Telehealth Psychoeducational Groups With Latinx College Students: Findings From Focus Groups

The literatures examining psychoeducational groups and telehealth services have demonstrated positive results but less is known about the efficacy of psychoeducational telehealth groups. This study examines the perspectives of 105 Latinx college students who participated in an 8-session psychoeducational group via a telehealth platform during the COVID-19 pandemic. The research questions included (a) What was the experience of these Latinx college students participating in telehealth psychoeducational groups? and (b) What were the potential perceived advantages and disadvantages of implementing telehealth psychoeducational groups? Postintervention, a total of 16 focus groups were convened with a total of 105 Latinx college students (average number of participants per group = 6). Interviews were coded using conventional qualitative analysis and yielded four main themes: (1) group cohesion, which involved group members feeling that they were connected and that the group was a safe space; (2) group leaders, which involved leaders' preparation and knowledge and their ability to foster a safe environment); (3) cultural issues, which involved cultural values and acculturative and first-generation stress.; and (4) telehealth implementation, wherein participants described advantages and disadvantages of the telehealth approach. We discuss study limitations and directions for future research.

Applying a Process-Oriented Model of Cultural Competence to Behavioral Activation for Depression

Efforts to integrate cultural competence and evidence-based treatments (EBTs) typically take the form of cultural adaptations of EBTs, characterized by modifications to the existing treatment based on presumed cultural notions of a given race or ethnic group. Much less attention has been given to ways EBTs can integrate a process model of cultural competence, which focuses on what clinicians do in-session to identify and integrate key cultural factors for a given individual in the treatment. Our objective is to consider how a process model of cultural competence (Shifting Cultural Lenses) can be integrated with an EBT (Behavioral Activation). We present a theoretical rationale for integrating the SCL model with BA and illustrate this integration, which clinician provides an additional approach to bringing culture to treatments and shows promise for identifying clinicians' in-session behaviors that reflect cultural competence.

Culturally adapted psychotherapies for depressed adults: A systematic review and meta-analysis

BACKGROUND

There is current debate about the effectiveness and generalizability of evidence-based psychological therapies in treatment of depression for diverse ethno-cultural groups. This has led to increasing interest in culturally adapted psychotherapies (CAPs).

METHODS

Studies on CAPs for face-to-face treatment of depressed adults were identified using nine electronic database searches. Data on the process of adaptation was analysed using thematic analysis and treatment efficacy was assessed through meta-analysis of Randomized Controlled Trials.

RESULTS

Fifteen studies were included in the review, of which eight were included in a meta-analysis. Cognitive Behavioural Therapy and Behavioural Activation were commonly selected approaches for CAPs, mainly based on their strong evidence base for effectiveness. Twelve studies reported the adaptation process that follows all or some phases recommended by the Medical Research Council Framework for developing complex interventions. A meta-analysis of 16 RCTs, which included eight studies from the current review and eight studies from an earlier review (Chowdhary et al. (2014), demonstrated a statistically significant benefit in favour of CAPs, reducing symptom burden [standardized mean difference -0.63, 95% confidence interval -0.87 to -0.39]. Subgroup analysis showed a larger effect when the intervention was for the majority ethnic group in a population, rather than a minority group.

LIMITATIONS

Some studies did not report all relevant information, and in the subgroup analysis only three studies were of minority groups.

CONCLUSIONS

CAPs were confirmed to be more efficacious than control treatments. This supports the continued development and evaluation of culturally adapted psychotherapies for depression.

"Abrazame Que Ayuda" (Hug Me, It Helps): Social Support and the Effect of Perceived Discrimination on Depression among US- and Foreign-Born Latinxs in the USA

BACKGROUND

Higher level of social support is known to mitigate the effect of ethnic discrimination on depression symptoms, yet little is known as to which type of social support may be most effective for ameliorating the negative health effects of perceived ethnic discrimination among Latinxs varying in nativity status. The purpose of this study is to examine the association between perceived ethnic discrimination and depression among US- and foreign-born Latinxs, and to identify specific types of social support that may buffer the aforementioned association in this population.

METHODS

Data from 1340 Latinx respondents (70% US-born; 30% foreign-born) collected from the Texas City Stress and Health Study (TCSHS) was used in this study. The primary outcome was depression, and it was measured using the Center for Epidemiologic Studies Depression Scale Revised (CESD-R).

RESULTS

Findings showed that higher perceived ethnic discrimination were associated with higher depressive symptoms for both foreign-born and US-born Latinxs, with higher levels of social support, specifically positive interaction support, being associated with lower depressive symptoms for both groups. Importantly, results also showed that regardless of nativity status, higher levels of affectionate support mitigated the adverse association between ethnic discrimination and depressive symptoms.

CONCLUSION

This study provides evidence that higher levels of positive interactions and affective support may be significant factors in helping Latinxs cope with ethnic discrimination. This information is essential to inform the development of interventions aimed at building resilience in the face of discrimination among the largest and fastest growing ethnic group in the USA.

Effects of resistance training on depression and cardiovascular disease risk in Black men: Protocol for a randomized controlled trial

BACKGROUND

Depression is severely undertreated in Black men. This is primarily because Black men are less likely to seek traditional psychiatric treatment, have less access and more barriers to treatment, and perceive more stigma associated with treatment. Depression contributes to cardiovascular disease (CVD), and Black men have the highest rate of mortality from CVD. Resistance training (RT) can have beneficial effects on both depression and CVD. This study will be the first randomized controlled trial to test the effects of RT on depression and cardiovascular health in a sample of depressed Black men.

METHOD/DESIGN

Fifty Black men with clinically significant symptoms of depression will be randomized to either (a) a 12-week RT or (b) an attention-control group. Behavioral Activation techniques will be used to support adherence to home-based RT goals. Both groups will meet on-site twice/week during the 12-week program, and follow-up assessments will occur at the end-of-treatment and 3 months post-treatment. Qualitative interviews will be conducted after the 3-month follow-up. The objectives of this study are (1) to assess the feasibility and acceptability of recruitment, retention, and intervention procedures, (2) to obtain preliminary evidence of efficacy, and (3) to explore potential mediators of the effects of RT on depression.

DISCUSSION

This study will advance the field of minority men's health by producing new data on the effects of RT for depression, the potential mechanisms of action that may support its use, and its effects on markers of CVD risk in Black men.

TRIAL REGISTRATION

ClinicalTrials.gov (NCT03107039).

Psychosocial factors associated with treatment outcomes in women with obesity and major depressive disorder who received behavioral activation for depression

Behavioral activation is an empirically supported treatment for depression, but much is unknown about factors associated with treatment response. The present study aimed to determine whether baseline levels and subsequent changes in psychosocial factors were associated with improvement in depression in women with comorbid obesity who received behavioral activation treatment for depression and a lifestyle intervention. Multilevel modeling was used to estimate the associations between psychosocial factors and change in depression scores during the first 10 weeks of treatment and associations between changes in psychosocial factors from baseline to 6-month follow-up and change in depression over the same time period. No baseline psychosocial factors were associated with depression improvement during treatment (p = 0.110-0.613). However, greater improvement in hedonic capacity (p = 0.001), environmental reward (p = 0.004), and social impairment (p = 0.012) were associated with greater reductions in depression over 6 months. Findings highlight the differential relationship specific psychosocial factors have with depression treatment outcomes.

Culturally Adapted Behavioral Activation

The scarcity of accessible culturally competent service providers and a general sense of mistrust in Eurocentric-based mental health settings exacerbate the lack of help seeking and effective therapeutic engagement for Latinos. Thus, clinical interventions that account for diverse values and worldviews may be an important step in the helpful treatment of U.S. Latino populations. Behavioral activation (BA), an evidence-based intervention for the treatment of depression, was recently evaluated through a preliminary clinical trial study in a community clinic primarily serving Spanish-speaking Latinos, and the results were promising. A culturally adapted version of BA was developed for Latinos, which took into consideration the cultural value of familismo (a collectivist worldview and preference for maintaining close connections to family); however, BA has not been previously applied to Latino families. The current case study presents the clinical treatment of a Mexican American family living in the southwest of the United States experiencing numerous stressors resulting in depressive symptoms. Specifically, this family sought therapy having experienced many negative life events, including stressors associated with institutionalized racism, their financial situation, and acculturation process. This led to a disruption of the family hierarchy, anger, unhappiness, fear, and isolation among family members. Outcomes of the intervention include a decrease in depressive symptoms and improved family communication and relationships by their involvement in activities such as attending cultural events in their community, family outings, and the children’s participation in extracurricular activities.

Brief Behavioral Activation for Adolescent Depression

Given the long-term negative outcomes associated with depression in adolescence, there is a pressing need to develop brief, evidence-based treatments that are accessible to more young people experiencing low mood. Behavioral Activation (BA) is an effective treatment for adult depression; however, little research has focused on the use of BA with depressed adolescents, particularly with briefer forms of BA. In this article, we outline an adaptation of brief Behavioral Activation Treatment of Depression (BATD) designed for adolescents and delivered in eight sessions (Brief BA). This case example illustrates how a structured, brief intervention was useful for a depressed young person with a number of complicating and risk factors.

A randomized hybrid efficacy and effectiveness trial of behavioral activation for Latinos with depression

Depression presents a significant public health burden for Latinos, the largest and fastest-growing minority group in the United States. The current study performed a randomized controlled trial of Behavioral Activation (BA) for Latinos (BAL, n=21), with relatively minor modifications, compared to treatment as usual (TAU, n=22) in a community mental health clinic setting with a sample of depressed, Spanish-speaking Latinos. TAU was a strong comparison condition, taking place at the same clinic, under the same guidelines and clinic protocols, with similar levels of ongoing consultation, and using the same pool of therapists as BAL. Results indicated that BAL performed well with respect to treatment engagement and retention. Regarding acute treatment outcomes, an interaction emerged between number of sessions attended and condition. Specifically, only BAL clients who were engaged in treatment and attended more sessions demonstrated significant reductions in depression and improvements in quality of life and mental health functioning. Results are discussed in terms of the balance of efficacy and effectiveness issues addressed in this trial.

Behavioral activation for the treatment of atypical depression: a pilot open trial

Psychosocial interventions for atypical depression (AD) have been relatively ignored in the clinical research literature, despite evidence that the atypical subtype of major depression is marked by earlier age of onset, longer duration of mood episode, greater symptom severity, and poorer response to pharmacologic treatment. Given the symptom profile of AD, which is characterized by mood reactivity, psychomotor slowing, and interpersonal withdrawal, the authors argue that a behavioral activation (BA) intervention may be particularly well suited to this population. As an initial exploration of this hypothesis, the current study presents preliminary outcome data from 10 outpatients with AD who participated in an open pilot trial of BA over a 16-week period. Overall, results provide encouraging preliminary support for the feasibility, acceptability, and efficacy of BA for AD, with significant reductions in depressive symptoms and associated improvements in functional impairment and BA level. Study results are discussed in the context of existing treatments for AD, and areas for future treatment development are highlighted.

Initial Outcomes of a Culturally Adapted Behavioral Activation for Latinas Diagnosed With Depression at a Community Clinic

Latinos demonstrate high rates of depression, often do not seek treatment, and terminate prematurely for a variety of reasons, including lack of sensitivity to contextual and cultural factors in treatment approaches. For decades researchers have suggested a behavioral approach to Latinos diagnosed with depression because such an approach targets the complex environmental stressors experienced by these populations with a simple, pragmatic approach. Recently, behavioral activation has been culturally and linguistically adapted for Latinos/Latinas diagnosed with depression (BA-Latino or BAL). The current study consists of a pilot evaluation of BAL at a bilingual (Spanish—English) community mental health clinic ( N = 10 Latinas). Results provide preliminary support for the feasibility and effectiveness of BAL for Latinas in a community setting in terms of treatment adherence, retention, and outcomes. Implications and future directions are discussed.