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Mwale O, Kasambala C, Houde A, Mpinga K, Kayira W, Harawa M, Kamwiyo M, Isaacs R, Nhlema B, Ruderman T, Liwimbi O, Udedi M, Kelly K, McBain RK. Patient perspectives on group problem management plus for adults with major depressive disorder in rural Malawi. Glob Health Action 2025; 18:2500785. [PMID: 40340587 PMCID: PMC12068342 DOI: 10.1080/16549716.2025.2500785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Accepted: 04/28/2025] [Indexed: 05/10/2025] Open
Abstract
BACKGROUND Major depressive disorder (MDD) frequently co-occurs with other medical conditions. Care integration and task shifting are two frameworks that may strengthen person-centered care among individuals with MDD and comorbid diagnoses, including for adults with limited access to healthcare resources living in rural settings within sub-Saharan Africa. OBJECTIVE We assessed the acceptability and feasibility of group psychotherapy (Problem Management Plus [PM+]) integrated into chronic healthcare services in Neno District, based on key informant (KI) interviews with clients who received PM+ services from local counselors. METHODS We conducted in-depth interviews with 31 KIs, comprising adult patients participating in group PM+ in rural Malawi. The interview covered facets such as knowledge acquisition, logistical considerations for organizing PM+ sessions, selection of appropriate venues, session format, and overall perceived acceptability. Themes were identified through thematic content analysis. RESULTS We identified five emergent themes: limited prior awareness and understanding of MDD, positive elements of the PM+ service delivery model, patients' perceived effectiveness of PM+, logistical challenges with effectively engaging PM+, and positive views on acceptability of PM+. Findings revealed a strong appreciation and enthusiasm for PM+, although KIs noted areas for improvement - including lengthy travel times to receive PM+, limited compensation and privacy, and counselors arriving late. CONCLUSION Insights from clients underscore the potential utility of group PM+ as a task-shifted model of MDD care that can be integrated into existing service packages in resource-limited settings, as well as opportunities for improvements such as reducing travel time to care and identifying venues with greater client privacy. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT04777006.
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Affiliation(s)
| | | | - Amruta Houde
- Ministry of Health, Zomba Mental Hospital, Zomba, Malawi
| | | | | | | | | | - Rachel Isaacs
- Ministry of Health, Zomba Mental Hospital, Zomba, Malawi
| | | | | | - Olive Liwimbi
- Clinical Services, Ministry of Health, Lilongwe, Malawi
| | | | - Ksakrad Kelly
- Ministry of Health, Zomba Mental Hospital, Zomba, Malawi
| | - Ryan K. McBain
- Healthcare Delivery, RAND Corporation, Washington, DC, USA
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Adjorlolo S, Boakye DS, Xatse E, Akorli VV, Adjorlolo PK, Battanis YY, Frempong AB, Ocansey LK, Yeboah C. Mental Health Interventions for Young People Living With HIV/AIDS in Sub-Saharan Africa: A Systematic Review. AIDS Res Treat 2025; 2025:5323539. [PMID: 40342493 PMCID: PMC12061527 DOI: 10.1155/arat/5323539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2024] [Accepted: 04/17/2025] [Indexed: 05/11/2025] Open
Abstract
Introduction: Young people (aged 15-24) living with HIV/AIDS (YPLHIV) in sub-Saharan Africa (SSA) experience higher rates of mental health conditions compared to their uninfected peers. Research and practitioners have expressed interest in designing and implementing mental health interventions to improve the mental health and well-being of this vulnerable population. However, there is limited effort to systematically synthesize existing evidence on mental health interventions for YPLHIV to address salient questions relating to effectiveness, characteristics, practice issues among others to inform practice, and future research endeavors. This systematic review was conducted to take stock and synthesize existing data to address the above issues. Methods: This review was conducted per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive search strategy was implemented, utilizing five electronic databases and gray literature repositories. Studies (1) from SSA that focused on young adults with HIV/AIDS and (2) examined the effectiveness of interventions designed to enhance mental health outcomes and treatment adherence were included. Two independent reviewers were involved in the study selection, data extraction, and quality assessment, resolving discrepancies by consensus or consultation. Data were presented using narrative syntheses. Results: Eight studies met the inclusion criteria, with a total sample size of 1510 participants, reporting on interventions from six African countries. The interventions were categorized as follows: cognitive behavioral therapy-based, family-based, peer support, and community-based. The interventions showed mixed effectiveness for depression, with three studies demonstrating significant improvements while four showed no substantial change. The only study on improving anxiety reported promising results. Four interventions positively influenced ART adherence, although with varying magnitudes. Peer support, family-based approach, and digital (mobile phone) approaches were identified as effective strategies. Conclusions: The review showed promising approaches to improve mental health in YPLHIV, namely, through peer support, family-based, and digital (i.e., mobile phone) approaches. Although the results were mixed for depression and limited but positive for anxiety, several interventions improved ART adherence. However, the modest evidence base and varied measurement approaches necessitate more research across SSA.
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Affiliation(s)
- Samuel Adjorlolo
- Department of Mental Health Nursing, College of Health Sciences, University of Ghana, Legon, Greater Accra Region, Ghana
- Research and Grant Institute of Ghana, Legon, Greater Accra Region, Ghana
| | - Dorothy Serwaa Boakye
- Department of Health Administration and Education, University of Education, Winneba, Central Region, Ghana
| | - Eugenia Xatse
- Department of Mental Health Nursing, College of Health Sciences, University of Ghana, Legon, Greater Accra Region, Ghana
| | | | - Paul Kwame Adjorlolo
- Department of Biostatistics, School of Public Health, University of Ghana, Legon, Greater Accra Region, Ghana
| | | | | | - Lydia Kaki Ocansey
- Research and Grant Institute of Ghana, Legon, Greater Accra Region, Ghana
| | - Cecilia Yeboah
- Research and Grant Institute of Ghana, Legon, Greater Accra Region, Ghana
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Helova A, Onono M, Ogolla-Onyando M, Ouma E, Imran R, Beres LK, Hampanda K, Owuor K, Szychowski JM, Ongeri L, Abuogi LL, Turan JM. Evaluation of risk stratification and problem management plus (PM+) for pregnant women with HIV in Kenya (Tatua study): Protocol paper. Contemp Clin Trials 2025; 151:107838. [PMID: 39921155 DOI: 10.1016/j.cct.2025.107838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2024] [Revised: 01/26/2025] [Accepted: 01/31/2025] [Indexed: 02/10/2025]
Abstract
BACKGROUND While many pregnant and postpartum women with HIV (PPWH) in the African Region successfully engage in HIV care, a substantial number still face significant barriers, including poor mental health and HIV stigma. These psychosocial barriers contribute to poor medication and clinic visit adherence, poor health outcomes, including unsuppressed viral load, and increased risk of perinatal transmission of HIV. To efficiently improve health outcomes within a resource-constrained health system, responsive and effective interventions are urgently needed to support women who are at the highest risk of sub-optimal outcomes. OBJECTIVE To determine whether risk stratification of PPWH in conjunction with an evidence-based, tailored, lay health worker-delivered psychological intervention can optimize health outcomes for PPWH and their infants. METHODS Using human-centered design, we will adapt Problem Management Plus (PM+) with PPWH for in-person and mobile delivery formats to prevent sub-optimal treatment adherence and HIV care disengagement among PPWH in Kisumu, Kenya. We will test the adapted PM+ intervention among 120 PPWH randomized 1:1:1 to standard of care, in-person PM+, or mobile PM+ in a hybrid type 2 implementation effectiveness pilot trial. Implementation outcomes, including feasibility, acceptability, and intervention satisfaction, as well as preliminary effectiveness outcomes in mental health and HIV, will be evaluated. EXPECTED STUDY OUTCOMES We anticipate that the adapted PM+ intervention will be highly acceptable and feasible to implement and have the potential to be effective at reducing care disengagement, viremia, and psychological distress in PPWH.
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Affiliation(s)
- Anna Helova
- Department of Health Policy and Organization, School of Public Health, The University of Alabama at Birmingham, 1665 University Blvd, Birmingham, 35233, AL, United States; Sparkman Center for Global Health, School of Public Health, The University of Alabama at Birmingham, 1665 University Blvd, Birmingham, 35233, AL, United States.
| | - Maricianah Onono
- Centre for Microbiology Research, Kenya Medical Research Institute, Karume Road/ Jairo Street Junction, Kisumu, Kenya
| | - Mercelline Ogolla-Onyando
- Centre for Microbiology Research, Kenya Medical Research Institute, Karume Road/ Jairo Street Junction, Kisumu, Kenya
| | - Emmah Ouma
- Centre for Microbiology Research, Kenya Medical Research Institute, Karume Road/ Jairo Street Junction, Kisumu, Kenya.
| | - Rabbia Imran
- Department of Pediatrics, School of Medicine, University of Colorado Denver, 13123 East 16th Avenue Box 055, Aurora, 80045, CO, United States.
| | - Laura K Beres
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, 21205, MD, United States.
| | - Karen Hampanda
- Department of OB-GYN-Gyn & OB Health, School of Medicine, University of Colorado Denver, 13199 E. Montview Blvd., Suite 310, A090, 80045 Aurora, CO, United States.
| | - Kevin Owuor
- Sparkman Center for Global Health, School of Public Health, The University of Alabama at Birmingham, 1665 University Blvd, Birmingham, 35233, AL, United States; Department of Biostatistics, School of Public Health, The University of Alabama at Birmingham, 1665 University Blvd, Birmingham, 35233, AL, United States.
| | - Jeff M Szychowski
- Department of Biostatistics, School of Public Health, The University of Alabama at Birmingham, 1665 University Blvd, Birmingham, 35233, AL, United States.
| | - Linnet Ongeri
- Centre for Clinical Research, Kenya Medical Research Institute, Mbagathi way, 20778 - 00200, Nairobi, Kenya
| | - Lisa L Abuogi
- Department of Pediatrics, School of Medicine, University of Colorado Denver, 13123 East 16th Avenue Box 055, Aurora, 80045, CO, United States.
| | - Janet M Turan
- Department of Health Policy and Organization, School of Public Health, The University of Alabama at Birmingham, 1665 University Blvd, Birmingham, 35233, AL, United States; Sparkman Center for Global Health, School of Public Health, The University of Alabama at Birmingham, 1665 University Blvd, Birmingham, 35233, AL, United States.
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Nadkarni A, Massazza A, Tol WA, Bogdanov S, Andersen LS, Moore Q, Roberts B, Weiss HA, Singh S, Neuman M, May C, Fuhr DC. Development of a non-specialist worker delivered psychological intervention to address alcohol use disorders and psychological distress among conflict-affected populations in Uganda and Ukraine. Int J Ment Health Syst 2025; 19:2. [PMID: 39780252 PMCID: PMC11708126 DOI: 10.1186/s13033-024-00656-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 11/25/2024] [Indexed: 01/11/2025] Open
Abstract
BACKGROUND Despite the significant burden of alcohol use disorders (AUD), there is a large treatment gap, especially in settings and populations affected by armed conflict. A key barrier to care is the lack of contextually relevant interventions and adequately skilled human resources to deliver them. This paper describes the systematic development of the CHANGE intervention, a potentially scalable psychological intervention for people with co-existing AUD and psychological distress in conflict-affected populations, delivered by non-specialist workers (NSWs). METHODS CHANGE was developed in sequential steps: (1) identifying potential treatment strategies through a meta-review and Delphi survey with international experts; (2) in-depth interviews (IDIs) with key stakeholders from the study settings in Uganda and Ukraine; and (3) three consultative workshops with international experts and experts from Uganda and Ukraine to develop a theoretical framework for the intervention informed by outputs of the Delphi and IDIs. RESULTS In the Delphi survey, experts reached agreement on the acceptability, feasibility and potential effectiveness of the following components: identify high-risk situations, problem solving skills, assessment, handling drinking urges, communication skills, pros and cons of drinking, and identifying high-risk situations. From the IDIs we identified (a) causal attributions for using alcohol e.g., psychosocial stressors; (b) cultural norms related to alcohol consumption such as patriarchal stereotypes; and (c) coping strategies to deal with drinking problems such as distraction. The CHANGE intervention developed through the consultative workshops can be delivered in three sequential phases focussed on assessment, feedback, and information (Phase 1); providing the client with need-based skills for dealing with high-risk situations related to alcohol use (Phase 2), and relapse prevention and management (Phase 3). CONCLUSIONS CHANGE is a contextually relevant and potentially scalable treatment for co-existing AUD and psychological distress to be delivered by NSWs to conflict-affected populations. Effectiveness and cost-effectiveness of CHANGE will be tested in Uganda and Ukraine.
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Affiliation(s)
- Abhijit Nadkarni
- Centre for Global Mental Health, Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK WC1E 7HT, UK.
| | - Alessandro Massazza
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
- United for Global Mental Health, Somerset House, Strand, London, WC2R 1LA, UK
| | - Wietse A Tol
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Sergiy Bogdanov
- Centre for Mental Health and Psychosocial Support, National University of Kyiv-Mohyla Academy, Kyiv, Ukraine
| | - Lena S Andersen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Quincy Moore
- Centre for Mental Health and Psychosocial Support, National University of Kyiv-Mohyla Academy, Kyiv, Ukraine
| | - Bayard Roberts
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Helen A Weiss
- Department of Infectious Disease Epidemiology and International Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Soumya Singh
- Addictions and Related Research Group, Sangath, India
| | - Melissa Neuman
- Department of Infectious Disease Epidemiology and International Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Carl May
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Daniela C Fuhr
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology, Bremen, Germany
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Fink G, Melero-Dominguez M, Chembe M, de Vernisy-Romero D, Tembo T, Billima T, Paul R, Alegria M, Parkerson D, Rockers PC, Banda Z, Lungu G, Sikazwe D, Falgas-Bague I. Feasibility and acceptability of the Problem Management for Moms programme for improving maternal mental health in Zambia: an open-label trial. Lancet Psychiatry 2024; 11:965-974. [PMID: 39515361 DOI: 10.1016/s2215-0366(24)00256-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 08/01/2024] [Accepted: 08/02/2024] [Indexed: 11/16/2024]
Abstract
BACKGROUND Psychological distress is common among mothers in low-income and middle-income countries, limiting their capacity to care for themselves and their children. This study aimed to test the feasibility and acceptability of an adapted psychosocial intervention for distressed mothers in low-resource settings. METHODS In this open-label trial, we enrolled women living in Lusaka, Zambia, with high mental distress (>7 score on the 20-item Self-Reporting Questionnaire [SRQ-20]) and children younger than 2 years, who had previously enrolled in the ZamCharts early childhood nutrition trial. We randomly assigned participants (1:1) to the intervention or control group using a random number draw. The intervention was a newly developed Problem Management for Moms (PM4M) programme: a ten-session treatment adapted from Problem Management Plus, which was offered by phone or in person. After randomisation, participants in the intervention group underwent pre-intervention screening, a post-intervention assessment, and a final follow-up assessment 9 months after treatment initiation (ie, final follow-up visit). The control group was assessed at the baseline of ZamCharts and at the final follow-up assessment, and these participants did not receive any intervention. The primary study outcomes were feasibility, acceptability, and participant mental distress measured using the SRQ-20. All primary and secondary outcomes were estimated in the intention-to-treat population, which included all participants who were randomised to the intervention group and attended the final follow-up assessment. Data on ethnicity were not collected. The trial is registered at ClinicalTrials.gov, NCT05627206, and has been completed. Women with lived experience of mental health symptoms were involved in this study. FINDINGS Between April 26, and July 14, 2021, 790 women were interviewed in the ZamCharts trial, of whom 265 had high mental distress and were randomly assigned to treatment groups in this trial (134 to the intervention group and 131 to the control group). Of the 134 women in the intervention group, 61 (46%) received the PM4M intervention and 73 (55%) were excluded; 103 in the intervention group and 106 in the control group were successfully interviewed at the final follow-up assessment. The mean age of participants was 27·6 years (SD 7·6) at ZamCharts baseline. PM4M sessions were conducted between Dec 16, 2022, and May 6, 2023. The 61 participants deemed eligible after pre-intervention screening who started the intervention completed a mean of 7·9 (SD 2·9) of ten sessions. 55 (77%) of these 61 participants were somewhat or very satisfied with the intervention. In adjusted intention-to-treat models, the intervention reduced mean SRQ-20 scores by 2·11 points (95% CI -3·50 to -0·63) at the final follow-up, and the adjusted odds ratio of having an SRQ-20 of more than 7 was 0·50 (95% CI 0·27 to 0·93). No serious adverse events were reported. INTERPRETATION The results presented here suggest that the PM4M mental health intervention is feasible and has high rates of acceptability. Further research is needed to assess the long-term efficacy of this intervention on women and their children, and its suitability for integration into routine care. FUNDING The Eckenstein-Geigy Professorship.
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Affiliation(s)
- Günther Fink
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Allschwil, Switzerland; University of Basel, Basel, Switzerland
| | - Maria Melero-Dominguez
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Allschwil, Switzerland; Disparities Research Unit, Mongan Institute, Massachusetts General Hospital, Boston, MA, USA
| | | | - Daniela de Vernisy-Romero
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Allschwil, Switzerland; Department of Global Health, Boston University School of Public Health, Boston, MA, USA
| | | | | | - Ravi Paul
- Department of Psychiatry, University of Zambia, Lusaka, Zambia
| | - Margarita Alegria
- Disparities Research Unit, Mongan Institute, Massachusetts General Hospital, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA
| | | | - Peter C Rockers
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
| | | | | | | | - Irene Falgas-Bague
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Allschwil, Switzerland; University of Basel, Basel, Switzerland; Department of Medicine, Harvard Medical School, Boston, MA, USA.
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Wambua GN, Stein A, Seedat S, Sijbrandij M, Baisley K, Shahmanesh M, Seeley J, Ngwenya N. Adaptation and feasibility of WHO PM+ for adolescents living with HIV in KwaZulu-Natal Province, South Africa: an implementation feasibility study protocol. BMJ Open 2024; 14:e088992. [PMID: 38986556 PMCID: PMC11243136 DOI: 10.1136/bmjopen-2024-088992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Accepted: 06/21/2024] [Indexed: 07/12/2024] Open
Abstract
INTRODUCTION Adolescents living with HIV (ALHIV) are an extremely vulnerable population, with the burden of mental health problems carefully documented together with the constraints for receiving timely and adequate management of the problems, especially in rural settings. Problem Management Plus (PM+) is a scalable psychological intervention for individuals impaired by distress in communities exposed to adversity. Initially developed for adult populations, few studies have assessed its potential to address adolescent distress. This study aims to co-adapt PM+ with an adherence component (PM+Adherence) for ALHIV and to evaluate its acceptability and feasibility in rural Kwa-Zulu Natal Province, South Africa. METHODS AND ANALYSIS We will use a mixed-methods approach over three phases. The first phase will include a realist synthesis and collection of formative data from up to 60 ALHIV, caregivers and healthcare providers to inform the adaptation of WHO PM+, including the components of an adherence module. During the second phase, we will undertake the cultural adaptation of the PM+Adherence intervention. The third phase will involve a hybrid type 3 implementation strategy among ALHIV aged 16-19 years (n=50) to implement and evaluate the feasibility of the culturally co-adapted PM+Adherence. The feasibility indicators to be evaluated include reach, adoption, attrition, implementation and acceptability of the adapted intervention, which will be assessed qualitatively and quantitatively. In addition, we will assess preliminary effectiveness using an intention-to-treat approach on HIV-related indicators and mental health outcomes at baseline, end intervention, 2-month follow-up during the 6-month implementation. DISCUSSION We expect that the PM+Adherence will be acceptable and can feasibly be delivered by lay counsellors in resource-limited rural KwaZulu-Natal. ETHICS AND DISSEMINATION Ethical clearance has been obtained from the University of KwaZulu-Natal Biomedical Research Ethics Committee, (BREC/00005743/2023). Dissemination plans include presentations at scientific conferences, peer-reviewed publications and community level.
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Affiliation(s)
| | - Alan Stein
- Africa Health Research Institute, Durban, KwaZulu Natal, South Africa
- University of Oxford, Oxford, UK
| | - Soraya Seedat
- SAMRC/SU Genomics of Brain Disorders Research Unit, Department of Psychiatry, Stellenbosch University, Cape Town, Western Cape, South Africa
| | - Marit Sijbrandij
- Vrije Universiteit, Department of Clinical, Neuro- and Developmental Psychology, WHO Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Kathy Baisley
- Africa Health Research Institute, Durban, KwaZulu Natal, South Africa
- London School of Hygiene and Tropical Medicine, London, UK
| | - Maryam Shahmanesh
- Africa Health Research Institute, Durban, KwaZulu Natal, South Africa
- University College London, London, UK
| | - Janet Seeley
- Africa Health Research Institute, Durban, KwaZulu Natal, South Africa
- London School of Hygiene and Tropical Medicine, London, UK
- University of KwaZulu-Natal, Durban, KwaZulu Natal, South Africa
| | - Nothando Ngwenya
- Africa Health Research Institute, Durban, KwaZulu Natal, South Africa
- University of KwaZulu-Natal, Durban, KwaZulu Natal, South Africa
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Mwangala PN, Makandi M, Kerubo A, Nyongesa MK, Abubakar A. A scoping review of the literature on the application and usefulness of the Problem Management Plus (PM+) intervention around the world. BJPsych Open 2024; 10:e91. [PMID: 38650067 PMCID: PMC11060090 DOI: 10.1192/bjo.2024.55] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 03/13/2024] [Accepted: 03/13/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Given the high rates of common mental disorders and limited resources, task-shifting psychosocial interventions are needed to provide adequate care. One such intervention developed by the World Health Organization is Problem Management Plus (PM+). AIMS This review maps the evidence regarding the extent of application and usefulness of the PM+ intervention, i.e. adaptability, feasibility, effectiveness and scalability, since it was introduced in 2016. METHOD We conducted a scoping review of seven literature databases and grey literature from January 2015 to February 2024, to identify peer-reviewed and grey literature on PM+ around the world. RESULTS Out of 6739 potential records, 42 met the inclusion criteria. About 60% of the included studies were from low- and middle-income countries. Findings from pilot/feasibility trials demonstrated that PM+ is feasible, acceptable and safe. Results from definitive randomised controlled trials at short-term follow-up also suggested that PM+ is effective, with overall moderate-to-large effect sizes, in improving symptoms of common mental health problems. Although PM+ was more effective in reducing symptoms of common mental disorders, it was found to be costlier compared to usual care in the only study that evaluated its cost-effectiveness. CONCLUSIONS Our findings indicate that PM+, in its individual and group formats, can be adapted and effectively delivered by trained helpers to target a wide range of common mental health concerns. More effectiveness and implementation evidence is required to understand the long-term impact of PM+, its cost-effectiveness and scalability, and moderators of treatment outcomes such as gender and delivery formats.
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Affiliation(s)
- Patrick N. Mwangala
- Institute for Human Development, Aga Khan University, Kenya; Centre for Geographic Medicine Research Coast, Kenya Medical Research Institute (KEMRI), Kilifi, Kenya; and School of Public Health, University of the Witwatersrand, South Africa
| | | | - Anita Kerubo
- Institute for Human Development, Aga Khan University, Kenya
| | | | - Amina Abubakar
- Institute for Human Development, Aga Khan University, Kenya; Centre for Geographic Medicine Research Coast, Kenya Medical Research Institute (KEMRI), Kilifi, Kenya; and Department of Psychiatry, University of Oxford, UK
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Mutahi J, Kangwana B, Khasowa D, Muthoni I, Charo O, Muli A, Kumar M. Integrating Mental Health Management into Empowerment Group Sessions for Out-of-School Adolescents in Kenyan Informal Settlements: A Process Paper. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:223. [PMID: 38397712 PMCID: PMC10888709 DOI: 10.3390/ijerph21020223] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 12/28/2023] [Accepted: 12/29/2023] [Indexed: 02/25/2024]
Abstract
This article presents processes for developing contextualized training procedures to better appreciate partnership, capacity-building experiences, and specific implementation challenges and opportunities for mental and public health teams. The program enrolled 469 out-of-school adolescents to participate in the integration of youth mental health into health and life-skill safe spaces. The teams utilized various methods to achieve process outcomes of restructuring and adapting curricula, training youth mentors, and assessing their self-efficacy before integrating the intervention for 18 months. The Coronavirus (COVID-19) pandemic became an additional unique concern in the preliminary and the 18-month implementation period of the program. This necessitated innovation around hybrid training and asynchronous modalities as program teams navigated the two study locations for prompt training, supervision, evaluation, and feedback. In conclusion, out-of-school adolescents face a myriad of challenges, and a safe space program led by youth mentors can help promote mental health. Our study demonstrated how best this can be achieved. We point to lessons such as the importance of adapting the intervention and working cohesively in teams, building strong and trusting partnerships, learning how to carry out multidisciplinary dialogues, and continuous supervision and capacity building. This article aimed to document the processes around the design and implementation of this innovative intervention and present a summary of lessons learned.
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Affiliation(s)
- Joan Mutahi
- Department of Psychiatry, School of Medicine, College of Health Sciences, University of Nairobi, Nairobi P.O. Box 30197-00100, Kenya; (J.M.); (D.K.)
| | - Beth Kangwana
- Population Council–Kenya-Avenue 5, 3rd Floor Rose Ave, Nairobi P.O. Box 17643-00500, Kenya; (B.K.); (A.M.)
| | - Dorcas Khasowa
- Department of Psychiatry, School of Medicine, College of Health Sciences, University of Nairobi, Nairobi P.O. Box 30197-00100, Kenya; (J.M.); (D.K.)
| | - Irene Muthoni
- Integrated Education for Community Empowerment, Nairobi P.O. Box 7631-00300, Kenya;
| | - Oliver Charo
- Rapid Effective Participatory Action in Community Theatre Education and Development, Nakuru P.O. Box 15614-20100, Kenya;
| | - Alfred Muli
- Population Council–Kenya-Avenue 5, 3rd Floor Rose Ave, Nairobi P.O. Box 17643-00500, Kenya; (B.K.); (A.M.)
| | - Manasi Kumar
- Department of Psychiatry, School of Medicine, College of Health Sciences, University of Nairobi, Nairobi P.O. Box 30197-00100, Kenya; (J.M.); (D.K.)
- Institute for Excellence in Health Equity, New York University Grossman School of Medicine, US-550 First Avenue New York, New York, NY 10016, USA
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Falgas-Bague I, Melero-Dominguez M, de Vernisy-Romero D, Tembo T, Chembe M, Lubozha T, Paul R, Parkerson D, Rockers PC, Sikazwe D, Fink G. Testing the feasibility, acceptability, and exploring trends on efficacy of the problem management plus for moms: Protocol of a pilot randomized control trial. PLoS One 2024; 19:e0287269. [PMID: 38181004 PMCID: PMC10769019 DOI: 10.1371/journal.pone.0287269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 11/24/2023] [Indexed: 01/07/2024] Open
Abstract
Mental health disorders are one of the most common causes that limit the ability of mothers to care for themselves and for their children. Recent data suggest high rates of distress among women in charge of young children in Zambia. Nevertheless, Zambia's public healthcare offers very limited treatment for common mental health distress. To address this treatment gap, this study aims to test the feasibility, acceptability, and potential efficacy of a context-adapted psychosocial intervention. A total of 265 mothers with mental health needs (defined as SRQ-20 scores above 7) were randomly assigned with equal probability to the intervention or control group. The intervention group will receive a locally adapted version of the Problem-Management Plus and "Thinking Healthy" interventions developed by the World Health Organization (WHO), combined with specific parts of the Strong Minds-Strong Communities intervention. Trained and closely supervised wellbeing-community health workers will provide the psychosocial intervention. Mental health distress and attendance to the intervention will be assessed at enrollment and 6 months after the intervention. We will estimate the impact of the intervention on mental health distress using an intention-to-treat approach. We previously found that there is a large necessity for interventions that aim to address mother anxiety/depression problems. In this study, we tested the feasibility and efficacy of an innovative intervention, demonstrating that implementing these mental health treatments in low-income settings, such as Zambia, is viable with an adequate support system. If successful, larger studies will be needed to test the effectiveness of the intervention with increased precision. Trial registration: This study is registered at clinicaltrials.gov as NCT05627206.
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Affiliation(s)
- Irene Falgas-Bague
- Department of Epidemiology and Public Health. Swiss Tropical and Public Health Institute, Basel, Switzerland
- Faculty of Economics, University of Basel, Basel, Switzerland
- Disparities Research Unit, Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Department of Medicine. Harvard Medical School, Boston, Massachusetts, United States of America
| | - Maria Melero-Dominguez
- Department of Epidemiology and Public Health. Swiss Tropical and Public Health Institute, Basel, Switzerland
- Disparities Research Unit, Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Daniela de Vernisy-Romero
- Department of Epidemiology and Public Health. Swiss Tropical and Public Health Institute, Basel, Switzerland
- Department of Global Health. Boston University School of Public Health, Boston, Massachusetts, United States of America
| | | | - Mpela Chembe
- Innovations for Poverty Action, New York, New York, New York, United States of America
| | - Theresa Lubozha
- Innovations for Poverty Action, New York, New York, New York, United States of America
| | - Ravi Paul
- Department of Psychiatry, University of Zambia, Lusaka, Zambia
| | - Doug Parkerson
- Innovations for Poverty Action, New York, New York, New York, United States of America
| | - Peter C. Rockers
- Department of Global Health. Boston University School of Public Health, Boston, Massachusetts, United States of America
| | | | - Günther Fink
- Department of Epidemiology and Public Health. Swiss Tropical and Public Health Institute, Basel, Switzerland
- Faculty of Economics, University of Basel, Basel, Switzerland
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Mediavilla R, García-Vázquez B, McGreevy KR, Underhill J, Bayón C, Bravo-Ortiz MF, Muñoz-Sanjosé A, Haro JM, Monistrol-Mula A, Nicaise P, Petri-Romão P, McDaid D, Park AL, Melchior M, Vuillermoz C, Turrini G, Compri B, Purgato M, Roos R, Witteveen AB, Sijbrandij M, Bryant RA, Fuhr D, Ayuso-Mateos JL. Beyond effectiveness in eHealth trials: Process evaluation of a stepped-care programme to support healthcare workers with psychological distress (RESPOND-HCWs). Digit Health 2024; 10:20552076241287678. [PMID: 39430699 PMCID: PMC11489946 DOI: 10.1177/20552076241287678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 09/10/2024] [Indexed: 10/22/2024] Open
Abstract
Objectives This study presents the process evaluation of an effective stepped-care programme of eHealth interventions (Doing What Matters in Times of Stress [DWM] and Problem Management Plus [PM+]) for healthcare workers (HCWs) with psychological distress (RESPOND-HCWs trial) conducted in Spain. The aim is to analyse the context in which the programme was delivered, assess key implementation outcomes and explore mechanisms of action. Methods We used mixed methods. Quantitative data came from routine randomised control trial monitoring and structured observation, and qualitative data were collected using semi-structured, in-depth interviews with trial participants (n = 12) and decision-makers (n = 7) and a focus group discussion with intervention providers (n = 7). We conducted a descriptive analysis of quantitative data using R software and a thematic analysis of qualitative data using NVivo. Results Context analysis revealed implementation barriers, including unrealistic expectations of participants about the programme and mental health-related stigma. The flexibility of interventions and the opportunity for mental health actions were enabling factors. Implementation outcomes showed that the trial was feasible, appropriate and timely, and that the intervention was delivered with minimal protocol deviations and good acceptance among participants. Mechanisms of action included confidence in the positive effect of the intervention, a good therapeutic relationship and specific intervention components. Conclusions These results supplement the outcome evaluation and can help inform large-scale implementation in similar settings. Specific recommendations include increasing mental health awareness and reducing stigma in the implementation setting, including a short orientation session and ensuring flexibility in schedules and peer support. Trial registration number NCT04980326.
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Affiliation(s)
- Roberto Mediavilla
- Department of Psychiatry, Universidad Autónoma de Madrid (UAM), Madrid, Spain
- Instituto de Investigación Sanitaria del Hospital Universitario La Princesa, Madrid, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
| | - Blanca García-Vázquez
- Department of Psychiatry, Universidad Autónoma de Madrid (UAM), Madrid, Spain
- Department of Psychiatry, Clinical Psychology, and Mental Health, Hospital Universitario La Paz, Madrid, Spain
- Instituto de Investigación Sanitaria del Hospital Universitario La Paz (IdiPAZ), Madrid, Spain
| | - Kerry R. McGreevy
- Department of Psychiatry, Universidad Autónoma de Madrid (UAM), Madrid, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
| | | | - Carmen Bayón
- Department of Psychiatry, Universidad Autónoma de Madrid (UAM), Madrid, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
- Department of Psychiatry, Clinical Psychology, and Mental Health, Hospital Universitario La Paz, Madrid, Spain
- Instituto de Investigación Sanitaria del Hospital Universitario La Paz (IdiPAZ), Madrid, Spain
| | - María-Fe Bravo-Ortiz
- Department of Psychiatry, Universidad Autónoma de Madrid (UAM), Madrid, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
- Department of Psychiatry, Clinical Psychology, and Mental Health, Hospital Universitario La Paz, Madrid, Spain
- Instituto de Investigación Sanitaria del Hospital Universitario La Paz (IdiPAZ), Madrid, Spain
| | - Ainoa Muñoz-Sanjosé
- Department of Psychiatry, Universidad Autónoma de Madrid (UAM), Madrid, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
- Department of Psychiatry, Clinical Psychology, and Mental Health, Hospital Universitario La Paz, Madrid, Spain
- Instituto de Investigación Sanitaria del Hospital Universitario La Paz (IdiPAZ), Madrid, Spain
| | - Josep Maria Haro
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
- Parc Sanitari Sant Joan de Deu, IRSJD, Sant Boi de Llobregat, Barcelona, Spain
| | - Anna Monistrol-Mula
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
- Parc Sanitari Sant Joan de Deu, IRSJD, Sant Boi de Llobregat, Barcelona, Spain
| | | | | | - David McDaid
- Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, London, UK
| | - A-La Park
- Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, London, UK
| | - Maria Melchior
- Sorbonne Université, INSERM, Institut Pierre Louis d’Épidémiologie Et de Santé Publique, IPLESP, Equipe de Recherche en Epidémiologie Sociale, ERES, Paris, France
| | - Cécile Vuillermoz
- Sorbonne Université, INSERM, Institut Pierre Louis d’Épidémiologie Et de Santé Publique, IPLESP, Equipe de Recherche en Epidémiologie Sociale, ERES, Paris, France
| | - Giulia Turrini
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Science, Section of Psychiatry, University of Verona, Verona, Italy
| | - Beatrice Compri
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Science, Section of Psychiatry, University of Verona, Verona, Italy
| | - Marianna Purgato
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Science, Section of Psychiatry, University of Verona, Verona, Italy
| | - Rinske Roos
- Department of Clinical, Neuro- and Developmental Psychology, WHO Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, The Netherlands
| | - Anke B. Witteveen
- Department of Clinical, Neuro- and Developmental Psychology, WHO Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, The Netherlands
| | - Marit Sijbrandij
- Department of Clinical, Neuro- and Developmental Psychology, WHO Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, The Netherlands
| | - Richard A. Bryant
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Daniela Fuhr
- Leibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany
- Health Sciences, University of Bremen, Bremen, Germany
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - José Luis Ayuso-Mateos
- Department of Psychiatry, Universidad Autónoma de Madrid (UAM), Madrid, Spain
- Instituto de Investigación Sanitaria del Hospital Universitario La Princesa, Madrid, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
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11
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Zhang L, Ni Z, Liu Y, Chen H. The effectiveness of e-health on reducing stigma, improving social support and quality of life among people living with HIV: A systematic review and meta-analysis of randomized controlled trials. Int J Nurs Stud 2023; 148:104606. [PMID: 37801937 DOI: 10.1016/j.ijnurstu.2023.104606] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 08/21/2023] [Accepted: 09/11/2023] [Indexed: 10/08/2023]
Abstract
BACKGROUND Many people living with HIV reported poor quality of life, which was primarily due to HIV-related stigma and the lack of social support. Compared with face-to-face interventions, e-health interventions are reported to have potential to help people living with HIV improve their adherence to antiretroviral therapy, promote their management of HIV and depressive symptoms. However, in the literature, the effectiveness of e-health interventions in helping people living with HIV reduce stigma, improve social support and quality of life is unclear. OBJECTIVE To examine the effectiveness of e-health interventions in reducing stigma and improving social support and quality of life among people living with HIV. DESIGN This study is a systematic review and meta-analysis of randomized controlled trials following the Cochrane Handbook guidelines and PRISMA2020. METHODS A comprehensive search was conducted from inception to 1st December 2022 in six databases: PubMed, CINAHL Plus with Full Text, PsycINFO (Ovid), Embase, Web of Science, and CENTRAL (Ovid), and an updated search took place on 11st June 2023. Two authors independently screened the studies and extracted the data. Cochrane's bias risk tool for randomized controlled trials was used to examine the methodological quality of the included studies. The intervention effect was estimated by calculating the standardized mean difference (SMD) and 95 % confidence interval (CI) using Review Manager 5.3. A sensitivity analysis was conducted to test the rigor of the pooled results using one-study-out method. The certainty of evidence was assessed using Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. RESULTS Nine studies met eligibility criteria and were included in this review. The results of the meta-analysis showed that e-health interventions could statistically significantly reduce stigma (SMD: -0.29, 95 % CI: [-0.48, -0.10], p = 0.002) and improve quality of life (SMD = 0.49, 95 % CI: [0.30, 0.68], P < 0.001), but had no significant effects on social support (SMD = -0.01, 95 % CI: [-0.48, 0.46] P = 0.96). CONCLUSIONS E-health interventions could reduce stigma and improve quality of life among people living with HIV. More studies are needed to further explore if e-health interventions can improve the social support for people living with HIV and investigate how to integrate e-health interventions into the existing health models to help people living with HIV treat and manage HIV/AIDS. REGISTRATION The protocol of this study has been registered in the database PROSPERO (registration ID: CRD42022373299).
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Affiliation(s)
- Liao Zhang
- Department of Nursing, West China Hospital/West China School of Nursing, Sichuan University, PR China
| | - Zhao Ni
- Center for Interdisciplinary Research on AIDS (CIRA), Yale University, New Haven, CT, USA; School of Nursing, Yale University, New Haven, CT, USA
| | - Ying Liu
- Department of Nursing, West China Hospital/West China School of Nursing, Sichuan University, PR China
| | - Hong Chen
- Department of Nursing, West China Hospital/West China School of Nursing, Sichuan University, PR China.
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12
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Schäfer SK, Thomas LM, Lindner S, Lieb K. World Health Organization's low-intensity psychosocial interventions: a systematic review and meta-analysis of the effects of Problem Management Plus and Step-by-Step. World Psychiatry 2023; 22:449-462. [PMID: 37713578 PMCID: PMC10503931 DOI: 10.1002/wps.21129] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/17/2023] Open
Abstract
Many societies have been recently exposed to humanitarian and health emergencies, which have resulted in a large number of people experiencing significant distress and being at risk to develop mental disorders such as depression, anxiety and post-traumatic stress disorder. The World Health Organization has released a series of scalable psychosocial interventions for people impaired by distress in communities exposed to adversities. Prominent among these is a low-intensity transdiagnostic psychosocial intervention, Problem Management Plus (PM+), and its digital adaptation Step-by-Step (SbS). This systematic review is the first to summarize the available evidence on the effects of PM+ and SbS. Up to March 8, 2023, five databases were searched for randomized controlled trials examining the effects of PM+ or SbS on distress indicators (i.e., general distress; anxiety, depressive or post-traumatic stress disorder symptoms; functional impairment, self-identified problems) and positive mental health outcomes (i.e., well-being, quality of life, social support/relationships). We performed random-effects multilevel meta-analyses on standardized mean differences (SMDs) at post-intervention and short-term follow-up assessments. Our search yielded 23 eligible studies, including 5,298 participants. We found a small to medium favorable effect on distress indicators (SMD=-0.45, 95% CI: -0.56 to -0.34) and a small beneficial effect on positive mental health outcomes (SMD=0.31, 95% CI: 0.14-0.47), which both remained significant at follow-up assessment and were robust in sensitivity analyses. However, our analyses pointed to substantial between-study heterogeneity, which was only partially explained by moderators, and the certainty of evidence was very low across all outcomes. These results provide evidence for the effectiveness of PM+ and SbS in reducing distress indicators and promoting positive mental health in populations exposed to adversities, but a larger high-quality evidence base is needed, as well as research on participant-level moderators of the effects of these interventions, their suitability for stepped-care programs, and their cost-effectiveness.
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Affiliation(s)
- Sarah K Schäfer
- Leibniz Institute for Resilience Research, Mainz, Germany
- Clinical Psychology, Psychotherapy and Psychodiagnostics, Technische Universität Braunschweig, Braunschweig, Germany
| | - Lea M Thomas
- Leibniz Institute for Resilience Research, Mainz, Germany
| | - Saskia Lindner
- Department of Psychiatry and Psychotherapy, University Medical Center of Johannes Gutenberg University, Mainz, Germany
| | - Klaus Lieb
- Leibniz Institute for Resilience Research, Mainz, Germany
- Department of Psychiatry and Psychotherapy, University Medical Center of Johannes Gutenberg University, Mainz, Germany
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