The Effectiveness of Peer-Delivered Services in the Management of Mental Health Conditions: a Meta-Analysis of Studies from Low- and Middle-Income Countries

2016 ◽  
Vol 38 (4) ◽  
pp. 330-344 ◽  
Author(s):  
Zahir Vally ◽  
Lameze Abrahams
Keyword(s):  
Mental Health ◽  
Meta Analysis ◽  
Health Conditions ◽  
Middle Income ◽  
Mental Health Conditions ◽  
Middle Income Countries ◽  
Low And Middle Income

scholarly journals Cultural adaptation framework of social interventions in mental health: Evidence-based case studies from low- and middle-income countries

2019 ◽  
Vol 66 (1) ◽  
pp. 41-48 ◽  
Author(s):  
Meredith Fendt-Newlin ◽  
Aarti Jagannathan ◽  
Martin Webber
Keyword(s):  
Mental Health ◽  
Cultural Adaptation ◽  
Health Conditions ◽  
Evidence Based ◽  
Middle Income ◽  
Mental Health Conditions ◽  
Social Interventions ◽  
Middle Income Countries ◽  
Low And Middle Income

Background: Evidence-based strategies for treating mental health conditions need to be scaled up to address the mental health treatment gap in low- and middle-income countries. Most medical and psychological interventions for the treatment of mental health conditions have been developed and evaluated in high-income countries. However, the imperative of scaling up such interventions potentially ignores local realities, and may also discredit or replace local frameworks for responding to distress. Aims: This article aims to develop a framework for the cultural adaptation of social interventions which are developed within, and draw upon, local contexts, to ensure they are acceptable, feasible and effective. Method: A case study approach is used to discuss the feasibility of developing and adapting psychosocial interventions which are embedded in local knowledge, values and practices. Results: The first case study introduces yoga as an alternative and/or complementary, and culturally relevant, approach for people experiencing mental health conditions in India. The second case study is a cross-cultural adaptation of a psychosocial intervention from the United Kingdom to fit the local idioms of distress and service context in Sierra Leone, as the country battled with the Ebola outbreak. We use these case studies to develop a Cultural Adaptation Framework, which recognises that people and their mental health are products of their culture and society, to inform the future development, adaptation and evaluation of sociocultural interventions for people experiencing mental health conditions in low- and middle-income countries. Conclusion: The Cultural Adaptation Framework can be used to ensure interventions are culturally relevant and responsive to local conditions prior to evaluating in experimental studies.

scholarly journals Impact of maternal mental health interventions on child-related outcomes in low- and middle-income countries: a systematic review and meta-analysis

2020 ◽  
Vol 29 ◽  
Author(s):  
W. A. Tol ◽  
M. C. Greene ◽  
M. E. Lasater ◽  
K. Le Roch ◽  
C. Bizouerne ◽  
...  
Keyword(s):  
Mental Health ◽  
Exclusive Breastfeeding ◽  
Home Visiting ◽  
Health Workers ◽  
Maternal Mental Health ◽  
Meta Analysis ◽  
Middle Income ◽  
Middle Income Countries ◽  
Child Height ◽  
Low And Middle Income

Abstract Aims Observational studies have shown a relationship between maternal mental health (MMH) and child development, but few studies have evaluated whether MMH interventions improve child-related outcomes, particularly in low- and middle-income countries. The objective of this review is to synthesise findings on the effectiveness of MMH interventions to improve child-related outcomes in low- and middle-income countries (LMICs). Methods We searched for randomised controlled trials conducted in LMICs evaluating interventions with a MMH component and reporting children's outcomes. Meta-analysis was performed on outcomes included in at least two trials. Results We identified 21 trials with 28 284 mother–child dyads. Most trials were conducted in middle-income countries, evaluating home visiting interventions delivered by general health workers, starting in the third trimester of pregnancy. Only ten trials described acceptable methods for blinding outcome assessors. Four trials showed high risk of bias in at least two of the seven domains assessed in this review. Narrative synthesis showed promising but inconclusive findings for child-related outcomes. Meta-analysis identified a sizeable impact of interventions on exclusive breastfeeding (risk ratio = 1.39, 95% confidence interval (CI): 1.13–1.71, ten trials, N = 4749 mother–child dyads, I2 = 61%) and a small effect on child height-for-age at 6-months (std. mean difference = 0.13, 95% CI: 0.02–0.24, three trials, N = 1388, I2 = 0%). Meta-analyses did not identify intervention benefits for child cognitive and other growth outcomes; however, few trials measured these outcomes. Conclusions These findings support the importance of MMH to improve child-related outcomes in LMICs, particularly exclusive breastfeeding. Given, the small number of trials and methodological limitations, more rigorous trials should be conducted.

scholarly journals Challenges to peer support in low- and middle-income countries during COVID-19

2020 ◽  
Vol 16 (1) ◽  
Author(s):  
Richard Mpango ◽  
Jasmine Kalha ◽  
Donat Shamba ◽  
Mary Ramesh ◽  
Fileuka Ngakongwa ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Care ◽  
Peer Support ◽  
Global Mental Health ◽  
Health Conditions ◽  
Middle Income ◽  
Low Resource Settings ◽  
Mental Health Conditions ◽  
Middle Income Countries

Abstract Background A recent editorial urged those working in global mental health to “change the conversation” on coronavirus disease (Covid-19) by putting more focus on the needs of people with severe mental health conditions. UPSIDES (Using Peer Support In Developing Empowering mental health Services) is a six-country consortium carrying out implementation research on peer support for people with severe mental health conditions in high- (Germany, Israel), lower middle- (India) and low-income (Tanzania, Uganda) settings. This commentary briefly outlines some of the key challenges faced by UPSIDES sites in low- and middle-income countries as a result of Covid-19, sharing early lessons that may also apply to other services seeking to address the needs of people with severe mental health conditions in similar contexts. Challenges and lessons learned The key take-away from experiences in India, Tanzania and Uganda is that inequalities in terms of access to mobile technologies, as well as to secure employment and benefits, put peer support workers in particularly vulnerable situations precisely when they and their peers are also at their most isolated. Establishing more resilient peer support services requires attention to the already precarious situation of people with severe mental health conditions in low-resource settings, even before a crisis like Covid-19 occurs. While it is essential to maintain contact with peer support workers and peers to whatever extent is possible remotely, alternatives to face-to-face delivery of psychosocial interventions are not always straightforward to implement and can make it more difficult to observe individuals’ reactions, talk about emotional issues and offer appropriate support. Conclusions In environments where mental health care was already heavily medicalized and mostly limited to medications issued by psychiatric institutions, Covid-19 threatens burgeoning efforts to pursue a more holistic and person-centered model of care for people with severe mental health conditions. As countries emerge from lockdown, those working in global mental health will need to redouble their efforts not only to make up for lost time and help individuals cope with the added stressors of Covid-19 in their communities, but also to regain lost ground in mental health care reform and in broader conversations about mental health in low-resource settings.

Physical injury and psychotic experiences in 48 low- and middle-income countries

2019 ◽  
pp. 1-8 ◽  
Author(s):  
A. Stickley ◽  
T. Sumiyoshi ◽  
Z. Narita ◽  
H. Oh ◽  
J. E. DeVylder ◽  
...  
Keyword(s):  
Mental Health ◽  
Meta Analysis ◽  
World Health ◽  
Multivariable Logistic Regression Analysis ◽  
Psychotic Experiences ◽  
Mental Health Systems ◽  
World Health Survey ◽  
Middle Income ◽  
Middle Income Countries ◽  
Low And Middle Income

AbstractBackgroundPsychotic experiences (PEs) may be associated with injuries, but studies focusing specifically on low- and middle-income countries (LAMICs) are scarce. Thus, the current study examined the link between injuries and PEs in a large number of LAMICs.MethodCross-sectional data were used from 242 952 individuals in 48 LAMICs that were collected during the World Health Survey in 2002–2004 to examine the association between traffic-related and other (non-traffic-related) forms of injury and PEs. Multivariable logistic regression analysis and meta-analysis were used to examine associations while controlling for a variety of covariates including depression.ResultsIn fully adjusted analyses, any injury [odds ratio (OR) 2.07, 95% confidence interval (CI) 1.85–2.31], traffic injury (OR 1.84, 95% CI 1.53–2.21) and other injury (OR 2.09, 95% CI 1.84–2.37) were associated with higher odds for PEs. Results from a country-wise analysis showed that any injury was associated with significantly increased odds for PEs in 39 countries with the overall pooled OR estimated by meta-analysis being 2.46 (95% CI 2.22–2.74) with a moderate level of between-country heterogeneity (I2 = 56.3%). Similar results were observed across all country income levels (low, lower-middle and upper-middle).ConclusionsDifferent types of injury are associated with PEs in LAMICs. Improving mental health systems and trauma capacity in LAMICs may be important for preventing injury-related negative mental health outcomes.

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