No Racial Differences Found in Effectiveness of Psychotherapy for Depression

Though studies show psychotherapies to be effective in general adult populations with depression, data evaluating whether this effectiveness holds true in racial minority groups with depression remain sparse.

Researchers at Vrije University and the EMGO Institute for Health and Care Research, both in Amsterdam, the Netherlands, conducted a meta-analysis to assess the relative effects of psychotherapy for individuals from racial and ethnic minority backgrounds. The study was published February 18 in Psychiatric Services in Advance.

“When we started our investigation, we noticed that little is known about the effectiveness of mainstream psychotherapy in depressed migrants in the Netherlands,” Burcin Unlu, M.Sc. the study’s lead author and a doctoral candidate in the Department of Clinical Psychology at Vrije, told Psychiatric News. “As we looked further in the literature, randomized, controlled trials focusing on the effectiveness of psychotherapy in racial-ethnic minorities [of Western civilizations] were also few in numbers.”

According to Unlu, research over the past 30 years has indicated that racial and ethnic minority groups are not only underrepresented in clinical trials, but are less likely to make use of mental health care services until late stages of mental illness than Caucasians are. A frequent explanation for this discrepancy, Unlu noted, has been that the lack of cultural and linguistic adaptions to psychotherapy makes mental health services less appealing to people from minority racial and ethnic backgrounds, but the studies confirming this theory are scarce.

“The literature isn’t straightforward in the differences in the effectiveness of psychotherapy regarding race,” Unlu said. “Therefore, we decided to select and analyze multiple randomized, controlled trials involving psychotherapy for depression that reported the overall racial-ethnic minority proportion of the sample.”

Unlu and colleagues gathered data from 56 randomized, controlled trials—with more than 5,800 participants—that evaluated the effects of psychotherapy in adults aged 18 and older with a depressive disorder diagnosis or an elevated level of depressive symptomatology. Psychotherapy was defined as an intervention in which verbal or written communication between a therapist and a patient was the primary form of therapy—including cognitive-behavioral therapy and intrapersonal psychotherapy. Effectiveness of psychotherapy among the nonminority and racial minority groups was determined by effect size, which was calculated by analyzing changes in depression symptomatology measured by the Beck Depression Inventory and Hamilton Rating Scale for Depression.

To meet inclusion criteria, all trials analyzed were required to report subjects’ race and ethnicity. Racial minorities were categorized as people of African, Asian, Hispanic, or Native-American ancestry or ancestry that could not be categorized.

Results from the meta-analysis showed that psychotherapy for depression was “moderately” effective in both nonminorities and ethnic minorities, with no significant association between the effect size among the two populations. In addition, no difference in psychotherapy effectiveness was found between each of the minority groups.

“Our study shows that we can assume psychotherapy is equally effective regardless of care seekers’ ethnicity,” Unlu told Psychiatric News. “There is not much reason to assume that Caucasians and racial-ethnic minority groups benefit differently from psychotherapy, suggesting that there are universal working mechanisms of psychotherapy for both groups.”

Unlu said that depression-based research should now focus on decreasing the disparities in psychotherapy use between Caucasians and ethnic minorities.

“Given the results of our study, the question can be shifted to how the delivery of psychotherapy can be improved. Enhancing recruitment methods and culturally sensitive approaches for improving the delivery of psychotherapies to these minorities are important topics for future studies. Culturally adapting psychotherapies to the needs of specific racial-ethnic minority groups may be beneficial in decreasing treatment disparity.” ■

“The Effects of Psychotherapy on Depression Among Racial-Ethnic Minority Groups: A Metaregression Analysis” is posted at http://ps.psychiatryonline.org/data/Journals/PSS/0/appi.ps.201300165.pdf.