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Meta-Analysis
. 2022 May 1;79(5):430-443.
doi: 10.1001/jamapsychiatry.2022.0301.

Association of Task-Shared Psychological Interventions With Depression Outcomes in Low- and Middle-Income Countries: A Systematic Review and Individual Patient Data Meta-analysis

Eirini Karyotaki  1 , Ricardo Araya  2 , Ronald C Kessler  3 , Ahmed Waqas  4 , Arvin Bhana  5   6 , Atif Rahman  7 , Camila T Matsuzaka  8 , Clara Miguel  1 , Crick Lund  2   9 , Emily C Garman  9 , Etheldreda Nakimuli-Mpungu  10 , Inge Petersen  5 , John A Naslund  11 , Marguerite Schneider  9 , Siham Sikander  12   13 , Mark J D Jordans  14 , Melanie Abas  14 , Pauline Slade  15 , Stephen Walters  16 , Traolach S Brugha  17 , Toshi A Furukawa  18 , Yagmur Amanvermez  1 , Marcelo F Mello  8   19 , Milton L Wainberg  20 , Pim Cuijpers  1 , Vikram Patel  11   21
Affiliations
Meta-Analysis

Association of Task-Shared Psychological Interventions With Depression Outcomes in Low- and Middle-Income Countries: A Systematic Review and Individual Patient Data Meta-analysis

Eirini Karyotaki et al. JAMA Psychiatry. .

Erratum in

Abstract

Importance: Task sharing, the training of nonspecialist workers with no formal experience in counseling, is a promising strategy for addressing the large gap in treatment for depression in low- and middle-income countries (LMICs).

Objective: To examine the outcomes and moderators of task-shared psychological interventions associated with depression severity, response, and remission.

Data sources: Systematic literature searches in PubMed, Embase, PsycINFO, and Cochrane Library up to January 1, 2021.

Study selection: Randomized clinical trials (RCTs) of task-shared psychological interventions compared with control conditions for adults with depressive symptoms in LMICs were included.

Data extraction and synthesis: Two researchers independently reviewed the titles, abstracts, and full text of articles from an existing generic meta-analytic database that includes all RCTs on psychotherapy for depression. A systematic review and individual patient data (IPD) meta-analysis was used to estimate the outcomes of task-shared psychological interventions across patient characteristics using mixed-effects models. Procedures for abstracting data and assessing data quality and validity followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guideline.

Main outcomes and measures: Primary outcome was reduction in depression symptom severity measured by the 9-item Patient Health Questionnaire (PHQ-9). Response and remission rates were also estimated.

Results: Of 13 eligible trials, 11 (4145 participants) contributed IPD. Task-shared psychological interventions were associated with a greater decrease in depressive symptom severity than control conditions (Hedges g, 0.32; 95% CI, -0.26 to -0.38). Participants in the intervention groups had a higher chance of responding (odds ratio, 2.11; 95% CI, 1.60 to 2.80) and remitting (odds ratio, 1.87; 95% CI, 1.20 to 1.99). The presence of psychomotor symptoms was significantly associated with the outcomes of task-shared psychological interventions (β [SE], -1.21 [0.39]; P = .002). No other significant associations were identified. Heterogeneity among the trials with IPD was 74% (95% CI, 53%-86%).

Conclusions and relevance: In this meta-analysis of IPD, task-shared psychological interventions were associated with a larger reduction in depressive symptom severity and a greater chance of response and remission than control conditions. These findings show potential for the use of task-sharing of psychological interventions across different groups of patients with depression. Further research would help identify which people are most likely to benefit and strengthen larger-scale implementation of this strategy to address the burden of depression in LMICs.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Kessler reported consultant fees from Datastat, Holmusk, RallyPoint Networks, and Sage Therapeutics and stock options from Mirah, PYM, and Roga Sciences during the conduct of the study. Dr Schneider reported a grant from the National Institute of Mental Health (NIMH) for the AFFIRM project during the conduct of the study. Dr Abas reported grants from NIMH during the conduct of the study. Dr Furukawa reported personal fees and/or grants from Mitsubishi-Tanabe, Shionogi, and Sony outside the submitted work; in addition, Dr Furukawa had a patent pending for 2018-177688 and a patent for copyrights licensed to Mitsubishi-Tanabe. Dr Wainberg reported grants from NIMH during the conduct of the study. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. PRISMA Individual Patient Data (IPD) Diagram of Study Selection Process
aDocuments that could not be retrieved from the university library, which were mainly abstracts published for conferences. bDocuments that did not match the description of the other exclusion categories (eg, trial registrations, replies to letters to the editor).
Figure 2.
Figure 2.. Effects of Task-Shared Psychological Interventions Compared With Controls on Depression Symptom Severity at Postintervention Assessment
See this image and copyright information in PMC

Comment in

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