Mental healthcare in primary and community-based settings: evidence beyond the WHO Mental Health Gap Action Programme (mhGAP) Intervention Guide.

IF 6.6 2区医学 Q1 PSYCHIATRY

Evidence Based Mental Health Pub Date : 2022-12-01 Epub Date: 2022-04-26 DOI:10.1136/ebmental-2021-300401

Roxanne C Keynejad, Jessica Spagnolo, Graham Thornicroft

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Abstract

Objectives: The WHO's Mental Health Gap Action Programme Intervention Guide (mhGAP-IG) has been widely used in low and middle-income countries. We reviewed literature describing interventions and training programmes beyond the mhGAP-IG, in primary healthcare (PHC) and community-based healthcare (CBH).

Design: We searched studies excluded from our updated mhGAP-IG systematic review, and included in other relevant systematic reviews, for evidence and experience of initiatives integrating mental health into PHC and CBH. Our 24 November 2020 mhGAP-IG search encompassed MEDLINE, Embase, PsycINFO, Web of Knowledge, Scopus, CINAHL, LILACS, ScieELO, Cochrane, PubMed databases, 3ie and Google Scholar. Although heterogeneity prevented meta-analysis, we descriptively summarised the evidence-base.

Results: Out of 1827 results, we identified 208 relevant records. They described randomised controlled trials of mental health interventions (98 studies, n=55 523 participants), non-randomised studies measuring clinical outcomes (22 studies, n=7405), training outcomes (36 studies, n=12 280) and implementation outcomes (21 studies, n=1090), plus descriptive accounts (18 studies, n=2526), baseline surveys and exploratory studies (6 studies, n=17 093) and commentaries (7 studies). Most (40%) were conducted in the African region, region of the Americas (16%), and South-East Asia (13%). Randomised and non-randomised studies reported improved symptoms, substance use, functioning, parenting and child outcomes. Non-randomised studies reported improved clinical knowledge, confidence and skills following training.

Conclusions: The literature beyond the mhGAP-IG is extensive and shares common findings. Future priorities are less-studied regions, interventions for severe mental illness, exploring ways that mhGAP-IG and alternative approaches complement each other in different contexts and scaling-up mental health integration.PROSPERO registration numberCRD42017068459.

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初级和社区环境中的心理保健：世界卫生组织心理健康差距行动方案（mhGAP）干预指南之外的证据。

目的：世界卫生组织的《心理健康差距行动方案干预指南》（mhGAP-IG）已在中低收入国家广泛使用。我们回顾了有关在初级医疗保健（PHC）和社区医疗保健（CBH）中超越 mhGAP-IG 的干预措施和培训计划的文献：设计：我们检索了从更新的 mhGAP-IG 系统性综述中排除的研究，以及其他相关系统性综述中包含的研究，以了解将心理健康纳入初级卫生保健和社区医疗保健的措施的证据和经验。我们于 2020 年 11 月 24 日进行的 mhGAP-IG 检索涵盖了 MEDLINE、Embase、PsycINFO、Web of Knowledge、Scopus、CINAHL、LILACS、ScieELO、Cochrane、PubMed 数据库、3ie 和 Google Scholar。尽管异质性阻碍了荟萃分析，但我们还是对证据基础进行了描述性总结：结果：在 1827 项结果中，我们发现了 208 项相关记录。这些记录描述了心理健康干预的随机对照试验（98 项研究，n=55 523 名参与者）、测量临床结果的非随机研究（22 项研究，n=7405 名参与者）、培训结果（36 项研究，n=12 280 名参与者）和实施结果（21 项研究，n=1090 名参与者），以及描述性叙述（18 项研究，n=2526 名参与者）、基线调查和探索性研究（6 项研究，n=17 093 名参与者）和评论（7 项研究）。大部分研究（40%）在非洲地区、美洲地区（16%）和东南亚地区（13%）进行。随机和非随机研究报告称，症状、药物使用、功能、养育子女和儿童结果均有所改善。非随机研究报告称，接受培训后，临床知识、信心和技能均有所提高：除 mhGAP-IG 之外，还有大量文献报道了共同的研究结果。未来的重点是研究较少的地区、对重性精神病的干预、探索 mhGAP-IG 和其他方法在不同情况下相互补充的方式，以及扩大心理健康整合的规模。

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来源期刊

Evidence Based Mental Health PSYCHIATRY-

CiteScore

18.10

自引率

7.70%

发文量

期刊介绍： Evidence-Based Mental Health alerts clinicians to important advances in treatment, diagnosis, aetiology, prognosis, continuing education, economic evaluation and qualitative research in mental health. Published by the British Psychological Society, the Royal College of Psychiatrists and the BMJ Publishing Group the journal surveys a wide range of international medical journals applying strict criteria for the quality and validity of research. Clinicians assess the relevance of the best studies and the key details of these essential studies are presented in a succinct, informative abstract with an expert commentary on its clinical application.Evidence-Based Mental Health is a multidisciplinary, quarterly publication.