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Articles   |    
The Effects of Psychotherapy on Depression Among Racial-Ethnic Minority Groups: A Metaregression Analysis
Burçin Ünlü Ince, M.Sc.; Heleen Riper, Ph.D.; Edith van ‘t Hof, Ph.D.; Pim Cuijpers, Ph.D.
Psychiatric Services 2014; doi: 10.1176/appi.ps.201300165
View Author and Article Information

The authors are with the Department of Clinical Psychology, VU University, Amsterdam, the Netherlands, and the EMGO Institute for Health and Care Research (e-mail: b.unlu@vu.nl).

Copyright © 2014 by the American Psychiatric Association

Abstract

Objective  Several psychotherapies have been found to be effective in the treatment of depression among adults. However, little is known about whether effectiveness differs by racial-ethnic minority group. The authors conducted a meta-analysis to assess the relative effects of psychotherapy for persons from racial-ethnic minority groups, by examining whether a sample’s racial-ethnic minority proportion was a moderator of the effect size of psychotherapy.

Methods  Eligible studies were identified with an existing database of randomized controlled trials (RCTs) on the psychological treatment of depression among adults. The analysis included all studies in which the effect of psychotherapy for adults with a depressive disorder or symptomatology was compared with a control condition in an RCT. Only studies that reported the overall racial-ethnic minority proportion of the sample or the studies reporting specific racial-ethnic backgrounds of participants were included. A total of 56 RCTs reported the proportion of participants from racial-ethnic minority groups (with 77 comparisons between psychotherapy treatment and control groups).

Results  An overall moderate effect size (g=.50) in favor of psychotherapy was found. No significant moderating effect of race-ethnicity was found in bivariate and multivariate analyses.

Conclusions  Results suggest that psychotherapy is equally effective regardless of care seekers’ race-ethnicity. Future research should focus on filling in the gap between effective mental health care and the delivery of these services.

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Table 1Efficacy of psychotherapy versus a control condition in meta-analyses of 56 randomized controlled trials of psychotherapy for depressiona
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a Efficacy (Hedges’ g) was analyzed with a random-effects model. Ncomp, number of comparisons; NNT, number needed to treat

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b Heterogeneity in proportions, with values in percentages. The p value indicates whether the Q statistic for heterogeneity is significant.

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c Values indicate whether the difference between the effect sizes in the subgroups is significant.

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d See appendix A of the online data supplement for the following outliers: Baker et al., 2010 (two comparisons); Dobkin et al., 2011; Dwight-Johnson et al., 2011; Jamison and Scogin, 1995; Miranda et al., 2003; O’Hara et al., 2000; Schmidt and Miller, 1983 (two comparisons); van Bastelaar et al., 2011; Williams Jr. et al., 2000.

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*p<.05, **p<.01, ***p<.001

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Table 2Multivariate regression analyses of predictors of psychotherapy use, by study characteristics and ethnicity in 56 randomized controlled trials of psychotherapy for depression
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a Study characteristics and ethnicity were categorized into nonminority and racial-ethnic minority groups.

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b Study characteristics and ethnicity were categorized into five groups: nonminority native born, black, Asian, Latin, and Native American.

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c Includes behavioral activation therapy, psychodynamic therapy, and other psychotherapies, as noted in Appendix C of the online data supplement

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References

Kessler  RC;  Angermeyer  M;  Anthony  JC  et al:  Lifetime prevalence and age-of-onset distributions of mental disorders in the World Health Organization’s World Mental Health Survey Initiative.  World Psychiatry 6:168–176, 2007
[PubMed]
 
Alonso  J;  Angermeyer  MC;  Bernert  S  et al:  Disability and quality of life impact of mental disorders in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project.  Acta Psychiatrica Scandinavica 109:38–46, 2004
[CrossRef] | [PubMed]
 
Ustün  TB;  Ayuso-Mateos  JL;  Chatterji  S  et al:  Global burden of depressive disorders in the year 2000.  British Journal of Psychiatry 184:386–392, 2004
[CrossRef] | [PubMed]
 
Saarni  SI;  Suvisaari  J;  Sintonen  H  et al:  Impact of psychiatric disorders on health-related quality of life: general population survey.  British Journal of Psychiatry 190:326–332, 2007
[CrossRef] | [PubMed]
 
Smit  F;  Cuijpers  P;  Oostenbrink  J  et al:  Costs of nine common mental disorders: implications for curative and preventive psychiatry.  Journal of Mental Health Policy and Economics 9:193–200, 2006
[PubMed]
 
Mathers  CD;  Loncar  D:  Projections of global mortality and burden of disease from 2002 to 2030.  PLoS Medicine 3:e442, 2006
[CrossRef] | [PubMed]
 
Missinne  S;  Bracke  P:  Depressive symptoms among immigrants and ethnic minorities: a population based study in 23 European countries.  Social Psychiatry and Psychiatric Epidemiology 47:97–109, 2012
[CrossRef] | [PubMed]
 
Hofmann  SG;  Asnaani  A;  Vonk  IJ  et al:  The efficacy of cognitive behavioral therapy: a review of meta-analyses.  Cognitive Therapy Research 36:427–440, 2012
[CrossRef] | [PubMed]
 
Churchill  R;  Hunot  V;  Corney  R  et al:  A systematic review of controlled trials of the effectiveness and cost-effectiveness of brief psychological treatments for depression.  Health Technology Assessment 5:1–173, 2001
[PubMed]
 
Cuijpers  P;  Geraedts  AS;  van Oppen  P  et al:  Interpersonal psychotherapy for depression: a meta-analysis.  American Journal of Psychiatry 168:581–592, 2011
[CrossRef] | [PubMed]
 
Cuijpers  P;  van Straten  A;  Warmerdam  L:  Problem solving therapies for depression: a meta-analysis.  European Psychiatry 22:9–15, 2007
[CrossRef] | [PubMed]
 
Cuijpers  P;  van Straten  A;  Warmerdam  L:  Behavioral activation treatments of depression: a meta-analysis.  Clinical Psychology Review 27:318–326, 2007
[CrossRef] | [PubMed]
 
Miranda  J;  Nakamura  R;  Bernal  G:  Including ethnic minorities in mental health intervention research: a practical approach to a long-standing problem.  Culture, Medicine and Psychiatry 27:467–486, 2003
[CrossRef] | [PubMed]
 
Weersing  VR;  Weisz  JR:  Community clinic treatment of depressed youth: benchmarking usual care against CBT clinical trials.  Journal of Consulting and Clinical Psychology 70:299–310, 2002
[CrossRef] | [PubMed]
 
 Mental Health: Culture, Race, and Ethnicity—A Supplement to Mental Health: A Report of the Surgeon General .  Rockville, Md,  US Department of Health and Human Services, 2001
 
Leong  FTL;  Kalibatseva  Z:  Cross-cultural barriers to mental health services in the United States.  Cerebrum 2011:5, 2011
[PubMed]
 
Santiago  CD;  Miranda  J:  Progress in improving mental health services for racial-ethnic minority groups: a ten-year perspective.  Psychiatric Services 65:180–185, 2014
[CrossRef] | [PubMed]
 
Trujillo  M:  Multicultural aspects of mental health.  Primary Psychiatry 15:65–84, 2008
 
Bhugra  D:  Cultural identities and cultural congruency: a new model for evaluating mental distress in immigrants.  Acta Psychiatrica Scandinavica 111:84–93, 2005
[CrossRef] | [PubMed]
 
Griner  D;  Smith  TB:  Culturally adapted mental health intervention: a meta-analytic review.  Psychotherapy 43:531–548, 2006
[CrossRef] | [PubMed]
 
Cuijpers  P;  van Straten  A;  Warmerdam  L  et al:  Psychological treatment of depression: a meta-analytic database of randomized studies.  BMC Psychiatry 8:36, 2008
[CrossRef] | [PubMed]
 
Higgins  JPT;  Green  S:  Cochrane Handbook for Systematic Reviews of Interventions .  Chichester, United Kingdom,  Wiley, 2008
 
Cohen  J:  Statistical Power Analysis for the Behavioral Sciences .  New York,  Routledge Academic, 1988
 
Hedges  LV;  Olkin  I:  Statistical Methods for Meta-Analysis .  New York,  Academic, 1985
 
Beck  AT;  Ward  CH;  Mendelson  M  et al:  An inventory for measuring depression.  Archives of General Psychiatry 4:561–571, 1961
[CrossRef] | [PubMed]
 
Hamilton  M:  A rating scale for depression.  Journal of Neurology, Neurosurgery, and Psychiatry 23:56–62, 1960
[CrossRef] | [PubMed]
 
Kraemer  HC;  Kupfer  DJ:  Size of treatment effects and their importance to clinical research and practice.  Biological Psychiatry 59:990–996, 2006
[CrossRef] | [PubMed]
 
Smit  F;  Ederveen  A;  Cuijpers  P  et al:  Opportunities for cost-effective prevention of late-life depression: an epidemiological approach.  Archives of General Psychiatry 63:290–296, 2006
[CrossRef] | [PubMed]
 
Higgins  JP;  Thompson  SG;  Deeks  JJ  et al:  Measuring inconsistency in meta-analyses.  BMJ 327:557–560, 2003
[CrossRef] | [PubMed]
 
Duval  S;  Tweedie  R:  Trim and fill: a simple funnel-plot–based method of testing and adjusting for publication bias in meta-analysis.  Biometrics 56:455–463, 2000
[CrossRef] | [PubMed]
 
Miranda  J;  Bernal  G;  Lau  A  et al:  State of the science on psychosocial interventions for ethnic minorities.  Annual Review of Clinical Psychology 1:113–142, 2005
[CrossRef] | [PubMed]
 
van’t Hof  E;  Cuijpers  P;  Waheed  W  et al:  Psychological treatments for depression and anxiety disorders in low- and middle- income countries: a meta-analysis.  African Journal of Psychiatry 14:200–207, 2011
[CrossRef] | [PubMed]
 
Cuijpers  P;  van Straten  A;  Andersson  G  et al:  Psychotherapy for depression in adults: a meta-analysis of comparative outcome studies.  Journal of Consulting and Clinical Psychology 76:909–922, 2008
[CrossRef] | [PubMed]
 
Cuijpers  P;  van Straten  A;  Bohlmeijer  E  et al:  The effects of psychotherapy for adult depression are overestimated: a meta-analysis of study quality and effect size.  Psychological Medicine 40:211–223, 2010
[CrossRef] | [PubMed]
 
Alvidrez  J;  Azocar  F;  Miranda  J:  Demystifying the concept of ethnicity for psychotherapy researchers.  Journal of Consulting and Clinical Psychology 64:903–908, 1996
[CrossRef] | [PubMed]
 
Hall  GCN:  Psychotherapy research with ethnic minorities: empirical, ethical, and conceptual issues.  Journal of Consulting and Clinical Psychology 69:502–510, 2001
[CrossRef] | [PubMed]
 
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