Nurse-led task-shifting strategies to substitute for mental health specialists in primary care: A systematic review.

Nine of the twelve included trials had a high overall risk of bias, largely because participants and providers could not be blinded to face-to-face psychosocial interventions. The review was not pre-registered, which raises the possibility of selective reporting or outcome switching. Only English-language studies were included, potentially excluding relevant trials from other regions. None of the included studies explicitly described themselves as task-shifting or task-sharing research, so the authors inferred eligibility based on provider roles, which may have introduced classification errors. Most trials were conducted in high-income countries in Europe and North America, limiting generalisability to low- and middle-income settings. Interventions were highly heterogeneous in components, duration, and outcome measures, preventing meta-analysis and making it difficult to identify which specific elements drove improvement.

The authors declared no conflicts of interest. The study was funded by the University of Manchester.

Do not conclude that nurse-led care is universally equivalent to specialist mental health care. Four of the twelve trials found no significant difference between groups, and nine had a high risk of bias, meaning the evidence supports non-inferiority in specific contexts rather than proven superiority across all conditions.