Integrated programs for common mental illnesses within primary care and community settings in Latin America: a scoping review of components and implementation strategies

Alejandra Paniagua-Avila; Charles Branas; Ezra Susser; Meredith P Fort; Rachel Shelton; Lourdes Trigueros; Barbara Camara; Elen Costigan; Lina Demis; Ana Florence; Maria Flores; Lucy Miller-Suchet; Angela Paredes-Montero; Mariana Rodrigues; Jeremy Kane

doi:10.1016/j.lana.2024.100931

Integrated programs for common mental illnesses within primary care and community settings in Latin America: a scoping review of components and implementation strategies

Lancet Reg Health Am. 2024 Dec 7:41:100931. doi: 10.1016/j.lana.2024.100931. eCollection 2025 Jan.

Authors

Alejandra Paniagua-Avila^{1

2}, Charles Branas¹, Ezra Susser¹, Meredith P Fort^{3

4}, Rachel Shelton⁵, Lourdes Trigueros⁶, Barbara Camara⁷, Elen Costigan^{8

9}, Lina Demis¹, Ana Florence^{10

11}, Maria Flores¹², Lucy Miller-Suchet¹³, Angela Paredes-Montero¹⁴, Mariana Rodrigues^{15

16}, Jeremy Kane¹

Affiliations

¹ Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City, NY, USA.
² Asociación para la Salud Mental FUNDAMENTAL, Guatemala City, Guatemala.
³ Colorado School of Public Health, University of Colorado Denver, Denver, CO, USA.
⁴ Centro de INCAP -Instituto de Nutrición de Centroamérica y Panamá- para la Investigación y Prevención de Enfermedades Crónicas (CIIPEC), Guatemala City, Guatemala.
⁵ Department Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York City, NY, USA.
⁶ Médicos Sin Fronteras Latinoamérica, Guatemala City, Guatemala.
⁷ New York Psychiatric Institute, Columbia University Irving Medical Center, New York City, NY, USA.
⁸ Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York City, NY, USA.
⁹ Médicos Sin Fronteras Latinoamérica, Mexico City, Mexico.
¹⁰ Department of Psychiatry, Columbia University, New York City, NY, USA.
¹¹ Faculdade de Ciencias e Letras, Universidade Estadual de Sao Paulo, Sao Paulo, Brazil.
¹² Hospital de Salud Mental Dr. Federico Mora, Guatemala City, Guatemala.
¹³ HIAS, New York City, NY, USA.
¹⁴ Global Mental Health Lab, Teachers College, Columbia University, New York City, NY, USA.
¹⁵ Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York City, NY, USA.
¹⁶ Departamento de Psicologia, Centro Universitário UNA, Brazil.

Abstract

Integrated programs for common mental illnesses are evidence-informed practices yet to be routinely implemented in Latin America. It synthesizes the literature on integrated programs for common mental illnesses (anxiety, depression, and posttraumatic stress disorder) in Latin American primary care and community settings. It maps program components (the 'what') to the collaborative care model core components and implementation strategies (the 'how') to the Expert Recommendations for Implementing Change (ERIC) taxonomy. Results from 18 programs across six countries (Belize, Brazil, Chile, Colombia, Mexico, Peru) show wide heterogeneity in component and strategy combinations. Overall, provider-level components and strategies were more common than family- or community-level ones. 'Team-based care' was the most commonly reported component, and 'family/user engagement' the least. The most common implementation strategy was 'supporting clinicians,' while 'changing infrastructure' was the least. Programs commonly addressed depression and only four followed experimental designs. We found limited evidence on the potential mechanisms of integrated program components and strategies.

Keywords: Anxiety; Collaborative care; Depression; Implementation research; Implementation strategies; Integrated service; Latin America; PTSD; Primary care; Scoping review.

Publication types

Review