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Taking Issue   |    
Robustness of Psychotherapy for Depression
Jeanne Miranda, Ph.D.; Isabel Lagomasino, M.D.; Anna Lau, Ph.D.; Laura Kohn, Ph.D.
Psychiatric Services 2009; doi: 10.1176/appi.ps.60.3.283
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In this issue, Grote and colleagues contribute to a growing literature documenting that short-term, evidence-based interventions are very effective for low-income and minority populations in the United States and abroad. In this study, brief interpersonal psychotherapy was provided to low-income, primarily African-American and white pregnant women. Six months postpartum, 88% of the women in the intervention group had improved, compared with only 25% of those in enhanced usual care.

Despite growing evidence that established depression treatments are extremely robust, concerns remain that such interventions may not be appropriate for low-income individuals, who must deal with substantial real-life problems, for individuals from ethnic minority groups, who might need extensive cultural adaptations, and for pregnant women, who may have different biological and psychological needs for treatment. Fortunately, global dissemination efforts are finding that depression treatments, such as interpersonal psychotherapy, lead to substantial improvements in groups that are as different from middle-class white Americans as rural Ugandans.

Grote and colleagues carefully document the ways in which they adapted the intervention for low-income pregnant women from minority groups. First, they provided an initial engagement session to build trust and make care accessible by holding it in a nonstigmatizing setting where the women already received routine services and by including child care and transportation. Other studies suggest that providing care in the participant's native language is an important aspect of making care accessible. Second, they were thoughtful about making women comfortable and being respectful of the women's feelings and ways of expressing themselves. Third, Grote and colleagues condensed acute-phase treatment to eight sessions targeting a single interpersonal area, with additional maintenance sessions. Therapists encouraged behavioral activation between sessions to help women face multiple environmental stressors.

This study is an exciting contribution to the growing literature that suggests that depression treatments are robust across diverse populations when thoughtful consideration is given to making care accessible and acceptable. Mental health care provided by ethnically matched therapists with finely adapted interventions for each distinct cultural and social group would undoubtedly be particularly effective. Given the dearth of mental health providers, particularly from ethnic minority groups, in the United States and abroad, and lack of infrastructure to adapt treatments, we are pleased to find that psychotherapy for depression is quite robust. With reasonable adaptations, evidence-based therapies can be effective for a wide range of individuals.




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