Moving beyond a 'one-size-fits-all' rationale in global mental health: prospects of a precision psychology paradigm.

Marianna Purgato,Rakesh Singh,Pim Cuijpers,Ceren Acarturk

doi:10.1017/s2045796021000500

Abstract

Research on the effectiveness of mental health and psychosocial support interventions for common mental disorders in global mental health provides controversial results. These results are based on mean values for different groups, often without due consideration of individual-level characteristics and contextual factors. Against this background, and based on the recent development of a precision theoretical framework in clinical psychology, which is calling for a renewed perspective on the development and implementation of trial designs, we propose to develop a precision psychology paradigm in global mental health, with emphasis not only on individual clinical and socio-demographic data, but also on the social determinants of mental health. A precision psychology paradigm would require a coordinated action of academics, stakeholders and humanitarian workers in planning a global mental health research agenda, including the design of trials aimed at reliably approximate prediction of intervention response at individual level.

Highlights

United Nations (UN) estimates suggest that in 2021 nearly 238 million people in more than 40 countries around the world will need humanitarian assistance and protection resulting from conflict or disaster
Political instability and natural disasters disproportionally affect populations living in low- and middle-income countries (LMICs), where extreme chronic poverty (World Bank, 2018) causes severe deprivation of basic human needs, including food, water, sanitation, health and education (Guha-Sapir et al, 2014)
Meta-analyses showed that psychological therapies substantially reduced symptoms of posttraumatic stress disorder (PTSD), depression and anxiety at study endpoint (0–4 weeks after the intervention ended), consistently with a review focused on Mental Health and Psychosocial Support (MHPSS) interventions in emergency settings in LMICs (Bangpan et al, 2019), but the intervention effect and the number of participants assessed gradually decreased over time

Summary

Introduction

UN estimates suggest that in 2021 nearly 238 million people in more than 40 countries around the world will need humanitarian assistance and protection resulting from conflict or disaster. Despite the growing interest over the last decade for testing MHPSS interventions, results from systematic reviews and meta-analyses of randomised controlled trials (RCTs) are heterogeneous and controversial, especially for common mental disorders (e.g., PTSD, depression and anxiety symptoms).

Results

Conclusion