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Gkintoni E, Nikolaou G. The Cross-Cultural Validation of Neuropsychological Assessments and Their Clinical Applications in Cognitive Behavioral Therapy: A Scoping Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:1110. [PMID: 39200719 PMCID: PMC11355053 DOI: 10.3390/ijerph21081110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2024] [Revised: 08/17/2024] [Accepted: 08/19/2024] [Indexed: 09/02/2024]
Abstract
OBJECTIVE The present study explores the cross-cultural validation of neuropsychological assessments and their clinical applications in cognitive behavioral therapy (CBT), focusing on culturally adapted CBT (CA-CBT) across diverse populations and settings. METHODS Following the PRISMA guidelines, a comprehensive search was conducted in multiple academic databases, including PubMed, PsycINFO, Scopus, and Web of Science. Keywords related to cognitive behavioral therapy, cultural adaptation, and specific populations were used. The inclusion criteria encompassed randomized controlled trials (RCTs) and pilot studies that assessed CA-CBT for various mental health conditions. RESULTS The review included studies involving Chinese Americans, Latino caregivers, Syrian refugees, Jordanian children, Malaysian Muslims, Afghan refugees, Iraqi women, Japanese children and adolescents, and Tanzanian and Kenyan children. CA-CBT demonstrated significant effectiveness in reducing symptoms of depression, anxiety, PTSD, and psychosis. For instance, research has shown that CA-CBT is more effective than standard CBT in reducing depressive symptoms among Chinese Americans and in significantly lowering PTSD symptoms in Syrian refugee women. This method has been well-received and is feasible for use in diverse populations, such as Jordanian children and Afghan refugees. The long-term benefits are promising, with sustained improvements being reported in various studies. Additionally, digital and remote delivery methods have demonstrated potential for expanding the accessibility of CA-CBT. CONCLUSIONS CA-CBT is a valuable and effective intervention for diverse cultural populations, significantly improving mental health outcomes. However, future research must address limitations such as small sample sizes, short follow-up periods, and variability in assessment tools. Future studies should include larger and more diverse sample sizes, longer follow-up periods, rigorous control groups, and comprehensive outcome measures to further validate and enhance the application of CA-CBT across different cultural contexts.
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Affiliation(s)
- Evgenia Gkintoni
- Department of Educational Sciences and Social Work, University of Patras, 26504 Patras, Greece;
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Auva'a-Alatimu T, Alefaio-Tugia S, Ioane J. Understanding the impact of digital therapeutic engagement in promoting mental wellbeing for Pacific youth in Aotearoa New Zealand: an exploration of the literature. Int J Ment Health Syst 2024; 18:22. [PMID: 38844998 PMCID: PMC11157858 DOI: 10.1186/s13033-024-00633-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 03/25/2024] [Indexed: 06/09/2024] Open
Abstract
The Pacific population in Aotearoa New Zealand is youthful, with the majority (55%) being under the age of 25 (Statistics New Zealand, 2014). It is vital that youth mental health for Pacific is understood in relation to their overall wellbeing (Paterson et al., 2018). In parallel to this, the World Health Organization (2022) accentuates the need to protect and promote mental wellbeing for young people globally. Specifically, Pacific youth were far more likely than Aotearoa New Zealand European counterparts to have poorer mental health and higher numbers of suicidality and self-harming behaviours (Ataera-Minster & Trowland, 2018; Fa'alili-Fidow et al., 2016). Moreover, research confirms that Pacific people aged 15-24 years have higher levels of psychological distress of 38% compared to 35% of Pacific adults aged 45-64 years (Ataera-Minster & Trowland, 2018). There is a lack of evidence-based psychological approaches that are culturally appropriate and applicable for Pacific people in Aotearoa New Zealand. Considerably, substantial evidence supports the need to provide more accessible resources and interventions that are flexible, culturally adaptable and cost-effective for Pacific youth. This review aims to (1) provide an insight into Pacific people in Aotearoa New Zealand, (2) have an understanding of Pacific worldview & wellbeing, (3) highlight mental health for Aotearoa New Zealand youth & globally (4) identify therapeutic approaches, including digital mental health globally and in Aotearoa New Zealand.Understanding the perspectives of Pacific youth is a significant first step. Therefore, this article will examine the therapeutic approaches, specifically in the digital space, that are proven effective when promoting wellness for Pacific youth.
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Affiliation(s)
| | | | - Julia Ioane
- Massey University, School of Psychology, Auckland, New Zealand
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Bjornstad G, Sonthalia S, Rouse B, Freeman L, Hessami N, Dunne JH, Axford N. A comparison of the effectiveness of cognitive behavioural interventions based on delivery features for elevated symptoms of depression in adolescents: A systematic review. CAMPBELL SYSTEMATIC REVIEWS 2024; 20:e1376. [PMID: 38188230 PMCID: PMC10771715 DOI: 10.1002/cl2.1376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 11/03/2023] [Indexed: 01/09/2024]
Abstract
Background Depression is a public health problem and common amongst adolescents. Cognitive behavioural therapy (CBT) is widely used to treat adolescent depression but existing research does not provide clear conclusions regarding the relative effectiveness of different delivery modalities. Objectives The primary aim is to estimate the relative efficacy of different modes of CBT delivery compared with each other and control conditions for reducing depressive symptoms in adolescents. The secondary aim is to compare the different modes of delivery with regard to intervention completion/attrition (a proxy for intervention acceptability). Search Methods The Cochrane Depression, Anxiety and Neurosis Clinical Trials Register was searched in April 2020. MEDLINE, PsycInfo, EMBASE, four other electronic databases, the CENTRAL trial registry, Google Scholar and Google were searched in November 2020, together with reference checking, citation searching and hand-searching of two databases. Selection Criteria Randomised controlled trials (RCTs) of CBT interventions (irrespective of delivery mode) to reduce symptoms of depression in young people aged 10-19 years with clinically relevant symptoms or diagnosis of depression were included. Data Collection and Analysis Screening and data extraction were completed by two authors independently, with discrepancies addressed by a third author. CBT interventions were categorised as follows: group CBT, individual CBT, remote CBT, guided self-help, and unguided self-help. Effect on depressive symptom score was estimated across validated self-report measures using Hedges' g standardised mean difference. Acceptability was estimated based on loss to follow-up as an odds ratio. Treatment rankings were developed using the surface under the cumulative ranking curve (SUCRA). Pairwise meta-analyses were conducted using random effects models where there were two or more head-to-head trials. Network analyses were conducted using random effects models. Main Results Sixty-eight studies were included in the review. The mean age of participants ranged from 10 to 19.5 years, and on average 60% of participants were female. The majority of studies were conducted in schools (28) or universities (6); other settings included primary care, clinical settings and the home. The number of CBT sessions ranged from 1 to 16, the frequency of delivery from once every 2 weeks to twice a week and the duration of each session from 20 min to 2 h. The risk of bias was low across all domains for 23 studies, 24 studies had some concerns and the remaining 21 were assessed to be at high risk of bias. Sixty-two RCTs (representing 6435 participants) were included in the pairwise and network meta-analyses for post-intervention depressive symptom score at post-intervention. All pre-specified treatment and control categories were represented by at least one RCT. Although most CBT approaches, except remote CBT, demonstrated superiority over no intervention, no approaches performed clearly better than or equivalent to another. The highest and lowest ranking interventions were guided self-help (SUCRA 83%) and unguided self-help (SUCRA 51%), respectively (very low certainty in treatment ranking). Nineteen RCTs (3260 participants) were included in the pairwise and network meta-analyses for 6 to 12 month follow-up depressive symptom score. Neither guided self-help nor remote CBT were evaluated in the RCTs for this time point. Effects were generally attenuated for 6- to 12-month outcomes compared to posttest. No interventions demonstrated superiority to no intervention, although unguided self-help and group CBT both demonstrated superiority compared to TAU. No CBT approach demonstrated clear superiority over another. The highest and lowest ranking approaches were unguided self-help and individual CBT, respectively. Sixty-two RCTs (7347 participants) were included in the pairwise and network meta-analyses for intervention acceptability. All pre-specified treatment and control categories were represented by at least one RCT. Although point estimates tended to favour no intervention, no active treatments were clearly inferior. No CBT approach demonstrated clear superiority over another. The highest and lowest ranking active interventions were individual CBT and group CBT respectively. Pairwise meta-analytic findings were similar to those of the network meta-analysis for all analyses. There may be age-based subgroup effects on post-intervention depressive symptoms. Using the no intervention control group as the reference, the magnitudes of effects appear to be larger for the oldest age categories compared to the other subgroups for each given comparison. However, they were generally less precise and formal testing only indicated a significant difference for group CBT. Findings were robust to pre-specified sensitivity analyses separating out the type of placebo and excluding cluster-RCTs, as well as an additional analysis excluding studies where we had imputed standard deviations. Authors' Conclusions At posttreatment, all active treatments (group CBT, individual CBT, guided self-help, and unguided self-help) except for remote CBT were more effective than no treatment. Guided self-help was the most highly ranked intervention but only evaluated in trials with the oldest adolescents (16-19 years). Moreover, the studies of guided self-help vary in the type and amount of therapist support provided and longer-term results are needed to determine whether effects persist. The magnitude of effects was generally attenuated for 6- to 12-month outcomes. Although unguided self-help was the lowest-ranked active intervention at post-intervention, it was the highest ranked at follow-up. This suggests the need for further research into whether interventions with self-directed elements enable young people to maintain effects by continuing or revisiting the intervention independently, and whether therapist support would improve long-term outcomes. There was no clear evidence that any active treatments were more acceptable to participants than any others. The relative effectiveness of intervention delivery modes must be taken into account in the context of the needs and preferences of individual young people, particularly as the differences between effect sizes were relatively small. Further research into the type and amount of therapist support that is most acceptable to young people and most cost-effective would be particularly useful.
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Affiliation(s)
- Gretchen Bjornstad
- NIHR Applied Research Collaboration South West Peninsula (PenARC)University of Exeter Medical SchoolExeterUK
- Dartington Service Design LabBuckfastleighUK
| | - Shreya Sonthalia
- Dartington Service Design LabBuckfastleighUK
- MRC/CSO Social and Public Health Sciences UnitUniversity of GlasgowGlasgowUK
| | - Benjamin Rouse
- Center for Clinical Evidence and Guidelines, ECRI InstitutePlymouth MeetingPennsylvaniaUSA
| | | | | | - Jo Hickman Dunne
- The Centre for Youth ImpactLondonUK
- University of ManchesterManchesterUK
| | - Nick Axford
- NIHR Applied Research Collaboration South West Peninsula (PenARC)University of PlymouthPlymouthUK
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Wang D, Lin B, Xiong F, Deng Y, Zhang L. Effectiveness of Internet-delivered self-help acceptance and commitment therapy (iACT) on nurses' obsessive-compulsive symptoms and sleep quality: A randomized controlled trial with 3-month follow-up. J Affect Disord 2023; 341:319-328. [PMID: 37659615 DOI: 10.1016/j.jad.2023.08.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 08/14/2023] [Accepted: 08/27/2023] [Indexed: 09/04/2023]
Abstract
BACKGROUND Frontline nurses suffered unprecedented mental distress during the COVID-19 pandemic. It's essential to explore new and more accessible alternatives to improve the availability of psychological treatments. This study aimed to investigate the influence of online self-help iACT linear intervention and iACT loop intervention on sleep quality (SQ), obsessive-compulsive symptoms (OCS), and psychological flexibility (PF) in nurses. METHODS A randomized controlled trial was conducted at a hospital in China. 602 participants were randomly assigned to the iACT linear intervention, iACT loop intervention, or wait list control group, and required to complete the questionnaires of OCS, PF and SQ. The linear mixed effects analysis (LMM) was used to analyze the impact of the intervention on outcome variables. RESULTS LMM analyses demonstrated that both two intervention had significant improvement on OCS (t = -38.235, p < 0.001), PF (t = 28.156, p < 0.001), as well as SQ (t = -16.336, p < 0.001). There were significant differences between the linear group and loop group on the PF in T2 (t = -8.271, p < 0.001), T3 (t = -8.366, p < 0.001), T4 (t = -8.302, p < 0.001), with the iACT loop model (Cohen's d = 1.652) showing a slight advantage over the iACT linear model (Cohen's d = 1.134). CONCLUSIONS The findings indicate that two interventions positively impact OCS, PF, and SQ. Compared to the iACT linear psychotherapy model, the iACT loop model shows greater effectiveness in enhancing PF, making it helpful to promote significant improvements in psychotherapy planning.
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Affiliation(s)
- Difan Wang
- School of Psychology, Central China Normal University, China; Key Laboratory of Adolescent Cyberpsychology and Behavior, Ministry of Education, China; Key Laboratory of Human Development and Mental Health of Hubei Province, Wuhan, China; Department of Field Internal Medicine, Psychological Counseling and Service Center, Graduate School of Medical College of Chinese PLA General Hospital, China
| | - Bingyan Lin
- School of Foreign Languages, Harbin University of Science and Technology, China
| | - Fen Xiong
- School of Psychology, Central China Normal University, China; Key Laboratory of Adolescent Cyberpsychology and Behavior, Ministry of Education, China; Key Laboratory of Human Development and Mental Health of Hubei Province, Wuhan, China
| | - Yu Deng
- School of Foreign Languages, Harbin University of Science and Technology, China
| | - Lin Zhang
- School of Psychology, Central China Normal University, China; Key Laboratory of Adolescent Cyberpsychology and Behavior, Ministry of Education, China; Key Laboratory of Human Development and Mental Health of Hubei Province, Wuhan, China.
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Listiyandini RA, Andriani A, Kusristanti C, Moulds M, Mahoney A, Newby JM. Culturally Adapting an Internet-Delivered Mindfulness Intervention for Indonesian University Students Experiencing Psychological Distress: Mixed Methods Study. JMIR Form Res 2023; 7:e47126. [PMID: 37651168 PMCID: PMC10502595 DOI: 10.2196/47126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 06/22/2023] [Accepted: 07/17/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND Psychological distress is prevalent among university students. However, the availability of evidence-based mental health treatment remains limited in many low- and middle-income countries, including Indonesia. Internet-delivered, mindfulness-based interventions that reduce distress have potential for treating university student distress at scale. Unfortunately, evidence-based, internet-delivered mindfulness treatments are not yet available in Indonesia. Cultural adaptation of established evidence-based, internet-delivered mindfulness interventions is needed. OBJECTIVE In this paper, we describe the process of culturally adapting an Australian internet-delivered mindfulness program (Introduction to Mindfulness) to be relevant and appropriate for treating Indonesian university students' psychological distress. METHODS To assist the cultural adaptation process, we used a systematic cultural adaptation framework and a mixed methods approach combining quantitative and qualitative methods. In study 1 (information gathering), we administered an internet-delivered questionnaire to Indonesian university students (n=248) to examine their preferences regarding an internet-delivered mindfulness intervention. In study 2 (preliminary design), a draft program was developed and independently reviewed by Indonesian stakeholders. Stakeholders (n=25) included local Indonesian mindfulness and mental health professionals (n=6) and university students (n=19), who were selected to maximize sample representativeness regarding personal and professional characteristics. To evaluate the initial design and cultural congruence of the internet-delivered mindfulness program in the Indonesian context, we conducted interviews and focus groups with stakeholders. Stakeholders also completed the Cultural Relevance Questionnaire. RESULTS In study 1, most Indonesian university students (240/248, 96.8%) reported openness to an internet-delivered mindfulness program. Most of interested students (127/240, 52.9%) preferred the length of the program to be 3 to 4 sessions, with 45.8% (110/240) preferring brief lessons taking only 15 to 30 minutes to complete. They (194/240, 80.8%) recommended that the program be accessible both through websites and mobile phones. In study 2, Indonesian stakeholders generally found the internet-delivered program to be highly culturally appropriate in terms of language, concepts, context, treatment goals, and depictions of students' emotional and behavioral experiences. However, stakeholders also recommended some specific adaptations regarding the program's delivery model (eg, combining visual and audio modalities when delivering psychoeducation), cultural components (eg, including more social and spiritual activities), program practicality (eg, including rewards to promote engagement), and design elements (eg, including additional culturally relevant illustrations). Following stakeholder feedback, a new culturally adapted Indonesian internet-delivered mindfulness program called Program Intervensi Mindfulness Daring Mahasiswa Indonesia was created. CONCLUSIONS This study highlights the process and importance of cultural adaptation of an evidence-based mindfulness treatment and demonstrates how this may be achieved for internet-delivered psychotherapy programs. We found that a culturally adapted internet-delivered mindfulness program was relevant for Indonesian students with some adjustments to the programs' content and delivery. Future research is now needed to evaluate the clinical benefit of this program.
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Affiliation(s)
- Ratih Arruum Listiyandini
- School of Psychology, Faculty of Science, University of New South Wales, Sydney, Australia
- Faculty of Psychology, Universitas YARSI, Jakarta Pusat, DKI Jakarta, Indonesia
| | | | | | - Michelle Moulds
- School of Psychology, Faculty of Science, University of New South Wales, Sydney, Australia
| | - Alison Mahoney
- Clinical Research Unit for Anxiety and Depression, St Vincent's Hospital, Sydney, Australia
- School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Jill M Newby
- School of Psychology, Faculty of Science, University of New South Wales, Sydney, Australia
- Black Dog Institute, Sydney, Australia
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Gueta K, Harel-Fisch Y, Walsh SD. Cultural accommodation of internet-based interventions for substance use and related disorders: a proposed comprehensive framework based on a pilot study and a literature review. Front Psychol 2023; 14:1063200. [PMID: 37416542 PMCID: PMC10321598 DOI: 10.3389/fpsyg.2023.1063200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 05/17/2023] [Indexed: 07/08/2023] Open
Abstract
Despite the low utilization rates of substance use and related disorders services, and the ability of internet-based interventions for substance use and related disorders (IBIS) to address challenges related to service engagement, limited attention has been placed on the processes for the accommodation of these interventions to diverse cultural settings. This study aimed to develop a framework for the cultural accommodation of IBIS across populations based on a pilot study and a literature review. A pilot study of cultural accommodation of an existing internet intervention for alcohol use was carried out in Israel, which involved focus groups and daily online surveys of prospective consumers (N = 24) as well as interviews with experts (N = 7) in the substance abuse treatment field. Thematic analysis revealed a range of themes that relate to the general Israeli culture and the specific Israeli drinking subculture, identified as needing to be addressed in the process of intervention accommodation. A comprehensive framework for cultural accommodation of IBIS is suggested, consisting of five stages: Technical and cultural feasibility; Engagement of target group; Identification of accommodation variables, Accommodation, and evaluation of the accommodated intervention. In addition, the framework consists of four dimensions of accommodation: Barriers and facilitators; Audio-visual materials and language; Mechanisms of change; Intersectional factors. We suggest that the proposed framework may serve as a guide for the cultural accommodation of existing internet-based interventions for substance use and related disorders across a range of cultural and geographical settings, thus augmenting the ecological validity of internet-based interventions for substance use and related disorders, expanding cross-cultural intervention research, and reducing health disparities worldwide.
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Affiliation(s)
- Keren Gueta
- Department of Criminology, Bar-Ilan University, Ramat Gan, Israel
| | - Yossi Harel-Fisch
- The International Research Program on Adolescent Well-Being and Health, School of Education, Bar-Ilan University, Ramat Gan, Israel
| | - Sophie D. Walsh
- Department of Criminology, Bar-Ilan University, Ramat Gan, Israel
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Narayan S, Mok H, Ho K, Kealy D. "I don't think they're as culturally sensitive": a mixed-method study exploring e-mental health use among culturally diverse populations. J Ment Health 2023; 32:241-247. [PMID: 35770901 DOI: 10.1080/09638237.2022.2091762] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Culturally diverse populations (CDPs), such as visible minorities, face challenges, such as lack of culturally tailored resources, when accessing mental health services. These barriers may be addressed by e-mental health (eMH) technologies. However, little attention has been devoted to understanding the cultural responsiveness of these services among CDPs. AIMS This study explores CDPs experience of eMH for anxiety and depressive disorders in an urban area and gauge its cultural responsiveness. METHODS In this mixed methods study, participants (N = 136) completed a survey regarding their eMH use, mental health status, and socio-demographic characteristics. Subsequently, participants (N = 14) shared their experiences through semi-structured focus groups. RESULTS The majority of participants (68%) indicated that the eMH resources used were not culturally tailored. However, most participants (65%) agreed that the resource was available in their preferred language. Focus group discussions revealed key experiences around limited language diversity, cultural representation and cultural competency, and culturally linked stigma. eMH recommendations suggested by participants focused on including culturally tailored content, graphics and phrases, and lived experiences of CDPs. CONCLUSIONS The findings showcase the need for more culturally responsive eMH beyond language translation, while providing healthcare professionals with a greater and nuanced understanding of treatment needs in cultural groups.
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Affiliation(s)
- Shawna Narayan
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Hiram Mok
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Kendall Ho
- University of British Columbia, Vancouver, British Columbia, Canada
| | - David Kealy
- University of British Columbia, Vancouver, British Columbia, Canada
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Chen IH, Niu SF, Yeh YC, Chen IJ, Kuo SF. Psychological distress among immigrant women who divorced: Resilience as a mediator. Arch Psychiatr Nurs 2022; 39:1-6. [PMID: 35688538 DOI: 10.1016/j.apnu.2021.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 11/17/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE The purpose of this study was to investigate relationships among the demands of immigration, resilience, and psychological distress in divorced immigrant women, and determine the mediating effects of resilience on the relationship between demands of immigration and psychological distress. DESIGN The cross-sectional study included 117 women who had immigrated and married Taiwanese men but later got divorced. METHODS The Chinese health questionnaire-12 scale, the resilience scale-Chinese version, and the demands of immigration (DI) scale were used to measure in this study. A multiple regression and Sobel test were used to examine whether resilience mediated the relationship between demands of immigration and psychological distress. FINDINGS In this study, 47% of the divorced immigrant women were experiencing psychological distress, and 25.6% exhibited high levels of demands of immigration. Women with psychological distress had higher demand scores (t = 2.592, p = 0.011) and lower resilience scores (t = -3.965, p < 0.001) compared to women without psychological distress. The demands of immigration negatively predicted resilience (t = -3.050, p = 0.003). Finally, resilience mediated the association of demands of immigration with psychological distress (z = 2.497, p = 0.0125). CONCLUSIONS Relationships among the demands of immigration, resilience, and psychological distress in divorced immigrant women were demonstrated in this study. Resilience played an important role in the relationship between demands of immigration and psychological distress. CLINICAL RELEVANCE Tailored programs that foster resilience to reduce risks of demands of immigration and psychological distress in this vulnerable population should be developed.
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Affiliation(s)
- I-Hui Chen
- School of Nursing, College of Nursing, Taipei Medical University, 250 Wuxing Street, Taipei 11031, Taiwan.
| | - Shu-Fen Niu
- Department of Nursing, Shin Kong Wu Ho-Su Memorial Hospital, 95 Wen Chang Road, Taipei 11101, Taiwan; Department of Nursing, Fu Jen Catholic University, 510 Zhong-Zheng Road, New Taipei City 242062, Taiwan.
| | - Yueh-Chen Yeh
- Department of Nursing, National Taichung University of Science and Technology, 193, Sec. 1, San-Min Road, Taichung City 40343, Taiwan.
| | - I-Ju Chen
- Physical Education Office & Department of Healthcare Administration, Asia University, 500 Lioufeng Rd., Wufeng Dist., Taichung City 41354, Taiwan.
| | - Shu-Fen Kuo
- School of Nursing, College of Nursing, Taipei Medical University, 250 Wuxing Street, Taipei 11031, Taiwan.
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Quiñonez-Freire C, Vara MD, Herrero R, Mira A, García-Palacios A, Botella C, Baños RM. Cultural adaptation of the Smiling is Fun program for the treatment of depression in the Ecuadorian public health care system: A study protocol for a randomized controlled trial. Internet Interv 2021; 23:100352. [PMID: 33335847 PMCID: PMC7733006 DOI: 10.1016/j.invent.2020.100352] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 10/13/2020] [Accepted: 10/28/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Depression is one of the world's major health problems. Due to its high prevalence, it constitutes the first cause of disability among the Americas, where only a very low percentage of the population receives the adequate evidence-based psychological treatment. Internet-Based Interventions (IBIs) are a great alternative to reduce the treatment gap for mental disorders. Although there are several studies in low-and middle-income countries proving IBIs' feasibility and acceptability, there is still little evidence of the effectiveness in diverse social and cultural contexts such as Latin America. METHODS Two studies will be described: Study 1 is focused on the cultural adaptation of a cognitive-behavioral IBI Smiling is Fun (Botella et al. 2012, 2015) for Ecuadorian population with depression based on the procedure by Salamanca-Sanabria et al. (2018). Study 2 describes the design of a randomized controlled trial to test the preliminary efficacy of the culturally adapted intervention in a Public Health Care setting. A total of 153 patients with mild to moderate degree of depression as assessed with the Mini-International Neuropsychiatric Interview (M.I.N.I.) and the Patient Health Questionnaire-9 (PHQ-9) will be randomly assigned to either an IBI group using only automated support by the system; an IBI group including also minimal human support; or a waiting list group. The primary outcome (depression) and secondary outcomes (e.g., anxiety, affect, quality of life) will be collected at baseline, 3, 6 and 12 months. Mixed-model analyses with no ad hoc imputations will be conducted. DISCUSSION This paper is pioneering in exploring the role of an Internet-based culturally adapted intervention for depression in a public care context in Ecuador. Results obtained will offer new insights into the viability and effectiveness of digital technologies for the psychological treatment of mental illnesses in developing countries.
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Key Words
- APOI, Attitudes Towards Psychological Online Interventions
- AQoL-6D, Assessment of Quality of Life 6 Dimensions
- BDI-II, Beck Depression Inventory-II
- CEQ, Credibility and Expectancy Questionnaire
- CONSORT, Consolidated Standards of Reporting Trials
- CRQ, Cultural Relevance Questionnaire
- CSQ, Client Satisfaction Questionnaire
- Cultural adaptation
- Depression
- E-SF, Ecuadorian Cultural Version of Smiling is Fun
- EBPTs, Evidence-Based Psychological Treatments
- GAD-7, Generalized Anxiety Disorder-7
- IBIs, Internet-Based Interventions
- ICD-10, International Classification of Diseases-10
- ICERs, Incremental Cost-Effectiveness Ratios
- Internet-based intervention
- Latin America
- M.I.N.I. 5.0, MINI International Neuropsychiatric Interview 5.0
- MCAR, Missing Completely at Random
- OASIS, Overall Anxiety Severity and Impairment Scale
- ODSIS, Overall Depression Severity and Impairment Scale
- PANAS, Positive and Negative Affect Schedule
- PC, Primary Care
- PHC, Public Health Care
- PHQ-9, Patient Health Questionnaire-9
- Public Health Care
- QALYs, Quality-Adjusted Life-Years
- RCI, Reliable Change Index
- RCT, Randomized Control Trial
- Randomized Controlled Trial
- SPIRIT, Recommendations for Interventional Trials
- SUS, System Usability Scale
- TiC-P, Trimbos/iMTA Questionnaire on Costs on Psychiatric Illnesses
- WAI-TECH-SF, Working Alliance Inventory for Online Intervention-Short Form
- WL, Waiting List
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Affiliation(s)
- Carlos Quiñonez-Freire
- Department of Personality, Evaluation and Psychological Treatments, University of Valencia, Valencia, Spain
- Mental Health Unit, Hospital Dr, Gustavo Dominguez Z, Santo Domingo, Ecuador
| | - M. Dolores Vara
- Department of Personality, Evaluation and Psychological Treatments, University of Valencia, Valencia, Spain
- CIBER Pathophysiology of Obesity and Nutrition (CB06/03), Carlos III Institute of Health, Madrid, Spain
- Polibienestar Research Institute, University of Valencia, Valencia, Spain
| | - Rocío Herrero
- Department of Personality, Evaluation and Psychological Treatments, University of Valencia, Valencia, Spain
- CIBER Pathophysiology of Obesity and Nutrition (CB06/03), Carlos III Institute of Health, Madrid, Spain
- Polibienestar Research Institute, University of Valencia, Valencia, Spain
| | - Adriana Mira
- Department of Personality, Evaluation and Psychological Treatments, University of Valencia, Valencia, Spain
| | - Azucena García-Palacios
- CIBER Pathophysiology of Obesity and Nutrition (CB06/03), Carlos III Institute of Health, Madrid, Spain
- Department of Basic Psychology, Clinical and Psychobiology, Jaume I University, Castellón, Spain
| | - Cristina Botella
- CIBER Pathophysiology of Obesity and Nutrition (CB06/03), Carlos III Institute of Health, Madrid, Spain
- Department of Basic Psychology, Clinical and Psychobiology, Jaume I University, Castellón, Spain
| | - Rosa M. Baños
- Department of Personality, Evaluation and Psychological Treatments, University of Valencia, Valencia, Spain
- CIBER Pathophysiology of Obesity and Nutrition (CB06/03), Carlos III Institute of Health, Madrid, Spain
- Polibienestar Research Institute, University of Valencia, Valencia, Spain
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Shala M, Morina N, Burchert S, Cerga-Pashoja A, Knaevelsrud C, Maercker A, Heim E. Cultural adaptation of Hap-pas-Hapi, an internet and mobile-based intervention for the treatment of psychological distress among Albanian migrants in Switzerland and Germany. Internet Interv 2020; 21:100339. [PMID: 32983906 PMCID: PMC7495109 DOI: 10.1016/j.invent.2020.100339] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 07/24/2020] [Accepted: 07/31/2020] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Internet- and mobile-based mental health interventions have the potential to narrow the treatment gap in ethnic groups. Little evidence exists on the cultural adaptation of such interventions. Cultural adaptation of evidence-based interventions distinguishes between surface and deep structure adaptation. Surface refers to matching materials (e.g., illustrations, language) or methods of treatment delivery to the target population, whereas deep structure adaptation considers cultural concepts of distress (CCD). So far, CCD have only been considered to a limited extent in cultural adaptation of psychological interventions, and there is a lack of well documented adaptation procedures. AIMS With a cross-disciplinary and mixed-method approach, following a new conceptual framework for cultural adaptation of scalable psychological interventions, this study aimed to develop both surface and deep structure adaptations of an internet- and mobile-based intervention called Hap-pas-Hapi for the treatment of psychological distress among Albanian migrants in Switzerland and Germany. METHODS A qualitative ethnopsychological study was conducted to examine the target group's CCD. Focus group discussions, an online survey, and individual key informant interviews were utilised to evaluate the original intervention, adaptation drafts and the final adapted intervention. A reporting system was developed to support the decision-making process and to report all adaptations in a transparent and replicable way. RESULTS The ongoing involvement of target population key informants provided valuable feedback for the development of a more person-centred intervention, which might enhance treatment acceptance, motivation and adherence. DISCUSSION This study provides empirical and theory-based considerations and suggestions for future implementation that may foster acceptability and effectiveness of culturally adapted evidence-based interventions.
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Affiliation(s)
- Mirëlinda Shala
- Psychopathology and Clinical Intervention, Department of Psychology, University of Zurich, Switzerland
| | - Naser Morina
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital of Zurich, University of Zurich, Switzerland
| | - Sebastian Burchert
- Division of Clinical-Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | - Arlinda Cerga-Pashoja
- Faculty of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Central and North West London NHS Foundation Trust, London, United Kingdom
| | - Christine Knaevelsrud
- Division of Clinical-Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | - Andreas Maercker
- Psychopathology and Clinical Intervention, Department of Psychology, University of Zurich, Switzerland
| | - Eva Heim
- Psychopathology and Clinical Intervention, Department of Psychology, University of Zurich, Switzerland
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11
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Palma-Gómez A, Herrero R, Baños R, García-Palacios A, Castañeiras C, Fernandez GL, Llull DM, Torres LC, Barranco LA, Cárdenas-Gómez L, Botella C. Efficacy of a self-applied online program to promote resilience and coping skills in university students in four Spanish-speaking countries: study protocol for a randomized controlled trial. BMC Psychiatry 2020; 20:148. [PMID: 32248795 PMCID: PMC7133009 DOI: 10.1186/s12888-020-02536-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Accepted: 03/06/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND There is evidence of a high prevalence of depression and anxiety in university students. Therefore, college time is a key period where prevention of mental disorders through interventions that promote resilience and mental health can be relevant. Currently, there are interventions available, but these are insufficient for those who need them. Online interventions are tools that can facilitate global accessibility and are easy for young people to use. CORE (Cultivating Our Resilience) is a self-administered online program, based on Ryff's psychological well-being model, to promote resilience and coping skills in university students at risk of developing symptoms of depression or anxiety. The objective is to evaluate the effectiveness of this intervention protocol in comparison with an active control condition targeting healthy lifestyle, and a waiting list control condition. The study will be conducted in four populations of Spanish-speaking university students (Spain, Argentina, Colombia, and Mexico). METHODS The study design is a randomized controlled trial (RCT). At least 324 university students will be randomly assigned to three conditions: 1) CORE, a 6-week training program to improve resilience; 2) HLP, a 6-week training to promote a healthy lifestyle; and 3) WL, waiting list control condition. The primary outcome measure will be the Connor-Davidson resilience scale. Additionally, measures of anxiety, depression, quality of life and socio-demographic variables (age, sex, incomes, marital status, among others) will be collected. Participants will be evaluated at pre-treatment, after each module, 6 weeks after allocation, and at 3-month follow-up. Intention-to-treat and per-protocol analyses will be performed. DISCUSSION The results of this study will contribute to research on Internet-administered interventions and the implementation of a protocol that includes a series of components designed to improve resilience and coping skills, increase psychological well-being, and prevent depression and anxiety disorders in Spanish-speaking university students. In addition, avenues will be opened up for new research on the effectiveness of these interventions focused on the prevention and promotion of mental health in Spanish-speaking countries. TRIAL REGISTRATION Registered at ClinicalTrials.gov NCT03903978 on April 2, 2019.
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Affiliation(s)
| | - Rocío Herrero
- CIBER of Physiopathology of Obesity and Nutrition (CB06/03) Instituto Salud Carlos III, Madrid, Spain
- Universidad de Valencia, Av. Blasco Ibañez, 21, 46021 Valencia, Spain
| | - Rosa Baños
- CIBER of Physiopathology of Obesity and Nutrition (CB06/03) Instituto Salud Carlos III, Madrid, Spain
- Universidad de Valencia, Av. Blasco Ibañez, 21, 46021 Valencia, Spain
| | - Azucena García-Palacios
- Universitat Jaume I, Castellón, Spain
- CIBER of Physiopathology of Obesity and Nutrition (CB06/03) Instituto Salud Carlos III, Madrid, Spain
| | | | | | | | | | | | | | - Cristina Botella
- Universitat Jaume I, Castellón, Spain
- CIBER of Physiopathology of Obesity and Nutrition (CB06/03) Instituto Salud Carlos III, Madrid, Spain
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12
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Salamanca-Sanabria A, Richards D, Timulak L, Connell S, Mojica Perilla M, Parra-Villa Y, Castro-Camacho L. A Culturally Adapted Cognitive Behavioral Internet-Delivered Intervention for Depressive Symptoms: Randomized Controlled Trial. JMIR Ment Health 2020; 7:e13392. [PMID: 32003749 PMCID: PMC7055858 DOI: 10.2196/13392] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 04/24/2019] [Accepted: 08/07/2019] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Internet-delivered treatments for depressive symptoms have proved to be successful in high-income Western countries. There may be potential for implementing such treatments in low- and middle-income countries such as Colombia, where access to mental health services is limited. OBJECTIVE The objective of this study was to assess the efficacy of a culturally adapted cognitive behavioral internet-delivered treatment for college students with depressive symptoms in Colombia. METHODS This was a randomized controlled trial with a 3-month follow-up. The program comprised seven modules. A total of 214 Colombian college students were recruited. They were assessed and randomly assigned to either the treatment group (n=107) or a waiting list (WL) control group (n=107). Participants received weekly support from a trained supporter. The primary outcome was symptoms of depression, as measured by the Patient Health Questionnaire - 9, and the secondary outcomes were anxiety symptoms assessed by the Generalized Anxiety Disorder questionnaire - 7. Other measures, including satisfaction with treatment, were evaluated after 7 weeks. RESULTS Research attrition and treatment dropouts were high in this study. On average, 7.6 sessions were completed per user. The mean time spent on the program was 3 hours and 18 min. The linear mixed model (LMM) showed significant effects after treatment (t197.54=-5.189; P<.001) for the treatment group, and these effects were maintained at the 3-month follow-up (t39.62=4.668; P<.001). Within-group results for the treatment group yielded a large effect size post treatment (d=1.44; P<.001), and this was maintained at the 3-month follow-up (d=1.81; P<.001). In addition, the LMM showed significant differences between the groups (t197.54=-5.189; P<.001). The results showed a large effect size between the groups (d=0.91; P<.001). In the treatment group, 76.0% (16/107) achieved a reliable change, compared with 32.0% (17/107) in the WL control group. The difference between groups was statistically significant (X22=10.5; P=.001). CONCLUSIONS This study was the first contribution to investigating the potential impact of a culturally adapted internet-delivered treatment on depressive symptoms for college students as compared with a WL control group in South America. Future research should focus on identifying variables associated both with premature dropout and treatment withdrawal at follow-up. TRIAL REGISTRATION ClinicalTrials.gov NCT03062215; https://clinicaltrials.gov/ct2/show/NCT03062215.
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Affiliation(s)
- Alicia Salamanca-Sanabria
- Trinity College Dublin, School of Psychology, E-mental Health Research Group, Dublin, Ireland.,SilverCloud Health, Clinical Research & Innovation, Dublin, Ireland
| | - Derek Richards
- Trinity College Dublin, School of Psychology, E-mental Health Research Group, Dublin, Ireland.,SilverCloud Health, Clinical Research & Innovation, Dublin, Ireland
| | - Ladislav Timulak
- Trinity College Dublin, School of Psychology, E-mental Health Research Group, Dublin, Ireland
| | - Sarah Connell
- SilverCloud Health, Clinical Research & Innovation, Dublin, Ireland
| | | | - Yamilena Parra-Villa
- Universidad Autonoma de Bucaramanga, School of Psychology, Bucaramanga, Colombia
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Salamanca-Sanabria A, Richards D, Timulak L. Adapting an internet-delivered intervention for depression for a Colombian college student population: An illustration of an integrative empirical approach. Internet Interv 2019; 15:76-86. [PMID: 30740313 PMCID: PMC6356089 DOI: 10.1016/j.invent.2018.11.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 10/15/2018] [Accepted: 11/05/2018] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Culturally adapted psychotherapy (CAP) studies are limited and until now there are few published examples that illustrate the process of cultural adaptation with internet-delivered treatments. AIM This paper aims to illustrate an integrative approach to the cultural adaptation of an evidence-based internet-delivered cognitive-behavioural therapy intervention for depression (Space from Depression programme). METHOD Mixed method approach utilising quantitative and qualitative methods to assist in the cultural adaptation of the Space from Depression programme was used. The adaptation involved a framework for cultural sensitivity (CSF), alongside an ecological validity framework (EVF) and principles from cross-cultural assessment research. The method included the development of a theory-informed measure, the Cultural Relevance Questionnaire (CRQ), designed specifically for this research. RESULTS The adaptation included an establishment of CSF, which included the incorporation of Colombian cultural expressions. College students' (n = 5) and experts' (n = 7) evaluated the EVF based on cross-cultural assessment principles of a preliminary adapted version through the CRQ, showing reliability in the sample (Cronbach's Alpha 0.744). Qualitative analysis supported the culturally sensitive changes or incorporations made to the programme, such as: personal stories and textual translations from English and these were considered ecologically valid and representative. CONCLUSIONS The research provided support for the idea that CAP can be conducted systematically for internet-delivered interventions.
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Affiliation(s)
- Alicia Salamanca-Sanabria
- E-mental Health Research Group, School of Psychology, Trinity College Dublin, Dublin, Ireland,Clinical Research & Innovation, SilverCloud Health, Dublin, Ireland,Corresponding author at: E-mental Health Research Group, School of Psychology, Trinity College Dublin, Dublin, Ireland.
| | - Derek Richards
- E-mental Health Research Group, School of Psychology, Trinity College Dublin, Dublin, Ireland,Clinical Research & Innovation, SilverCloud Health, Dublin, Ireland
| | - Ladislav Timulak
- E-mental Health Research Group, School of Psychology, Trinity College Dublin, Dublin, Ireland
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