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      Promotion, prevention and protection: interventions at the population- and community-levels for mental, neurological and substance use disorders in low- and middle-income countries

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          Abstract

          Background

          In addition to services within the health system, interventions at the population and community levels are also important for the promotion of mental health, primary prevention of mental, neurological and substance use (MNS) disorders, identification and case detection of MNS disorders; and to a lesser degree treatment, care and rehabilitation. This study aims to identify “ best practice” and “ good practice” interventions that can feasibly be delivered at these population- and community-levels in low- and middle-income countries (LMICs), to aid the identification of resource efficiencies and allocation in LMICs.

          Methods

          A narrative review was conducted given the wide range of relevant interventions. Expert consensus was used to identify “ best practice” at the population-level on the basis of existing quasi-experimental natural experiments and cost effectiveness, with small scale emerging and promising evidence comprising “ good practice”. At the community-level, using expert consensus, the ACE (Assessing Cost-Effectiveness in Prevention Project) grading system was used to differentiate “ best practice” interventions with sufficient evidence from “ good practice” interventions with limited but promising evidence.

          Results

          At the population-level, laws and regulations to control alcohol demand and restrict access to lethal means of suicide were considered “ best practice”. Child protection laws, improved control of neurocysticercosis and mass awareness campaigns were identified as “ good practice”. At the community level, socio-emotional learning programmes in schools and parenting programmes during infancy were identified as “ best practice”. The following were all identified as “ good practice”: Integrating mental health promotion strategies into workplace occupational health and safety policies; mental health information and awareness programmes as well as detection of MNS disorders in schools; early child enrichment/preschool educational programs and parenting programs for children aged 2–14 years; gender equity and/or economic empowerment programs for vulnerable groups; training of gatekeepers to identify people with MNS disorders in the community; and training non-specialist community members at a neighbourhood level to assist with community-based support and rehabilitation of people with mental disorders.

          Conclusion

          Interventions provided at the population- and community-levels have an important role to play in promoting mental health, preventing the onset, and protecting those with MNS disorders. The importance of inter-sectoral engagement and the need for further research on interventions at these levels in LMICs is highlighted.

          Electronic supplementary material

          The online version of this article (doi:10.1186/s13033-016-0060-z) contains supplementary material, which is available to authorized users.

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          Most cited references110

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          Effect of a structural intervention for the prevention of intimate-partner violence and HIV in rural South Africa: a cluster randomised trial.

          HIV infection and intimate-partner violence share a common risk environment in much of southern Africa. The aim of the Intervention with Microfinance for AIDS and Gender Equity (IMAGE) study was to assess a structural intervention that combined a microfinance programme with a gender and HIV training curriculum. Villages in the rural Limpopo province of South Africa were pair-matched and randomly allocated to receive the intervention at study onset (intervention group, n=4) or 3 years later (comparison group, n=4). Loans were provided to poor women who enrolled in the intervention group. A participatory learning and action curriculum was integrated into loan meetings, which took place every 2 weeks. Both arms of the trial were divided into three groups: direct programme participants or matched controls (cohort one), randomly selected 14-35-year-old household co-residents (cohort two), and randomly selected community members (cohort three). Primary outcomes were experience of intimate-partner violence--either physical or sexual--in the past 12 months by a spouse or other sexual intimate (cohort one), unprotected sexual intercourse at last occurrence with a non-spousal partner in the past 12 months (cohorts two and three), and HIV incidence (cohort three). Analyses were done on a per-protocol basis. This trial is registered with ClinicalTrials.gov, number NCT00242957. In cohort one, experience of intimate-partner violence was reduced by 55% (adjusted risk ratio [aRR] 0.45, 95% CI 0.23-0.91; adjusted risk difference -7.3%, -16.2 to 1.5). The intervention did not affect the rate of unprotected sexual intercourse with a non-spousal partner in cohort two (aRR 1.02, 0.85-1.23), and there was no effect on the rate of unprotected sexual intercourse at last occurrence with a non-spousal partner (0.89, 0.66-1.19) or HIV incidence (1.06, 0.66-1.69) in cohort three. A combined microfinance and training intervention can lead to reductions in levels of intimate-partner violence in programme participants. Social and economic development interventions have the potential to alter risk environments for HIV and intimate-partner violence in southern Africa.
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            This quantitative meta-analysis sought to determine the effectiveness of occupational stress-reducing interventions and the populations for which such interventions are most beneficial. Forty-eight experimental studies (n = 3736) were included in the analysis. Four intervention types were distinguished: cognitive-behavioral interventions, relaxation techniques, multimodal programs, and organization-focused interventions. A small but significant overall effect was found. A moderate effect was found for cognitive-behavioral interventions and multimodal interventions, and a small effect was found for relaxation techniques. The effect size for organization-focused interventions was nonsignificant. Effects were most pronounced on the following outcome categories: complaints, psychologic resources and responses, and perceived quality of work life. Stress management interventions are effective. Cognitive-behavioral interventions are more effective than the other intervention types.
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              Targeted prevention of unipolar depressive disorder in an at-risk sample of high school adolescents: a randomized trial of a group cognitive intervention.

              This investigation attempted to prevent unipolar depressive episodes in a sample of high school adolescents with an elevated risk of depressive disorder. Adolescents at risk for future depressive disorder by virtue of having elevated depressive symptomatology were selected with a two-stage case-finding procedure. The Center for Epidemiologic Studies-Depression Scale (CES-D) was administered to 1,652 students; adolescents with elevated CES-D scores were interviewed with the Schedule for Affective Disorders and Schizophrenia for School-Age Children. Subjects with current affective diagnoses were referred to nonexperimental services. The remaining 150 consenting subjects were considered at risk for future depression and randomized to either a 15-session cognitive group prevention intervention or an "usual care" control condition. Subjects were reassessed for DSM-III-R diagnostic status after the intervention and at 6- and 12-month follow-up points. Survival analyses indicated a significant 12-month advantage for the prevention program, with affective disorder total incidence rates of 14.5% for the active intervention, versus 25.7% for the control condition. No differences were detected for nonaffective disorders across the study period. Depressive disorder can be successfully prevented among adolescents with an elevated future risk.
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                Author and article information

                Contributors
                peterseni@ukzn.ac.za
                sara.evans-lacko@kcl.ac.uk
                maya.semrau@kcl.ac.uk
                margaret.barry@nuigalway.ie
                chisholmd@who.int
                petra.gronholm@kcl.ac.uk
                Catherine.egbe@ucsf.edu
                graham.thornicroft@kcl.ac.uk
                Journal
                Int J Ment Health Syst
                Int J Ment Health Syst
                International Journal of Mental Health Systems
                BioMed Central (London )
                1752-4458
                11 April 2016
                11 April 2016
                2016
                : 10
                : 30
                Affiliations
                [ ]Centre for Rural Health, School of Nursing and Public Health and School of Applied Human Sciences, University of KwaZulu Natal, Durban, South Africa
                [ ]Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
                [ ]World Health Organization Collaborating Centre for Health Promotion Research, National University of Ireland Galway, Galway, Ireland
                [ ]Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
                [ ]School of Applied Human Sciences, University of KwaZulu Natal, Durban, South Africa
                [ ]Center for Tobacco Control Research and Education, University of California, San Francisco, USA
                Article
                60
                10.1186/s13033-016-0060-z
                4827227
                27069506
                a23edde8-028d-4e1c-b486-029e4019e949
                © Petersen et al. 2016

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 3 July 2015
                : 23 March 2016
                Categories
                Review
                Custom metadata
                © The Author(s) 2016

                Neurology
                mental health,community,population-level,low- and middle-income countries
                Neurology
                mental health, community, population-level, low- and middle-income countries

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