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      The methods and outcomes of cultural adaptations of psychological treatments for depressive disorders: a systematic review

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          Abstract

          Background

          Cultural adaptations of evidence-based psychological treatments (PTs) are important to enhance their universal applicability. The aim of this study was to review systematically the literature on adaptations of PTs for depressive disorders for ethnic minorities in Western countries and for any population in non-Western countries to describe the process, extent and nature of the adaptations and the effectiveness of the adapted treatments.

          Method

          Controlled trials were identified using database searches, key informants, previous reviews and reference lists. Data on the process and details of the adaptations were analyzed using qualitative methods and meta-analysis was used to assess treatment effectiveness.

          Results

          Twenty studies were included in this review, of which 16 were included in the meta-analysis. The process of adaptation was reported in two-thirds of the studies. Most adaptations were found in the dimensions of language, context and therapist delivering the treatment. The meta-analysis revealed a statistically significant benefit in favor of the adapted treatment [standardized mean difference (SMD) −0.72, 95% confidence interval (CI) −0.94 to −0.49].

          Conclusions

          Cultural adaptations of PTs follow a systematic procedure and lead primarily to adaptations in the implementation of the treatments rather than their content. Such PTs are effective in the treatment of depressive disorders in populations other than those for whom they were originally developed.

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          Cultural adaptations of behavioral health interventions: a progress report.

          N. Castro, Deborah Toobert, L A Strycker … (2013)
          To reduce health disparities, behavioral health interventions must reach subcultural groups and demonstrate effectiveness in improving their health behaviors and outcomes. One approach to developing such health interventions is to culturally adapt original evidence-based interventions. The goals of the article are to (a) describe consensus on the stages involved in developing cultural adaptations, (b) identify common elements in cultural adaptations, (c) examine evidence on the effectiveness of culturally enhanced interventions for various health conditions, and (d) pose questions for future research. Influential literature from the past decade was examined to identify points of consensus. There is agreement that cultural adaptation can be organized into 5 stages: information gathering, preliminary design, preliminary testing, refinement, and final trial. With few exceptions, reviews of several health conditions (e.g., AIDS, asthma, diabetes) concluded that culturally enhanced interventions are more effective in improving health outcomes than usual care or other control conditions. Progress has been made in establishing methods for conducting cultural adaptations and providing evidence of their effectiveness. Future research should include evaluations of cultural adaptations developed in stages, tests to determine the effectiveness of cultural adaptations relative to the original versions, and studies that advance our understanding of cultural constructs' contributions to intervention engagement and efficacy.
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            Group interpersonal psychotherapy for depression in rural Uganda: a randomized controlled trial.

            Paul Bolton, Judith D. Bass, Richard Neugebauer … (2003)
            Despite the importance of mental illness in Africa, few controlled intervention trials related to this problem have been published. To test the efficacy of group interpersonal psychotherapy in alleviating depression and dysfunction and to evaluate the feasibility of conducting controlled trials in Africa. For this cluster randomized, controlled clinical trial (February-June 2002), 30 villages in the Masaka and Rakai districts of rural Uganda were selected using a random procedure; 15 were then randomly assigned for studying men and 15 for women. In each village, adult men or women believed by themselves and other villagers to have depressionlike illness were interviewed using a locally adapted Hopkins Symptom Checklist and an instrument assessing function. Based on these interviews, lists were created for each village totaling 341 men and women who met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria for major depression or subsyndromal depression. Interviewers revisited them in order of decreasing symptom severity until they had 8 to 12 persons per village, totaling 284. Of these, 248 agreed to be in the trial and 9 refused; the remainder died or relocated. A total of 108 men and 116 women completed the study and were reinterviewed. Eight of the 15 male villages and 7 of the 15 female villages were randomly assigned to the intervention arm and the remainder to the control arm. The intervention villages received group interpersonal psychotherapy for depression as weekly 90-minute sessions for 16 weeks. Depression and dysfunction severity scores on scales adapted and validated for local use; proportion of persons meeting DSM-IV major depression diagnostic criteria. Mean reduction in depression severity was 17.47 points for intervention groups and 3.55 points for controls (P<.001). Mean reduction in dysfunction was 8.08 and 3.76 points, respectively (P<.001). After intervention, 6.5% and 54.7% of the intervention and control groups, respectively, met the criteria for major depression (P<.001) compared with 86% and 94%, respectively, prior to intervention (P =.04). The odds of postintervention depression among controls was 17.31 (95% confidence interval, 7.63-39.27) compared with the odds among intervention groups. Results from intention-to-treat analyses remained statistically significant. Group interpersonal psychotherapy was highly efficacious in reducing depression and dysfunction. A clinical trial proved feasible in the local setting. Both findings should encourage similar trials in similar settings in Africa and beyond.
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              Culturally adapted psychotherapy and the legitimacy of myth: a direct-comparison meta-analysis.

              Daniel Quintana, Bruce E Wampold, Steven G Benish (2011)
              Psychotherapy is a culturally encapsulated healing practice that is created from and dedicated to specific cultural contexts (Frank & Frank, 1993; Wampold, 2007; Wrenn, 1962). Consequently, conventional psychotherapy is a practice most suitable for dominant cultural groups within North America and Western Europe but may be culturally incongruent with the values and worldviews of ethnic and racial minority groups (e.g., D. W. Sue, Arredondo, & McDavis, 1992). Culturally adapted psychotherapy has been reported in a previous meta-analysis as more effective for ethnic and racial minorities than a set of heterogeneous control conditions (Griner & Smith, 2006), but the relative efficacy of culturally adapted psychotherapy versus unadapted, bona fide psychotherapy remains unestablished. Furthermore, one particular form of adaptation involving the explanation of illness-known in an anthropological context as the illness myth of universal healing practices (Frank & Frank, 1993)-may be responsible for the differences in outcomes between adapted and unadapted treatments for ethnic and racial minority clients. The present multilevel-model, direct-comparison meta-analysis of published and unpublished studies confirms that culturally adapted psychotherapy is more effective than unadapted, bona fide psychotherapy by d = 0.32 for primary measures of psychological functioning. Adaptation of the illness myth was the sole moderator of superior outcomes via culturally adapted psychotherapy (d = 0.21). Implications of myth adaptation in culturally adapted psychotherapy for future research, training, and practice are discussed.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Psychol Med
                Journal ID (iso-abbrev): Psychol Med
                Journal ID (publisher-id): PSM
                Title: Psychological Medicine
                Publisher: Cambridge University Press (Cambridge, UK )
                ISSN (Print): 0033-2917
                ISSN (Electronic): 1469-8978
                Publication date (Print): April 2014
                Publication date (Electronic): 19 July 2013
                Volume: 44
                Issue: 6
                Pages: 1131-1146
                Affiliations
                [1 ]Centre for Global Mental Health, London School of Hygiene and Tropical Medicine , UK, and Sangath, India
                [2 ]Institute of Psychiatry, King's College , London, UK, Public Health Foundation of India, and Sangath, India
                [3 ]London School of Hygiene and Tropical Medicine , UK
                [4 ]Vanderbilt University , Nashville, TN, USA
                [5 ]Faculty of Brain Sciences, University College London Medical School , UK
                [6 ]HealthNet TPO , Amsterdam, The Netherlands
                [7 ]University of Liverpool , UK
                [8 ]Teachers College, Columbia University and Columbia College of Physicians and Surgeons , NY, USA
                [9 ]University of Bristol , UK
                Author notes
                [* ]Address for correspondence: Professor V. Patel, MRCPsych., Ph.D., F.Med.Sci., Sangath Centre, 841/1 Alto Porvorim, Goa 403521, India. (Email: Vikram.Patel@ 123456lshtm.ac.uk )
                Article
                Publisher Item ID: S0033291713001785 Publisher ID: 00178
                DOI: 10.1017/S0033291713001785
                PMC ID: 3943384
                PubMed ID: 23866176
                SO-VID: db44140b-9c78-4769-ba29-3e0505e00353
                Copyright © © Cambridge University Press 2013
                License:

                The online version of this article is published within an Open Access environment subject to the conditions of the Creative Commons Attribution licence < http://creativecommons.org/licenses/by/3.0/.

                History
                Date received : 05 March 2013
                Date revision received : 11 June 2013
                Date accepted : 15 June 2013
                Page count
                Figures: 2, Tables: 3, References: 51, Pages: 16
                Categories
                Subject: Review Article

                ScienceOpen disciplines: Clinical Psychology & Psychiatry
                Keywords: cultural adaptation,depression,developing countries,ethnic minorities,psychological treatment
                Data availability:
                ScienceOpen disciplines: Clinical Psychology & Psychiatry
                Keywords: cultural adaptation, depression, developing countries, ethnic minorities, psychological treatment

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