2. Agreements and disagreements with related reviews.
| Author/year | Summary of review | Agreements | Disagreements/differences |
| Barbui 2020 | An umbrella review of systematic reviews to evaluate the strength and credibility of evidence generated in low‐income and middle‐income countries (LMICs) on the efficacy of psychosocial interventions for various mental health outcomes | Review authors identified 123 studies from 8 systematic reviews (Asher 2017; Burkey 2018; Cuijpers 2018; De Silva 2013; Purgato 2018; Rahman 2013; Singla 2017; Turrini 2019), and from the previous version of this review (van Ginneken 2013). The focus was on treatment interventions only, as it was for this review. They found strongest evidence for using psychosocial intervention for adults with depression in humanitarian settings, which correlates with our findings for primary‐level workers. There was some evidence for psychosocial interventions to help functioning in schizophrenia, for adults with depression, and for adults with PTS/PTSD, and possibly for children with PTS/PTSD | Review authors cover all psychosocial interventions whether or not they are delivered by PWs. They do not include any other types of interventions such as those involving use of pharmacotherapy |
| Boer 2005 | Review on paraprofessionals delivering psychological interventions for anxiety and depression (HIC only) (Cochrane Review) | Included studies were from HICs only but support our findings that non‐professional care is generally equivalent to professional care (this review's equivalent of specialist care), and that non‐professional care is better than usual care | Some of the paraprofessionals would have been classified as specialist health workers in our review |
| Bower 2006 | Systematic review on the effects of collaborative care models on antidepressant use. All included studies were from HICs, except Araya 2003. |
Bower 2006 found improvement with antidepressant use, particularly in studies where the case manager had a mental health background, where there was adequate supervision, and where there was systematic identification of patients (rather than waiting for a referral) | We were not able to assess, as did Bower 2006, whether lengths of training, supervision, or other intervention characteristics modified these outcomes because only 5 studies were included in this comparison |
| Barry 2013 | Systematic review and narrative synthesis on interventions promoting positive mental health for young people in school and community‐based settings in LMICs | Similar to our review, Barry 2013 identified interventions that were predominantly delivered in school‐based settings across a wide range of LMIC settings, including those in areas of conflict or humanitarian need, with paucity of data in very young primary school‐aged children. Similar to ours, their findings suggest that trained teachers can effectively deliver mental health promotion interventions | Barry 2013 differed from our review, as it also included quasi‐experimental studies. Barry performed a more detailed review of psychosocial outcomes including self‐esteem, self‐efficacy, coping skills, resilience, social participation, empowerment, communication, and social support, which we did not examine. The review included only papers published in English |
| Burkey 2018 | Systematic review of randomised controlled trials examining effects of psychosocial interventions on reducing behaviour problems among children (under 18) living in LMICs | Similar to our review, this review focuses on the importance of early intervention and recognises the need for task‐shifting. This review also included RCTs | Review authors cover all psychosocial interventions whether or not they are delivered by PWs. They therefore include those delivered by specialists (the majority). They also do not include any other types of interventions such as those involving use of pharmacotherapy, and thus excluded ADHD. They included both prevention and treatment strategies but possibly with stronger emphasis on prevention |
| Clarke 2013 | Systematic review of psychological or social interventions delivered by primary health workers for prevention and care of maternal mental disorders in LMIC | This review included 2 of our treatment studies and focused (as did our review) on PHP and LHW (but not CP) delivery of interventions in LMICs. The effects of psychosocial interventions delivered by PWs for treatment and prevention (combined) compared with usual perinatal care show they may slightly improve maternal depression symptoms (SMD ‐0.34, 95% CI ‐0.53 to ‐0.16; I² = 83.9%) and may reduce the number of women with maternal depression (OR 0.59, 95% CI 0.26 to 0.92; I² = 79.3%) | All other studies (9 of their 11 included RCTs) were prevention interventions. They did not include pharmacological disorders. Clarke 2013 undertook subgroup analyses of group and individual interventions as well as of whether interventions were delivered antenatally or postnatally. However, the numbers of studies per subgroup were small. We considered similar subgroup analyses, but these were not feasible, as the subgroups included fewer than 10 studies |
| Fuhr 2014 | Systematic review of peer‐delivered interventions for severe mental illness and depression | This review is a systematic review and meta‐analysis that showed peer‐led interventions may have some effect in high‐income settings, but findings in low‐income settings were inconclusive due to insufficient evidence | Peer‐led interventions are not included in this review unless the peer has an LHW‐type role for a wider group of people ‐ not just 1‐to‐1 support or ad hoc support for peers |
| Huntley 2012 | Systematic review of the effects of CBT and group CBT | Huntley 2012 found that LHW‐led psychological interventions are effective in the short and medium term in reducing symptoms of depression | Huntley 2012 described the effects of CBT and group CBT (rather than the effects of PWs) |
| Gajaria 2018 | Systematic review of psychological interventions for perinatal depression in low‐ and middle‐income countries | “Majority of the interventions were psychosocial, and were often provided by lay health workers and in the community.” Review authors concluded that there was “evidence for the benefit of psychological interventions in perinatal depression in LMICs.” Rahman 2008 and Rojas 2007 were also included in our review |
Not all 18 studies were RCTs; several studies were preventive in nature; no meta‐analysis was performed |
| Gamieldien 2020 | Protocol paper for a scoping review to map the literature related to recovery of people living with severe mental illness in LMICs | No findings presented, as this was a study protocol | The purpose of Gamieldien 2020 is to identify where the literature has not yet been comprehensively reviewed, or where working definitions and concepts are still under development |
| Keynejad 2018 | Systematic review to identify evidence to date for mhGAP‐IG implementation in LMICs | The 2 RCTs included in this review are also included in our review: protocols of Sikander 2019 and Madhombiro 2017, which is an ongoing study. Review authors concluded that although there is substantial observational and implementation literature on mhGAP, evidence on the effectiveness of training for PWs is insufficient | The review included all grey literature and non‐RCT designs, including non‐intervention literature such as training material and reports and economic modelling |
| Klasen 2013 | Systematic review of all randomised controlled trials in child and adolescent mental health in LMICs, supplemented by evidence from HIC as well as suitable information from child programme evaluations and adult studies in LMICs | This review included 8 trials that are also included in our review. None of the other 17 RCTs met all inclusion criteria for this review (as mentioned in the next column). Given their review has many RCTs, these review authors may have more confidence than authors of our review in saying some interventions developed in HICs may be "stripped down to basic principles" (delivered by lay health workers and simplified interventions) and yet still be effective in LMICs. For example, 10 RCTs (+4 quasi RCTs) addressed trauma‐related disorders | Of the 25 RCTs included in Klasen 2013, 13 studies were prevention studies, 7 employed interventions that were not eligible for inclusion in our review, 3 reported interventions that were delivered by specialists, 1 described interventions delivered by peers, 3 provided traditional or herbal non‐evidence‐based interventions, and 1 may not be a randomised trial (we considered Thabet 2005 to be a controlled before‐and‐after study, not an RCT). In addition, this was a narrative review, so no meta‐analyses provided figures for comparison |
| Kohrt 2018 | A review‐of‐reviews to perform a narrative synthesis to map community interventions in LMIC, identify competencies for community‐based providers, and highlight research gaps | Kohrt 2018 described some of the community interventions included in our review, such as psychoeducation, case management, psychological treatments, and training and supervision of community health workers, formal and non‐formal providers outside the healthcare system, and other primary health professionals in delivering these interventions | Kohrt 2018 differed from our review, as its focus was purely on the role of community components to map community interventions, identify competencies for community‐based providers, and identify research gaps, and it was more process‐oriented than outcomes‐oriented compared to our review, and included only systematic reviews for the synthesis. Our review has included only RCTs to evaluate the effectiveness of mental health interventions delivered by non‐specialists in primary health |
| Lassi 2013 | A systematic review of studies on the role of mid‐level health workers in delivering to the general population healthcare services that are associated with achievement of Millennium Development Goals for health and nutrition or with management of non‐communicable diseases | Lassi 2013 examined the role of task‐shifting to non‐physician health providers (i.e. nurse and allied health providers) to deliver clinical care in the community or at a primary care facility or hospital. This review supported our findings that task‐sharing, especially when part of a team‐based approach with adequate training and supervision, can be useful in helping overcome issues such as poor access to care and costs; however most of the evidence of low to very low certainty | Lassi 2013 focused on non‐communicable diseases and did not examine any mental health outcomes |
| Munodawafa 2018 | Systematic review of process evaluation of task‐sharing interventions for perinatal depression in LMICs | “All three RCTs indicated that the intervention was effective.” Rahman 2008 is featured in this review as well as in ours | Of the 3 studies that were included, 2 were preventive in nature. Process evaluation data were meta‐synthesised |
| Mutamba 2013 | Systematic review of LHWs in prevention of mental, neurological, and substance use disorders in LMICs | This review was based on the same searches and principles of examining a type of health worker as the first review of PWs (van Ginneken 2013), concluding that robust evidence is insufficient for assessing effectiveness | This review will be more relevant to compare to our parallel review on prevention interventions (Purgato 2021), as it pertains to prevention of mental disorders rather than treatment. This new Cochrane prevention review will be an update and an extension of this review |
| Parker 2008 | Review on consultation liaison in primary care ‐ HICs (Cochrane protocol) | ‐ | Our review process did not find any consultation liaison in primary care in LMICs, so results cannot be compared |
| Purgato 2018 | A systematic review and meta‐analysis evaluating the effectiveness of focused psychosocial support interventions for children exposed to traumatic events in humanitarian settings in LMICs, to explore which children are likely to benefit most | Similar to our review, Purgato 2018 provided meta‐analytical evidence for the beneficial effects of focused psychosocial support interventions on PTSD/PTS symptoms (SMD ‐0.33, 95% CI ‐0.52 to ‐0.14) that were maintained at follow‐up (‐0.21, ‐0.42 to ‐0.01), benefits for functional impairment (‐0.29, ‐0.43 to ‐0.15) and for strengths: coping (‐0.22, ‐0.43 to ‐0.02), hope (‐0.29, ‐0.48 to ‐0.09), and social support (‐0.27, ‐0.52 to ‐0.02) | The focus of Purgato 2018 was to identify which population subsets benefit the most from psychosocial interventions, which was beyond the scope of our review, including analyses by age, gender, displacement status, region, and household size |
| Rahman 2013 | Systematic review on interventions for common perinatal mental disorders among women in LMICs | This was a similar but more in‐depth review of our perinatal depression pooled comparison, which also looked at LHW‐led interventions for mothers with perinatal depression. The final pooled outcome was similar in magnitude and direction to ours for our perinatal depression category (SMD ‐0.38, 95% CI ‐0.56 to ‐0.21) vs our findings (SMD ‐0.42, 95% CI ‐0.58 to ‐0.26) | This review differed from ours in that its study inclusion criteria were broader, as it included studies that measured maternal (all perinatal disorders) or child (or both) outcomes, even if the intervention was not primarily targeted at these groups. It also reported child outcomes, which ours did not |
| Shahmalak 2019 | Qualitative analysis of LHW opinions on training, barriers, and facilitators of therapy delivery, factors in successful therapy delivery, and personal impact | Many authors whose studies featured in our review conducted the studies that were featured in this review (I.e. they studied LHWs who had carried out interventions in their studies). Thus, the 2 reviews are complementary to each other | Patient outcomes were not studied |
| Singla 2017 | Systematic review of RCTs using non‐specialist providers to provide psychological treatments for depression, anxiety, and post‐traumatic stress disorder outcomes | They found a positive treatment effect favouring intervention (pooled effect size 0.49, 95% CI 0.36 to 0.62). Studies common between this review and ours include Ali 2003, Araya 2003, Bass 2013, Bolton 2014 (Iraq), Bolton 2014 (Thailand), Bolton 2003, Chibanda 2014, Dybdahl 2001, Fritsch 2007, Milani 2015, Patel 2010, Rahman 2008, Rojas 2007, Weiss 2015, and Yeomans 2010 | Search was up to 2016. Studies conducted in Taiwan and Hong Kong were included. Some included studies are not in our review but will be included in the sister prevention review ‐ Purgato 2018. Authors also studied types of psychological treatments and techniques. They did not extract dichotomous outcomes, nor did they focus on analysis by type of health worker |
| Tol 2011 | Systematic review on mental health interventions in humanitarian settings | Tol 2011 found similar results to our review for school‐based interventions for children with PTSD (i.e. no significant benefit) (an extra study was included in this comparison, which we had excluded, as it did not meet our PW definitions). This review went further and found a statistically significant benefit for improving internalising symptoms (SMD ‐0.34, 95% CI ‐0.40 to ‐0.09). For adults, potential benefit of interventions was also seen | Tol 2011 differed from our review in that it included studies of both PWs and specialists, according to our definitions |
| Woltmann 2012 | Systematic review on collaborative care/chronic care management (HICs) | These review authors also found a statistically significant effect on reduction in depression severity among the 14 HIC studies that were included in the meta‐analysis (SMD 0.31, 95% CI 0.16 to 0.47) (Araya 2003 and Patel 2010 were included in the narrative review but did not qualify for the meta‐analysis). Review authors suggested that collaborative care is of moderate benefit; however, Woltmann 2012 estimated a more conservative value of SMD > 0.5 to show moderate benefit (from the analysis of scales and how to interpret their SMDs). Our meta‐analyses of collaborative care models suggest similar improvements in symptoms and recovery from depression or from CMD (same direction of effect, similar magnitude) | In Woltmann 2012, chronic care management had a stricter definition than our collaborative care definition |
CBT: cognitive‐behavioural therapy; CI: confidence interval; CMD: common mental disorder; CP: community professional; HIC: high‐income country; LHW: lay health worker; LMIC: low‐ and medium‐income country; OR: odds ratio; PHP: primary health professional; PTS: post‐traumatic stress; PTSD: post‐traumatic stress disorder; PW: primary‐level worker; RCT: randomised controlled trial; SMD: standardised mean difference.