Effectiveness of combining psychological prevention interventions with interventions that address the social determinants of mental health in low- and middle-income countries: a systematic review and meta-analysis

QUESTION: Task-shared preventive psychological interventions combined with interventions addressing social determinants of mental health may prevent common mental health conditions (CMHCs), particularly in low- and middle-income countries (LMICs). However, an evidence synthesis of their combination has not yet been investigated. We aimed to systematically assess the effectiveness of these combined interventions in LMICs. STUDY SELECTION AND ANALYSIS: We searched Epistemonikos, CENTRAL, MEDLINE, Embase, PsycINFO, CINAHL, GIM, ClinicalTrials.gov and WHO ICTRP until 2 September 2024. Two reviewers independently abstracted the data and evaluated the risk of bias of included studies using the Cochrane Risk of Bias 2 tool. We performed random-effects meta-analyses to assess the primary outcome, which was the incidence of CMHCs, and rated the certainty of evidence using the Grading of Recommendations Assessment, Development, and Evaluation approach. The protocol was registered in PROSPERO (CRD42023451072). FINDINGS: Of the 21 780 records identified from electronic sources, we included 31 randomised controlled trials from 21 LMICs involving 35 885 participants. Combined interventions were effective in reducing the incidence of depression and post-traumatic stress disorders at postintervention compared with control conditions for adults (risk ratio (RR) 0.82, 95% CI 0.73 to 0.93) and children (RR 0.70, 95% CI 0.49 to 0.99). At 7-24 months, we only found beneficial effects of combined interventions for depressive symptoms in children (standardised mean difference -0.41, 95% CI -0.63 to -0.18). No data were available on the incidence of anxiety. CONCLUSIONS: Combined task-shared interventions are effective in mostly short-term prevention of CMHCs in LMICs. Combining strategies targeting social determinants with psychological prevention approaches offers a potential opportunity to reduce the global mental health burden. Future research should focus on key intervention components and head-to-head comparisons between different interventions and between their components. PROSPERO REGISTRATION NUMBER: CRD42023451072.