, the World Health Organization (WHO) introduced the Mental Health Gap Action Programme (mhGAP), aiming to integrate mental healthcare into primary and community care settings. Central to this initiative is task-sharing: empowering non-specialist healthcare providers to detect and treat mental disorders. Adaptation and modification of mhGAP to the national and local contexts is an integral aspect of the guidelines.
This systematic review of reviews employs the Framework for Reporting Adaptations and Modifications-Expanded (FRAME) to document and characterize modifications to mhGAP implementation in LMICs. The databases searched included Embase, PubMed, PsycINFO, CINAHL, Google Scholar, Cochrane, and Web of Science. Reviews selected in stage 1 were used to find empirical studies from which relevant data was extracted.
Narrative synthesis suggests that modifications primarily focus on content, delivery, and training methods, with limited attention to scaling up. Modifications adopt top down, yet consultative and participatory approaches. There is a notable lack of reporting on challenges, processes, and outcomes. Recommendations have been made to expand FRAME, namely, sources of knowledge, financial and temporal resources employed during the process of modification.
Modifications are essential for adapting interventions to diverse settings, yet they are often researcher-led with limited stakeholder involvement. Better documentation-particularly on challenges and outcomes-is needed. Strengthening frameworks like FRAME can improve reporting, optimize resources, and enhance implementation and scale-up in similar contexts.
低收入和中等收入国家（LMICs）在其医疗保健预算中分配给心理健康的比例小得不成比例，导致治疗缺口超过75%。为了解决这一差距，世界卫生组织（WHO）推出了精神卫生差距行动规划（mhGAP），旨在将精神卫生保健纳入初级和社区护理环境。该倡议的核心是任务分担：使非专科医疗保健提供者有能力检测和治疗精神障碍。使mhGAP适应当地和国家情况是指南的一个组成部分。
本系统综述采用报告改编和修改扩展框架（FRAME）来记录和描述低收入和中等收入国家对mhGAP实施的修改情况。检索的数据库包括Embase、PubMed、PsycINFO、CINAHL、谷歌学术、Cochrane和科学引文索引。第一阶段选择的综述用于查找实证研究，并从中提取相关数据。
叙述性综合分析表明，修改主要集中在内容、交付和培训方法上，对扩大规模的关注有限。修改采用自上而下但协商和参与性的方法。在挑战、过程和结果方面的报告明显不足。有人建议扩大FRAME，即知识来源、修改过程中使用的财务和时间资源。
修改对于使干预措施适应不同环境至关重要，但这些修改往往由研究人员主导，利益相关者参与有限。需要更好的记录，特别是关于挑战和结果的记录。加强FRAME等框架可以改善报告、优化资源，并在类似背景下加强实施和扩大规模。
