Eva Heim|Brandon A. Kohrt|Mirja Koschorke|Maria Milenova|Graham Thornicroft
Reducing mental health-related stigma in primary health care settings in low- and middle-income countries: a systematic review
University of Zurich|George Washington University|King's College London|King's College London|King's College London
abstract aims systematic review compiled evidence interventions reduce mental healthrelated stigma primary health care phc low middleincome countries lmics studies targeting phc staff including nonprofessionals included primary outcomes stigmatising attitudes discriminatory behaviours methods data collection included two strategies first previous systematic reviews searched studies met inclusion criteria current review second new search done covering time since previous reviews ie january 2013 may 2017 five search concepts combined order capture relevant literature stigma mental health intervention phc staff lmics qualitative analysis included fulltexts done software maxqda fulltexts analysed regards content interventions didactic methods mental disorders cultural adaptation type outcome measure primary outcomes furthermore risk bias assessment undertaken results total 18 studies included risk bias rated high included studies six studies tested intervention control condition two used random allocation frequently used interventions lectures providing theoretical information many studies also used interactive methods n 9 discussed case studies n 8 used role plays n 5 three studies reported used clinical practice supervision results studies mixed little effects found brief training interventions eg 1 h 1 day longer training interventions sophisticated didactic methods produced statistically significant changes validated stigma questionnaires results interpreted caution due risk bias methods cultural adaptation interventions rarely documented conclusions rigorous trials needed lmics test interventions target discriminatory behaviours relationship patients cultural adaptation stigma interventions structuralinstitutional factors explicitly addressed trials