Effects of psychological and health promotion interventions on continuous PCMD outcomes.

<p>The pooled effect of three health promotion interventions delivered by non-mental health specialists was significant compared to usual care (ES −0.15; 95% CI −0.27, −0.02). Three psychological interventions were associated with a larger overall ES (−0.46; 95% CI −0.58, −0.33). CES-D, Center for Epidemiological Studies Depression Scale; CIS-R, Clinical Interview Schedule–Revised; EPDS, Edinburgh Postnatal Depression Scale; HDRS, Hamilton Depression Rating Scale; K-10, Kessler 10-Item Scale; PHQ-9, nine-item Patient Health Questionnaire; SCID, Structured Clinical Interview for DSM Disorders; SRQ, Self Reporting Questionnaire; STAI, State-Trait Anxiety Inventory.</p

Effects of antenatal and postnatal psychosocial interventions on continuous PCMD outcomes.

<p>Antenatal interventions were not effective for PCMDs compared to usual care (ES −0.46; 95% CI −0.94, 0.01), whereas interventions delivered both antenatally and postnatally were (ES −0.26; 95% CI −0.42, −0.10). Only one trial assessed an intervention delivered in the postnatal period only. CES-D, Center for Epidemiological Studies Depression Scale; CIS-R, Clinical Interview Schedule–Revised; EPDS, Edinburgh Postnatal Depression Scale; HDRS, Hamilton Depression Rating Scale; K-10, Kessler 10-Item Scale; PHQ-9, nine-item Patient Health Questionnaire; SRQ, Self Reporting Questionnaire; STAI, State-Trait Anxiety Inventory.</p

Assessment of risk of bias for trials included in the review.

<p>✓ = yes (low risk of bias); ✗ = no (high risk of bias); ? = unclear risk of bias.</p

Psychosocial Interventions for Perinatal Common Mental Disorders Delivered by Providers Who Are Not Mental Health Specialists in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis

<div><p>Background</p><p>Perinatal common mental disorders (PCMDs) are a major cause of disability among women. Psychosocial interventions are one approach to reduce the burden of PCMDs. Working with care providers who are not mental health specialists, in the community or in antenatal health care facilities, can expand access to these interventions in low-resource settings. We assessed effects of such interventions compared to usual perinatal care, as well as effects of interventions based on intervention type, delivery method, and timing.</p><p>Methods and Findings</p><p>We conducted a systematic review, meta-analysis, and meta-regression. We searched databases including Embase and the Global Health Library (up to 7 July 2013) for randomized and non-randomized trials of psychosocial interventions delivered by non-specialist mental health care providers in community settings and antenatal health care facilities in low- and middle-income countries. We pooled outcomes from ten trials for 18,738 participants. Interventions led to an overall reduction in PCMDs compared to usual care when using continuous data for PCMD symptomatology (effect size [ES] −0.34; 95% CI −0.53, −0.16) and binary categorizations for presence or absence of PCMDs (odds ratio 0.59; 95% CI 0.26, 0.92). We found a significantly larger ES for psychological interventions (three studies; ES −0.46; 95% CI −0.58, −0.33) than for health promotion interventions (seven studies; ES −0.15; 95% CI −0.27, −0.02). Both individual (five studies; ES −0.18; 95% CI −0.34, −0.01) and group (three studies; ES −0.48; 95% CI −0.85, −0.11) interventions were effective compared to usual care, though delivery method was not associated with ES (meta-regression β coefficient −0.11; 95% CI −0.36, 0.14). Combined group and individual interventions (based on two studies) had no benefit compared to usual care, nor did interventions restricted to pregnancy (three studies). Intervention timing was not associated with ES (β 0.16; 95% CI −0.16, 0.49). The small number of trials and heterogeneity of interventions limit our findings.</p><p>Conclusions</p><p>Psychosocial interventions delivered by non-specialists are beneficial for PCMDs, especially psychological interventions. Research is needed on interventions in low-income countries, treatment versus preventive approaches, and cost-effectiveness.</p><p><i>Please see later in the article for the Editors' Summary</i></p></div

Flow diagram of search results.

<p>Out of 6,177 abstracts retrieved through a search of electronic databases, 11 articles were included in the systematic review, including one unpublished trial identified following personal communication with the author.</p

Effects of psychosocial interventions on continuous PCMD outcomes.

<p>The pooled effect of interventions delivered by non-mental health specialists compared to usual perinatal care was a reduction in PCMD symptomatology compared to usual care, using effect estimates from assessments immediately following delivery of the intervention (ES −0.34; 95% CI −0.53, −0.16). CES-D, Center for Epidemiological Studies Depression Scale; EPDS, Edinburgh Postnatal Depression Scale; HDRS, Hamilton Depression Rating Scale; PHQ-9, nine-item Patient Health Questionnaire; SRQ, Self Reporting Questionnaire; STAI, State-Trait Anxiety Inventory.</p

Components of psychosocial interventions for PCMDs delivered by non-mental health specialists in middle-income countries.

<p>?, not reported; Con, control arm; Int, intervention arm; Tot, total.</p

Effects of group and individually based psychosocial interventions on continuous PCMD outcomes.

<p>Individual (ES −0.18; 95% CI −0.34, −0.01) and group-based (ES −0.48; 95% CI −0.85, −0.11) psychosocial interventions were associated with significant ESs for PCMDs compared to usual care. Interventions combining group and individual components had no significant effect compared to usual care. CES-D, Center for Epidemiological Studies Depression Scale; CIS-R, Clinical Interview Schedule–Revised; EPDS, Edinburgh Postnatal Depression Scale; HDRS, Hamilton Depression Rating Scale; K-10, Kessler 10-Item Scale; PHQ-9, nine-item Patient Health Questionnaire; SRQ, Self Reporting Questionnaire; STAI, State-Trait Anxiety Inventory.</p

Components of interventions and key features of controlled trials of community-based approaches to improve newborn survival.

a<p>Intervention 2 added liquid crystal thermometry by community health workers.</p>b<p>Rate ratio.</p>c<p>Comparison was pre-post intervention, not intervention-control.</p><p>CI, confidence interval; RCT, randomised controlled trial.</p

Maternity as a life event, components of care with potential effects on newborn survival, and 11 possible delivery strategies.

<p>Maternity as a life event, components of care with potential effects on newborn survival, and 11 possible delivery strategies.</p