Psychological interventions for bipolar disorder in low- and middle-income countries: systematic review

Mekdes Demissie; Charlotte Hanlon; Rahel Birhane; Lauren Ng; Girmay Medhin; Abebaw Fekadu

doi:10.1192/bjo.2018.46

Psychological interventions for bipolar disorder in low- and middle-income countries: systematic review

BJPsych Open. 2018 Aug 30;4(5):375-384. doi: 10.1192/bjo.2018.46. eCollection 2018 Sep.

Authors

Mekdes Demissie¹, Charlotte Hanlon², Rahel Birhane³, Lauren Ng⁴, Girmay Medhin⁵, Abebaw Fekadu⁶

Affiliations

¹ Lecturer, College of Health Sciences, Department of Psychiatry, Addis Ababa University, Ethiopia.
² Associate Professor, College of Health Sciences, Department of Psychiatry, Addis Ababa University, Ethiopia and Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, Health Services and Population Research, King's College London, UK.
³ Research Assistant, College of Health Sciences, Department of Psychiatry, Addis Ababa University, Ethiopia.
⁴ Assistant Professor, School of Medicine, Boston University, USA.
⁵ Associate Professor, Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Ethiopia.
⁶ Associate Professor, College of Health Sciences, Department of Psychiatry and Centre for Innovative Drug Development and Therapeutic Studies for Africa (CDT-Africa), Collage of Health Science, Addis Ababa University, Ethiopia and Department of Global Health and Infection, Brighton and Sussex Medical School, University of Sussex and Center for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, King's College London, UK.

Abstract

Background: Adjunctive psychological interventions for bipolar disorder have demonstrated better efficacy in preventing or delaying relapse and improving outcomes compared with pharmacotherapy alone.

Aims: To evaluate the efficacy of psychological interventions for bipolar disorder in low- and middle-income countries.

Method: A systematic review was conducted using PubMed, PsycINFO, Medline, EMBASE, Cochrane database for systematic review, Cochrane central register of controlled trials, Latin America and Caribbean Center on Health Science Literature and African Journals Online databases with no restriction of language or year of publication. Methodological heterogeneity of studies precluded meta-analysis.

Results: A total of 18 adjunctive studies were identified: psychoeducation (n = 14), family intervention (n = 1), group cognitive-behavioural therapy (CBT) (n = 2) and group mindfulness-based cognitive therapy (MBCT) (n = 1). In total, 16 of the 18 studies were from upper-middle-income countries and none from low-income countries. All used mental health specialists or experienced therapists to deliver the intervention. Most of the studies have moderately high risk of bias. Psychoeducation improved treatment adherence, knowledge of and attitudes towards bipolar disorder and quality of life, and led to decreased relapse rates and hospital admissions. Family psychoeducation prevented relapse, decreased hospital admissions and improved medication adherence. CBT reduced both depressive and manic symptoms. MBCT reduced emotional dysregulation.

Conclusions: Adjunctive psychological interventions alongside pharmacotherapy appear to improve the clinical outcome and quality of life of people with bipolar disorder in middle-income countries. Further studies are required to investigate contextual adaptation and the role of non-specialists in the provision of psychological interventions to ensure scalability and the efficacy of these interventions in low-income country settings.

Declaration of interest: None.

Keywords: Psychosocial interventions; bipolar affective disorders; low- and middle-income countries.

Publication types

Review

Abstract

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