Psychosocial interventions for addiction-affected families in Low and Middle Income Countries: A systematic review

The Translated and Adapted Brazilian Version of the Behavioral Enabling Scale for Family Members of Psychoactive Substance Users: An Analysis of the Factorial Structure and Internal Consistency

OBJECTIVE

The enabling behaviors of family members of psychoactive substance users can be crucial in maintaining addiction. There are no psychometrically evaluated instruments to measure the frequency of the enabling behaviors of family members of psychoactive substance users. Therefore, this study aimed to assess the internal consistency and factor structure of the Behavioral Enabling Scale.

DESIGN

A cross-sectional study was carried out, with a secondary analysis of data collected from 400 family members of psychoactive substance users that used a hotline service in Brazil. Exploratory factor analysis was conducted with an initial sample of 200 protocols, and with the remaining 200 protocols, a confirmatory factor analysis was conducted.

RESULTS

The internal consistency estimate proved entirely satisfactory in both samples, where the first presented a Cronbach's alpha of 0.76 and the second had a consistency estimate of 0.79. Factor analysis was conducted using a shortened version of the instrument, with 15 items, during which six factors that cover 65% of the scale's explained variance were extracted. KMO = 0.68 and Bartlett's test of sphericity = X2 (gl = 153) 497.201, p < 0.0001, were significant.

CONCLUSION

The Brazilian version of the Behavioral Enabling Scale is a valid tool that measures the frequency of the enabling behaviors of family members of psychoactive substance users. The measurement instrument enables further investigations into the behavior of family members regarding the use of psychoactive substances by their relatives.

Exploring caregiver perspectives in the context of parental substance use: A qualitative study

Background

Parental substance use is a substantial public health and safeguarding concern. Research examining the impact of parental substance use upon children is well-established, but there is a lack of research examining how parents/caregivers cope with their parenting role within the context of another parent's substance use, or how best to support these parents/caregivers.

Objective

This paper examines the experiences and support needs of parents/caregivers impacted by another parent's substance use.

Participants

Nineteen parents/caregivers from substance exposed families via local community-based voluntary sector support organizations, in urban and rural settings in northeast England.

Methods

Qualitative, in-depth interviews with caregivers (mothers, fathers, grandparents, aunts, uncles, siblings, aged 25 to 65+ years) of dependent aged children (aged 4 to17 years) in substance exposed families. Thematic analysis explored their experiences and support needs.

Results

Cumulative stress impacted parents/caregivers in their parenting role, creating further challenges in caring for children impacted by another parent's substance use. Parents/caregivers felt their needs went unrecognized by support services, and interactions with statutory services frequently exacerbated their stress. Parents/caregivers worried about what to disclose to children about substance use and how and when to do this.

Conclusion

Parents/caregivers attempted to mitigate the risk of another parent's substance use upon the children in their care. They often perceived lack of appropriate support specifically for parents/caregivers, particularly considering the extra challenges they faced caring for children in the context of parental substance use. Resources to support parents/caregivers in talking with children about these issues may offer guidance and reassurance to caregivers to alleviate some of their stress.

Advancing opioid stewardship in low-middle-income countries: challenges and opportunities

The increased utilization of opioids in low- and middle-income countries (LMICs) presents a growing threat of opioid-related abuse, misuse and diversion. Pharmacists, as integral members of healthcare teams, are responsible for dispensing and monitoring opioid use and hold a pivotal role in opioid stewardship within LMICs. This commentary describes the potential and multifaceted roles of pharmacists in opioid stewardship in resource-constrained settings and highlights appropriate strategies for promoting responsible opioid utilization. Opioid stewardship involves prioritising evidence-based prescribing, management and practices for pain management. It includes measures such as incorporating prescription drug monitoring programmes for appropriate opioid prescription, implementing safe disposal through drug take-back programmes, promoting non-opioid pain management, addressing the opioid addiction stigma, tapering opioid dose, educating patients and caregivers, establishing drug information centers, providing rehabilitative services and integrating collaboration with communities and experts. The combined difficulties of restricted access to healthcare resources and services coupled with low levels of literacy worsen the susceptibility to opioid abuse, misuse, and diversion in LMICs. Early detection, assessment and implementation of interventions to optimise opioid use are imperative for ensuring safe and effective opioid utilization, thereby mitigating the risks of overdose and addiction. The involvement of pharmacists in promoting safe and effective opioid utilization through education, monitoring, collaboration, and policy advocacy serves as a critical component in bridging existing gaps in opioid stewardship within LMICs.

Forgone healthcare for medically vulnerable groups during the pandemic era: experiences of family caregivers of young adults with substance use disorders in Zambia

Introduction

Scholars worldwide have defined the COVID-19 pandemic as a mass-disabling event of our time. The situation is grave for families experiencing financial hurdles while caring for young adults in recovery from addiction problems.

Methods

Using semi-structured interviews with 30 purposively selected family caregivers (FCGs) of young adults with substance use disorders (SUDs) in Lusaka, Zambia, this study reveals several factors influencing forgone healthcare for this medically vulnerable group.

Results

Financial challenges and huge out-of-pocket bills; caregivers' perceived far-fetched recovery of the young adult; the cost of medication and transportation; the young adult's little perceived need for healthcare service use, their runaway and treatment elusive tendencies; caregiver concerns about contracting the virus, and the stigma associated with it; and a fragmented child and adolescent mental health system influenced forgone healthcare. The young adults were often unavailable for days and months, posing challenges to the continuity of care. Despite caregivers' acknowledgment of the availability of healthcare professionals, young adults with problematic substance use had limited access to SUD recovery services, resulting in adverse health outcomes. Results also show that most family caregivers encountered challenges in accessing and purchasing psychotropic medications, which were difficult to find during the lockdowns. Some family caregivers lost their sources of income by being laid off from work due to the pandemic and skipping work to attend to caregiving responsibilities. Most of those in self-employment had to close their business and stay home to look after their youth. Several caregivers kept their youth at home because they failed to access private residential SUD recovery services. Family caregivers mostly relied on outpatient public health services, alternative medicine from traditional healers, and faith-based healing, all of which some young adults rarely accessed because of their problematic behaviors of escaping healthcare.

Conclusion

These identifiable risk factors, and their detrimental consequences highlight the need for interventions to improve healthcare access for this vulnerable population. Supporting FCGs of addicted young adults is crucial in ensuring the well-being of both the caregivers and care recipients. Further research is warranted to explore potential solutions, such as peer support programs, policy changes, and education initiatives for carers and recipients in the (post) pandemic era.

Correlates of impulsivity among female sex workers in Mexico

Impulsivity is a trait characteristic that is associated with sexual risk behavior. We examined correlates of impulsivity among 602 female sex workers (FSWs) enrolled in a sexual risk reduction intervention in Mexico (2016-2020). Impulsivity was positively associated with condomless sex with clients. Higher levels of impulsivity were associated with greater use of alcohol and heavy drugs, use of illicit drugs with clients, sexual/physical abuse history, and clinical depression. Global public health policy that supports free substance abuse treatment in combination with psychotherapeutic treatments (e.g. regulation management skills) and behavioral-focused therapy may help to reduce HIV/STI incidence in this vulnerable population.

Challenges in addiction-affected families: a systematic review of qualitative studies

BACKGROUND

The relative paucity of research on Addiction-Affected Families' (AAF) issues and the lack of attention given to their difficulties and treatment in interventions and clinical practices indicate that the primary focus consistently revolves around individuals with addictive disorders, even when the treatment process involves their families. However, it is believed that family members endure significant pressures that result in extensive negative consequences on the personal, familial, and social aspects of their lives. Aiming for a better understanding of the challenges and issues that AAF's experience, this systematic review explored qualitative studies with a focus on the impact of addiction on different aspects of families.

METHODS

We searched Research Gate, Scopus, Web of Science, ProQuest, Elsevier, and Google Scholar Databases. We included studies of qualitative design which have investigated the effects of addiction on families. Non-English language studies, medical views, and quantitative approaches were excluded. Participants in the selected studies included parents, children, couples, sisters/brothers, relatives, drug users and specialists. The data from the selected studies were extracted using a standard format for the systematic review of qualitative research (the National Institute of Health and Care Excellence [NICE] 2102a).

RESULTS

A thematic analysis of the findings of the studies identified 5 main themes: 1) initial shock (family encounter, searching for why), 2) family in the fog (social isolation, stigma and label), 3) sequence of disorders (emotional decline, negative behavioral experiences, mental disturbance, physical degeneration, family burden), 4) internal family chaos (instability of relationships, shadow people, erosive confrontation with the drug-using member, a newly emerging member, collapsing system, financial collapse), and 5) self-protection (attracting information, support, and protective sources, coping and adjusting the effects, the emergence of spirituality).

CONCLUSION

This systematic review of qualitative research highlights the various and complex issues which addiction-affected families go through in terms of financial, social, cultural, mental and physical health problems, as a result of which experts of the field are needed to investigate and take measures. The findings can inform policy and practice and the development of interventions aimed to lighten the burdens which addiction-affected families carry.

The effectiveness of psychosocial interventions for family members impacted by another's substance use: A systematic review and meta-analysis

INTRODUCTION

Family members affected by another's substance use disorder experience physical health problems, breakdowns in relationships and reduced psychological wellbeing. This review examines the effectiveness of psychosocial interventions for improving the wellbeing of family members.

METHODS

A systematic review of randomised-controlled trials (RCT), non-RCTs and pre-post studies examining group or individual interventions for affected families. Five databases were searched (PubMed, PsycINFO, Medline, Web of Science, Cochrane Library). Outcomes included psychological functioning, quality of life, physical health and substance use, family functioning and coping. Outcomes were analysed by study design and mode of delivery (individual or group). Risk of bias was assessed using the Cochrane tools (RoB2, ROBINS-I). The review followed PRISMA reporting guidelines and was prospectively registered with the PROSPERO database (CRD42020200260).

RESULTS

Nineteen studies were included (k = 10 included in meta-analyses). In k = 3 RCTs, individually administered interventions significantly reduced depression (standardised mean difference [SMD] 0.50, 95% confidence interval [CI] 0.21, 0.79) and distress (SMD 0.28, 95% CI 0.03, 0.54). In k = 2 pre-post studies, individual interventions improved family functioning (d = 0.51, 95% CI 0.28, 0.73) and coping (d = 0.43, 95% CI 0.24, 0.61). In k = 3 non-RCTs and k = 2 pre-post designs group interventions significantly reduced depression (d = 0.50, 95% CI 0.17, 0.82) and distress (d = 0.44, 95% CI 0.13, 0.75), and improved coping (d = 0.81, 95% CI 0.29, 1.33).

DISCUSSION AND CONCLUSIONS

This review summarises the contemporary literature evaluating interventions for affected families, with both individual and group interventions demonstrating favourable outcomes. However, small sample sizes and methodologically weak-quality studies limit conclusions.

Closing the treatment gap for alcohol use disorders in low- and middle-income countries

The alcohol-attributable disease burden is greater in low- and middle-income countries (LMICs) as compared to high-income countries. Despite the effectiveness of interventions such as health promotion and education, brief interventions, psychological treatments, family-focused interventions, and biomedical treatments, access to evidence-based care for alcohol use disorders (AUDs) in LMICs is limited. This can be explained by poor access to general health and mental health care, limited availability of relevant clinical skills among health care providers, lack of political will and/or financial resources, historical stigma and discrimination against people with AUDs, and poor planning and implementation of policies. Access to care for AUDs in LMICs could be improved through evidence-based strategies such as designing innovative, local and culturally acceptable solutions, health system strengthening by adopting a collaborative stepped care approach, horizontal integration of care into existing models of care (e.g., HIV care), task sharing to optimise limited human resources, working with families of individuals with AUD, and leveraging technology-enabled interventions. Moving ahead, research, policy and practice in LMICs need to focus on evidence-based decision-making, responsiveness to context and culture, working collaboratively with a range of stakeholders to design and implement interventions, identifying upstream social determinants of AUDs, developing and evaluating policy interventions such as increased taxation on alcohol, and developing services for special populations (e.g., adolescents) with AUDs.

'Even though you hate everything that's going on, you know they are safer at home': The role of Aboriginal and Torres Strait Islander families in methamphetamine use harm reduction and their own support needs

Introduction

First Nations people who use methamphetamine are overrepresented in regional and remote Australia and more likely to turn to family for support. This can place strain on families. The support needs of family members of individuals using methamphetamine are poorly understood.

Methods

We conducted 19 focus groups and seven interviews with mostly First Nations community, family members and service providers. In total, 147 participants across six sites participated as part of a larger study investigating First Nations perspectives of how to address methamphetamine use and associated harms. We applied a social and emotional wellbeing framework to examine support needs and role of family in mitigating methamphetamine harms.

Results

Findings highlighted the importance of families in providing support to people using methamphetamine and in reducing associated harms, often without external support. The support provided encompassed practical, social, emotional, financial, access to services and maintaining cultural connection. Providing support took a toll on family and negatively impacted their own social and emotional wellbeing.

Discussion and Conclusions

First Nations families play an important and under‐recognised role in reducing methamphetamine‐related harms and greater efforts are required to support them. Professional resources are needed to deal with impacts of methamphetamine on families; these should be pragmatic, accessible, targeted and culturally appropriate. Support for families and communities should be developed using the social and emotional wellbeing framework that recognises wellbeing and healing as intrinsically connected to holistic health, kinship, community, culture and ancestry, and socioeconomic and historical influences on peoples' lives.

Supporting addiction affected families effectively: a feasibility randomised controlled trial of a psychosocial intervention delivered by lay counsellors in Goa, India

BACKGROUND

Despite evidence of the burden of alcohol use on families, there is a lack of adequate and targeted support. We aimed to examine the feasibility, acceptability and impact of Supporting Addiction Affected Families Effectively (SAFE), a brief lay counsellor-delivered intervention for affected family members (AFMs).

METHODS

Parallel arm feasibility randomised controlled trial [1:1 allocation to SAFE or enhanced usual care (EUC)]. The primary outcome was mean difference in symptom score assessed by the Symptom Rating Test and secondary outcomes were difference in coping, impact and social support scores measured by the Coping Questionnaire, Family Member Impact Questionnaire, and Alcohol, Drugs and the Family Social Support Scale. Process data examining feasibility and acceptability were also collected. The primary analysis was intention to treat at the 3-month endpoint.

RESULTS

In total, 115 AFMs were referred to the trial, and 101 (87.8%) consenting participants were randomised to the two arms (51 SAFE arm and 50 EUC arm). Seventy-eight per cent completed treatment, with the mean number of sessions being 4.25 sessions and mean duration being 53 min. Ninety-five per cent completed outcome assessment. There were no statistically significant differences between SAFE and EUC on any of the outcome measures, except for the between-group adjusted mean differences for social support scores (AMD -6.05, 95% CI -10.98 to -1.12, p = 0.02).

CONCLUSION

Our work indicates that it is possible to identify AFMs through community networking, and have high rates of participation for lay counsellor-delivered psychosocial care. Nevertheless, there is a need for further intervention development to ensure its contextual relevance and appropriateness.

Education and training on addiction psychiatry in low and middle income countries: Observations from existing literature and recommendations going ahead

BACKGROUND

Addictive disorders are a significant contributor to the global burden of disease. The burden of addictive disorders in LMIC is expected to grow further over the coming years.

AIMS

In this article we present the observations from the existing literature on the current status of education and training on addiction psychiatry in LMIC and provide recommendation on way forward for this specialized field of psychiatry.

MATERIALS AND METHODS

We searched electronic databases of PubMed to access the literature on the current status of education and training on addiction psychiatry. Additional searches were also conducted in other database of Google Scholar for potential 'grey' literature.

RESULTS

We were able to identify a total of 11 relevant articles.

DISCUSSION

Currently there is limited published literature on education and training on addiction psychiatry from the LMICs.

CONCLUSIONS

Strengthening of the training on addictive disorders shall not only help bridge the gap of the unmet need for the evidence-based interventions of addictive disorders across these countries it shall also help enhance the research capacity on addictive disorders in these countries.

Family therapy interventions in India for persons with gambling disorder

Gambling is a popular pastime in India and the number of problem gamblers is on the rise. Although the impact of gambling disorder on families is grossly under-researched in India, drawing on international evidence it is only reasonable to assume that this is an important area deserving further clinical and research attention. Of the several types of interventions possible with families of persons with gambling disorder, in our clinical experience, the 5-step intervention is a feasible and culturally adaptable psychotherapeutic intervention. In this paper we have looked at the theoretical aspects of this intervention and also raise some of the practical challenges of offering psychological interventions to families of persons with gambling disorder in India. Albeit limited, we discuss the evidence base to have emerged from India in this field. Finally, we suggest some intervention measures as the way forward.

Experiences of family members of drivers who violate the law against rinking and driving and its repercussions

OBJECTIVES

to understand the experiences of family members of drivers who violate the law against drinking and driving and the post-penal repercussions.

METHODS

a qualitative study, with family members of drivers who violated the law against drinking and driving who participated in the Projeto Justiça e Sobriedade no Trânsito de Maringá - PR (Traffic Justice and Sobriety Project in Maringá - PR). Data collection was carried through semi-structured interviews, analyzed through thematic analysis.

RESULTS

it was observed in the family members' reports: the suffering of families due to the consumption of alcohol and other drugs; the violation of the law against drinking and driving meaning turning point, with positive and negative changes in the family context; and the meanings of the Traffic Justice and Sobriety Project.

FINAL CONSIDERATIONS

the law against drinking and driving penalties triggered unemployment and financial expenses, but the positive aspects were quitting alcohol use and/or not drinking and driving anymore. The Traffic Justice and Sobriety Project was informed as solidarity and a trigger for changing the offenders' behavior.

Psychosocial Interventions to Improve Psychological, Social and Physical Wellbeing in Family Members Affected by an Adult Relative's Substance Use: A Systematic Search and Review of the Evidence

It is estimated that over 100 million people worldwide are affected by the substance use of a close relative and often experience related adverse health and social outcomes. There is a growing body of literature evaluating psychosocial interventions intended to reduce these adverse outcomes. We searched the international literature, using rigorous systematic methods to search and review the evidence for effective interventions to improve the wellbeing of family members affected by the substance use of an adult relative. We synthesised the evidence narratively by intervention type, in line with the systematic search and review approach. Sixty-five papers (from 58 unique trials) meeting our inclusion criteria were identified. Behavioural interventions delivered conjointly with the substance user and the affected family members were found to be effective in improving the social wellbeing of family members (reducing intimate partner violence, enhancing relationship satisfaction and stability and family functioning). Affected adult family members may derive psychological benefit from an adjacent individually focused therapeutic intervention component. No interventions fully addressed the complex multidimensional adversities experienced by many families affected by substance use. Further research is needed to determine the effect of a multi-component psychosocial intervention, which seeks to support both the substance user and the affected family member.

Mental and physical health in family members of substance users: A scoping review

BACKGROUND

Due to the high pressure they sustain, family members of substance users are thought to experience negative consequences in mental and physical health. This scoping review provided a comprehensive overview on the mental and physical health of adult Affected Family Members (AFMs).

METHOD

We searched in-journal English articles in PubMed, with no date limit, guided by the concepts of stress, strain, and burden, and including several terms related to substance use. Eligibility criteria included focus on adult AFMs, mental and physical health, and clinical forms of substance use.

RESULTS

PubMed search identified 3549 articles, with 46 additional papers from other sources. Fifty-six articles were included, quantitative (N = 39), qualitative (N = 15) and both (N = 2). Quantitative findings show that AFMs are subject to increased stress and burden, and impaired mental health. Variable rates of physical problems emerge, with some medical conditions being more common among AFMs of substance users versus controls. Finally, evidence shows increased risk for aggression and reduced quality of life and social adjustment. AFMs report higher stress and strain if they are women, in low socio-economic families, and co-habiting with more severe substance users. Qualitative studies additionally suggest that stigma, self-blame, and social isolation are common.

CONCLUSIONS

AFMs of substance users represent a population at higher risk for negative health-related outcomes and should be systematically regarded as targets for treatment.

Community-based psychosocial substance use disorder interventions in low-and-middle-income countries: a narrative literature review

BACKGROUND

Mental health and substance use disorders (SUDs) are the world's leading cause of years lived with disability; in low-and-middle income countries (LIMCs), the treatment gap for SUDs is at least 75%. LMICs face significant structural, resource, political, and sociocultural barriers to scale-up SUD services in community settings.

AIM

This article aims to identify and describe the different types and characteristics of psychosocial community-based SUD interventions in LMICs, and describe what context-specific factors (policy, resource, sociocultural) may influence such interventions in their design, implementation, and/or outcomes.

METHODS

A narrative literature review was conducted to identify and discuss community-based SUD intervention studies from LMICs. Articles were identified via a search for abstracts on the MEDLINE, Academic Search Complete, and PsycINFO databases. A preliminary synthesis of findings was developed, which included a description of the study characteristics (such as setting, intervention, population, target SUD, etc.); thereafter, a thematic analysis was conducted to describe the themes related to the aims of this review.

RESULTS

Fifteen intervention studies were included out of 908 abstracts screened. The characteristics of the included interventions varied considerably. Most of the psychosocial interventions were brief interventions. Approximately two thirds of the interventions were delivered by trained lay healthcare workers. Nearly half of the interventions targeted SUDs in addition to other health priorities (HIV, tuberculosis, intimate partner violence). All of the interventions were implemented in middle income countries (i.e. none in low-income countries). The political, resource, and/or sociocultural factors that influenced the interventions are discussed, although findings were significantly limited across studies.

CONCLUSION

Despite this review's limitations, its findings present relevant considerations for future SUD intervention developers, researchers, and decision-makers with regards to planning, implementing and adapting community-based SUD interventions.

Measuring Coping Among Family Members with Substance-Misusing Relatives: Testing Competing Factor Structures of the Coping Questionnaire (CQ) in England and Italy

Background: The Coping Questionnaire measures affected family members' responses to their relatives' substance misuse related problems. The Coping Questionnaire examines three main coping strategies: engaged, tolerant-inactive, and withdrawal coping. Objectives: The aim of the current study was to compare competing conceptual measurement models across two countries, including one-factor, three-factor, and higher order factor models. Methods: Secondary analysis of data from five previous studies was conducted. Samples of affected family members from England (N = 323) and Italy (N = 165) were aggregated into two country specific groups. Series of confirmatory factor analyses were performed to test the degree of model fit and the effects of socio-demographic variables on the coping factors. Results: A bifactor model fitted the data most closely relative to the one- and three-factor models. High rates of common variance (60-65%) were attributable to the general coping factor, while a high proportion of the variance related to the withdrawal coping subscale score was independent (66-89%) of the general coping factor. Family members' country, age, gender, the type of relationship and the main problematic substance had significant effects on the coping factors. Conclusions: A bifactor model related to coping behaviors is consistent with the theoretical assumptions of the general coping literature. The concept of a general coping factor also fits the theoretical assumptions of the stress-strain-coping-support model, with family members showing a general tendency to cope with the harmful circumstances which arise due to substance misuse.

The Effect of Cognitive Behavioral Therapy on the Burden in Drug Dependent Persons' Caregivers: A Randomized Controlled Clinical Trial

Background:

Drug dependence is one of the current problems that leads to the drug dependents persons' suffer and imposes a huge mental burden to their family members. This study aimed investigating to determine the effect of cognitive- behavioral therapy (CBT) on the burden of the caregivers of drug dependent people. In CBT, caregivers discover thought and behavioral mistakes and recover them.

Materials and Methods:

This randomized controlled clinical trial was conducted on 64 caregivers of drug dependent individuals referring to one of the clinical and educational centers in Isfahan, Iran, which were randomly assigned to two equal groups (intervention and control) in 2016. Intervention group under went eight 90-min CBT sessions, whereas control group attended 3 group sessions to express their experiences. Data were collected by Zarit Burden scale and the demographic questionnaire and analyzed by independent t-test, Chi-square, and ANCOVA repeated measure through SPSS 18.

Results:

Before the intervention, no statistical difference was observed among two groups in the mean scores of burden (t = 0.75, p = 0.46). There was a significant difference between three time points in the intervention group (F = 3.24, p < 0.001). However, care burden mean score did not show a significant reduction in the control group (F = 0.17, p = 0.96).

Conclusions:

The CBT can lead to reduction of burden in drug dependent caregivers'. We suggest encouraging nurses to establish educational programs such as CBT to maintain and improve caregiver's mental health.

The Role of Communities in Mental Health Care in Low- and Middle-Income Countries: A Meta-Review of Components and Competencies

Community-based mental health services are emphasized in the World Health Organization’s Mental Health Action Plan, the World Bank’s Disease Control Priorities, and the Action Plan of the World Psychiatric Association. There is increasing evidence for effectiveness of mental health interventions delivered by non-specialists in community platforms in low- and middle-income countries (LMIC). However, the role of community components has yet to be summarized. Our objective was to map community interventions in LMIC, identify competencies for community-based providers, and highlight research gaps. Using a review-of-reviews strategy, we identified 23 reviews for the narrative synthesis. Motivations to employ community components included greater accessibility and acceptability compared to healthcare facilities, greater clinical effectiveness through ongoing contact and use of trusted local providers, family involvement, and economic benefits. Locations included homes, schools, and refugee camps, as well as technology-aided delivery. Activities included awareness raising, psychoeducation, skills training, rehabilitation, and psychological treatments. There was substantial variation in the degree to which community components were integrated with primary care services. Addressing gaps in current practice will require assuring collaboration with service users, utilizing implementation science methods, creating tools to facilitate community services and evaluate competencies of providers, and developing standardized reporting for community-based programs.