Citation

Cubillos L, Bartels SM, Torrey WC, Naslund J, Uribe-Restrepo JM, Gaviola C, Díaz SC, John DT, Williams MJ, Cepeda M, Gómez-Restrepo C, Marsch LA. BJPsych Bull 2021; 45(1): 40-52.

Copyright

(Copyright © 2021, Royal College of Psychiatrists)

DOI

10.1192/bjb.2020.35

PMID

unavailable

Abstract

Aims and method This systematic review examines the effectiveness and cost-effectiveness of behavioural health integration into primary healthcare in the management of depression and unhealthy alcohol use in low-and middle-income countries. Following PRISMA guidelines, this review included research that studied patients aged ≥18 years with unhealthy alcohol use and/or depression of any clinical severity. An exploration of the models of integration was used to characterise a typology of behavioural health integration specific for low-and middle-income countries.

RESULTS Fifty-eight articles met inclusion criteria. Studies evidenced increased effectiveness of integrated care over treatment as usual for both conditions. The economic evaluations found increased direct health costs but cost-effective estimates. The included studies used six distinct behavioural health integration models. Clinical implications Behavioural health integration may yield improved health outcomes, although it may require additional resources. The proposed typology can assist decision-makers to advance the implementation of integrated models. © 2020 The Authors.

Language: en

Keywords

adult; human; suicide; systematic review; female; male; Review; alcohol; alcoholism; quality of life; depression; motivational interviewing; alcohol use; primary care; alcohol consumption; primary medical care; prescription; antidepressant agent; tricyclic antidepressant agent; mental health service; middle aged; psychopharmacotherapy; follow up; patient compliance; cost effectiveness analysis; clinical effectiveness; economic evaluation; data extraction; young adult; randomized controlled trial (topic); medication compliance; cognitive behavioral therapy; Hamilton Depression Rating Scale; low income country; middle income country; lay health worker; Mental health integration; provision of services