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Purgato M, Prina E, Ceccarelli C, Cadorin C, Abdulmalik JO, Amaddeo F, Arcari L, Churchill R, Jordans MJ, Lund C, Papola D, Uphoff E, van Ginneken N, Tol WA, Barbui C. Primary-level and community worker interventions for the prevention of mental disorders and the promotion of well-being in low- and middle-income countries. Cochrane Database Syst Rev 2023; 10:CD014722. [PMID: 37873968 PMCID: PMC10594594 DOI: 10.1002/14651858.cd014722.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
BACKGROUND There is a significant research gap in the field of universal, selective, and indicated prevention interventions for mental health promotion and the prevention of mental disorders. Barriers to closing the research gap include scarcity of skilled human resources, large inequities in resource distribution and utilization, and stigma. OBJECTIVES To assess the effectiveness of delivery by primary workers of interventions for the promotion of mental health and universal prevention, and for the selective and indicated prevention of mental disorders or symptoms of mental illness in low- and middle-income countries (LMICs). To examine the impact of intervention delivery by primary workers on resource use and costs. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, CINAHL, Global Index Medicus, PsycInfo, WHO ICTRP, and ClinicalTrials.gov from inception to 29 November 2021. SELECTION CRITERIA Randomized controlled trials (RCTs) of primary-level and/or community health worker interventions for promoting mental health and/or preventing mental disorders versus any control conditions in adults and children in LMICs. DATA COLLECTION AND ANALYSIS Standardized mean differences (SMD) or mean differences (MD) were used for continuous outcomes, and risk ratios (RR) for dichotomous data, using a random-effects model. We analyzed data at 0 to 1, 1 to 6, and 7 to 24 months post-intervention. For SMDs, 0.20 to 0.49 represented small, 0.50 to 0.79 moderate, and ≥ 0.80 large clinical effects. We evaluated the risk of bias (RoB) using Cochrane RoB2. MAIN RESULTS Description of studies We identified 113 studies with 32,992 participants (97 RCTs, 19,570 participants in meta-analyses) for inclusion. Nineteen RCTs were conducted in low-income countries, 27 in low-middle-income countries, 2 in middle-income countries, 58 in upper-middle-income countries and 7 in mixed settings. Eighty-three RCTs included adults and 30 RCTs included children. Cadres of primary-level workers employed primary care health workers (38 studies), community workers (71 studies), both (2 studies), and not reported (2 studies). Interventions were universal prevention/promotion in 22 studies, selective in 36, and indicated prevention in 55 RCTs. Risk of bias The most common concerns over risk of bias were performance bias, attrition bias, and reporting bias. Intervention effects 'Probably', 'may', or 'uncertain' indicates 'moderate-', 'low-', or 'very low-'certainty evidence. *Certainty of the evidence (using GRADE) was assessed at 0 to 1 month post-intervention as specified in the review protocol. In the abstract, we did not report results for outcomes for which evidence was missing or very uncertain. Adults Promotion/universal prevention, compared to usual care: - probably slightly reduced anxiety symptoms (MD -0.14, 95% confidence interval (CI) -0.27 to -0.01; 1 trial, 158 participants) - may slightly reduce distress/PTSD symptoms (SMD -0.24, 95% CI -0.41 to -0.08; 4 trials, 722 participants) Selective prevention, compared to usual care: - probably slightly reduced depressive symptoms (SMD -0.69, 95% CI -1.08 to -0.30; 4 trials, 223 participants) Indicated prevention, compared to usual care: - may reduce adverse events (1 trial, 547 participants) - probably slightly reduced functional impairment (SMD -0.12, 95% CI -0.39 to -0.15; 4 trials, 663 participants) Children Promotion/universal prevention, compared to usual care: - may improve the quality of life (SMD -0.25, 95% CI -0.39 to -0.11; 2 trials, 803 participants) - may reduce adverse events (1 trial, 694 participants) - may slightly reduce depressive symptoms (MD -3.04, 95% CI -6 to -0.08; 1 trial, 160 participants) - may slightly reduce anxiety symptoms (MD -2.27, 95% CI -3.13 to -1.41; 1 trial, 183 participants) Selective prevention, compared to usual care: - probably slightly reduced depressive symptoms (SMD 0, 95% CI -0.16 to -0.15; 2 trials, 638 participants) - may slightly reduce anxiety symptoms (MD 4.50, 95% CI -12.05 to 21.05; 1 trial, 28 participants) - probably slightly reduced distress/PTSD symptoms (MD -2.14, 95% CI -3.77 to -0.51; 1 trial, 159 participants) Indicated prevention, compared to usual care: - decreased slightly functional impairment (SMD -0.29, 95% CI -0.47 to -0.10; 2 trials, 448 participants) - decreased slightly depressive symptoms (SMD -0.18, 95% CI -0.32 to -0.04; 4 trials, 771 participants) - may slightly reduce distress/PTSD symptoms (SMD 0.24, 95% CI -1.28 to 1.76; 2 trials, 448 participants). AUTHORS' CONCLUSIONS The evidence indicated that prevention interventions delivered through primary workers - a form of task-shifting - may improve mental health outcomes. Certainty in the evidence was influenced by the risk of bias and by substantial levels of heterogeneity. A supportive network of infrastructure and research would enhance and reinforce this delivery modality across LMICs.
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Affiliation(s)
- Marianna Purgato
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
- Cochrane Global Mental Health, University of Verona, Verona, Italy
| | - Eleonora Prina
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Caterina Ceccarelli
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Camilla Cadorin
- Department of Neurosciences, Biomedicine and Movement Sciences, Verona, Italy
| | | | - Francesco Amaddeo
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | | | - Rachel Churchill
- Cochrane Common Mental Disorders, Centre for Reviews and Dissemination, University of York, York, UK
| | - Mark Jd Jordans
- Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Crick Lund
- King's Global Health Institute, Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Davide Papola
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
- Cochrane Global Mental Health, University of Verona, Verona, Italy
| | - Eleonora Uphoff
- Cochrane Common Mental Disorders, Centre for Reviews and Dissemination, University of York, York, UK
| | - Nadja van Ginneken
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
| | - Wietse Anton Tol
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Corrado Barbui
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
- Cochrane Global Mental Health, University of Verona, Verona, Italy
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Eseadi C, Ilechukwu LC, Victor-Aigbodion V, Sewagegn AA, Amedu AN. Intervention for depression among undergraduate religious education students: A randomized controlled trial. Medicine (Baltimore) 2022; 101:e31034. [PMID: 36254029 PMCID: PMC9575794 DOI: 10.1097/md.0000000000031034] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND This research was designed to investigate the management of depression among undergraduate religious education students and identify the research implications for school-based religious intervention. METHODS This research is a randomized controlled trial. The treatment condition had 34 undergraduate religious education students but 33 undergraduate religious education students were in the control condition. The treatment process involved a 12-week application of religious rational emotive behavior therapy (RREBT). With Beck's depression inventory, version 2 (BDI-II), data collection was made possible. RESULTS Compared to students in the control condition, undergraduate religious education students in the treatment condition demonstrated a significant drop in mean BDI-II scores at post-test (F [1, 65] = 592.043, P < .05, η2p = .90). The effect of RREBT among students in the treatment condition stayed consistent at 2 weeks follow-up (F [1, 65] = 786.396, P < .05, η2p = .92, ΔR2 = .922). CONCLUSION The effect of RREBT on depression treatment among undergraduate religious education students was positive and can be consistent. The study results underscore the importance of expanding this treatment approach for these undergraduate education students in Nigeria.
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Affiliation(s)
- Chiedu Eseadi
- Department of Educational Psychology, University of Johannesburg, South Africa
| | | | | | - Abatihun Alehegn Sewagegn
- Department of Educational Psychology, University of Johannesburg, South Africa
- Institute of Education and Behavioral Science, Debre Markos University, Debre Markos, Ethiopia
- *Correspondence: Abatihun Alehegn Sewagegn, Institute of Education and Behavioral Science, Debre Markos University, Debre Markos, Ethiopia (e-mail: )
| | - Amos Nnaemeka Amedu
- Department of Social Science Education, University of Nigeria, Nsukka, Enugu State, Nigeria
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Ifelunni CO, Ede MO, Okeke CI. Rational emotive intervention for work-family conflict and female primary school teachers' well-being. CURRENT PSYCHOLOGY 2022; 42:1-14. [PMID: 36124047 PMCID: PMC9476453 DOI: 10.1007/s12144-022-03704-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 08/21/2022] [Accepted: 08/24/2022] [Indexed: 11/29/2022]
Abstract
Globally, work and family conflict has been investigated by many researchers. Yet there is an increased prevalence of work-family conflict and its influence on the well-being of the female teaching population, especially Nigerian primary school teachers. This incidence has kept a good proportion of schoolteachers vulnerable to health problems as well as affected their wellbeing. This study evaluates the effect of rational emotive behaviour therapy on improving the well-being of female teachers with irrational behaviours arising from the work-family conflict. This is a randomized study. A total of 69 female primary school teachers in Enugu state Nigeria who met the criteria for inclusion were used as the study participants. Three self-report measures (Work-Family Conflict questionnaire, Multidimensional Health States Scale-Short Form, and Teacher Irrational Belief Scale) were used to collect data. Repeated measures with analysis of variance (ANOVA) were used to determine the effects of the intervention. The findings of the study revealed that REBT had a significant effect on the well-being scores of Nigerian female primary school teachers with work-family conflict when compared to their counterparts in the no-intervention group at Time 2. In addition, the effect of REBT on improving well-being in female teachers with work-family conflict was significantly maintained at the follow-up measurements (Time 3). In conclusion, it is suggested that REBT is an effective intervention for moderating the effect of work-family conflict on the well-being of career female teachers. As such, cognitive behavioural therapists can further examine the effectiveness of REBT using other constructs and cultures.
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Affiliation(s)
- Clara Odozi Ifelunni
- Department of Educational Foundations, Faculty of Education, University of Nigeria, Nsukka, Nigeria
| | - Moses Onyemaechi Ede
- Department of Education Foundations, Faculty of Education, University of the Free State, Bloemfontein, South Africa
| | - Chinedu Ifedi Okeke
- Department of Education Foundations, Faculty of Education, University of the Free State, Bloemfontein, South Africa
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Ede MO, Agah JJ, Okeke CI, Chuks ZO, Oguguo BC, Agu PU, Ene CU, Ekesionye NE, Nji IA, Eze C, Manafa IF. Effect of cognitive behavioral active engagement training on test item construction skills among primary school teachers in Nigeria: Implication for educational policy makers. Medicine (Baltimore) 2021; 100:e26876. [PMID: 34516489 PMCID: PMC8428696 DOI: 10.1097/md.0000000000026876] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 07/23/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Most classroom teachers are weak in constructing test items for assessment of students. This study examined the effects of cognitive behavioral active engagement training on test items construction skills among primary school teachers in Nigeria. METHODS We adopted a randomized pretest-posttest control group design. A total of 148 participants served as the study sample. One instrument was used for data collection. The participants were administered the instrument at 4 different times. Test construction guide was employed to implement the training. Data analysis was completed using analysis of covariance. RESULTS The researchers found that cognitive behavioral active engagement training had a significant effect on participants' test items construction scores as measured by test construction skills inventory at posttest, first and second follow-up stages. CONCLUSION The researchers concluded that cognitive behavioral active engagement training is efficacious in the improvement of test items construction skills among primary school teachers in Nigeria.
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Affiliation(s)
- Moses Onyemaechi Ede
- A Postdoctoral Fellow, School of Education Studies, Faculty of Education, University of the Free State, South Africa
| | - John J. Agah
- Department of Science Education, University of Nigeria, Nsukka, Nigeria
| | - Chinedu Ifedi Okeke
- Head/Host, School of Education Studies, Faculty of Education, University of the Free State, South Africa
| | - Zudonu Onisoman Chuks
- Chemistry Education Department, School of Science Education, Federal College of Education (Technical), Omoku, River State, Nigeria
| | - Basil C.E. Oguguo
- Department of Science Education, University of Nigeria, Nsukka, Nigeria
| | | | - Catherine U. Ene
- Department of Science Education, University of Nigeria, Nsukka, Nigeria
| | - Ngozi E. Ekesionye
- Department of Educational Foundations, University of Nigeria, Nsukka, Nigeria
| | - Ifeyinwa Awele Nji
- Department of Social Science Education, University of Nigeria, Nsukka, Nigeria
| | - Chikodili Eze
- Department of Economics, University of Nigeria, Nsukka, Nigeria
| | - Ifeyinwa F. Manafa
- Chukwuemeka Odumegwu Ojukwu University, Igbariam, Anambra State, Nigeria
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