Abstract

We evaluate the effectiveness of psychological interventions for depression in people with NCDs in South Asia and explore the individual, organizational, and policy-level barriers and facilitators for the implementation and scaling up of these interventions. Eight databases (and local web pages) were searched in May 2022. We conducted random effects models to evaluate the pooled effect of psychological interventions on depression in people with NCDs. We extracted the individual, organizational, and policy level barriers and facilitators. We found five randomized control trials, nine qualitative studies, and 35 policy documents that fitted the inclusion criteria. The pooled standardized mean difference in depression comparing psychological interventions with usual care was −2.31 (95% CI, −4.16 to −0.45; p = .015, I² = 96.0%). We found barriers and facilitators to intervention delivery, mental health appears in the policy agenda in Bangladesh and Pakistan. However, there is a lack of policies relating to training in mental health for NCD health providers and a lack of integration of mental health care with NCD care. All of the psychological interventions reported to be effective in treating depression in this population. There are important delivery and policy barriers to the implementation and scaling up of psychological interventions for people with NCDs.

摘要

我们评估了南亚非传染性疾病患者抑郁症心理干预的有效性，并探讨了实施和扩大这些干预措施的个人、组织和政策层面的障碍和促进因素。2022 年 5 月检索了八个数据库（和本地网页）。我们建立了随机效应模型来评估心理干预对非传染性疾病患者抑郁症的综合影响。我们提取了个人、组织和政策层面的障碍和促进因素。我们发现了 5 项随机对照试验、9 项定性研究和 35 份符合纳入标准的政策文件。心理干预与常规护理相比，抑郁症的汇总标准化平均差异为-2.31（95% CI，-4.16至-0.45；p  = .015，I ²  = 96.0%）。我们发现干预实施的障碍和促进因素，心理健康出现在孟加拉国和巴基斯坦的政策议程中。然而，缺乏与非传染性疾病卫生服务提供者心理健康培训相关的政策，也缺乏心理卫生保健与非传染性疾病护理的整合。据报道，所有心理干预措施均可有效治疗该人群的抑郁症。对非传染性疾病患者实施和扩大心理干预措施存在重要的实施和政策障碍。