Global Mental Health Series: Treatment and prevention in low and middle income countries

The featured article is ‘Treatment and Prevention of Mental Disorders in Low-Income and Middle-Income Countries’ by Professor Vikram Patel and colleagues, the third in the Global Mental Health series. The aims of this paper were to examine treatment and prevention of mental disorders in low and middle-income countries by focusing on depression, schizophrenia, alcohol misuse and developmental disabilities.

The authors describe their method for identifying relevant papers which includes a search of the PsiTri database. Randomised controlled trials in low and middle-income countries were selected although multicentre trials which partly took place in high income countries were excluded.

11501 trials were identified but of these only 10%  took place in low and middle-income countries. More than half of this latter group involved studies looking at treatment of schizophrenia in China. Roughly 25% of the trials in low and middle-income countries looked at depression, with 75% looking at schizophrenia and only a small number of studies looking at alcohol misuse.

The studies considered took place in many different countries and corresponding health infrastructures. Studies were identified which showed the benefits of antidepressants, psychoeducation and group interpersonal therapy for depression. There were other studies which showed equivalent efficacy of first and second generation antipsychotics for schizophrenia as well as family interventions. Brief physician-delivered interventions, acamprosate and naltrexone showed benefit in alcohol misuse and developmental disabilities studies showed the benefits of rehabilitation programmes, parenting skills groups and for the use of methylphenidate in ADHD. The authors then examine some of the treatment trials in more detail and also looked at work done on prevention some of which was done at the level of government e.g. taxation for alcohol use. There was also a discussion of some work on Iodine in reducing prevalence of developmental disabilities.The authors then look at some more detailed cost-benefit analyses of treatment interventions before reaching a number of conclusions the most important of which I thought was the need for scaling up of effective and evidence-based intervention programmes.

This paper covers diverse issues. What impressed me most about the paper was the emphasis that was placed on the effectiveness of resources. Thus using scarce resources to their maximum benefit has implications for mental health programmes not only in low and middle-income countries but also in high-income countries. Now that there is a good evidence base for interventions, how quickly will we see the development of effective programmes which are scaled up in the areas where they are needed most?



The comments made here represent the opinions of the author and do not represent the profession or any body/organisation. The comments made here are not meant as a source of medical advice and those seeking medical advice are advised to consult with their own doctor. The author is not responsible for the contents of any external sites that are linked to in this blog.

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