Cultural Adaptation of Minimally Guided Interventions for Common Mental Disorders: A Systematic Review and Meta-Analysis

Melissa Harper Shehadeh, Eva Heim, Neerja Chowdhary, Andreas Maercker, Emiliano Albanese, Melissa Harper Shehadeh, Eva Heim, Neerja Chowdhary, Andreas Maercker, Emiliano Albanese

Abstract

Background: Cultural adaptation of mental health care interventions is key, particularly when there is little or no therapist interaction. There is little published information on the methods of adaptation of bibliotherapy and e-mental health interventions.

Objective: To systematically search for evidence of the effectiveness of minimally guided interventions for the treatment of common mental disorders among culturally diverse people with common mental disorders; to analyze the extent and effects of cultural adaptation of minimally guided interventions for the treatment of common mental disorders.

Methods: We searched Embase, PubMed, the Cochrane Library, and PsycINFO for randomized controlled trials that tested the efficacy of minimally guided or self-help interventions for depression or anxiety among culturally diverse populations. We calculated pooled standardized mean differences using a random-effects model. In addition, we administered a questionnaire to the authors of primary studies to assess the cultural adaptation methods used in the included primary studies. We entered this information into a meta-regression to investigate effects of the extent of adaptation on intervention efficacy.

Results: We included eight randomized controlled trials (RCTs) out of the 4911 potentially eligible records identified by the search: four on e-mental health and four on bibliotherapy. The extent of cultural adaptation varied across the studies, with language translation and use of metaphors being the most frequently applied elements of adaptation. The pooled standardized mean difference for primary outcome measures of depression and anxiety was -0.81 (95% CI -0.10 to -0.62). Higher cultural adaptation scores were significantly associated with greater effect sizes (P=.04).

Conclusions: Our results support the results of previous systematic reviews on the cultural adaptation of face-to-face interventions: the extent of cultural adaptation has an effect on intervention efficacy. More research is warranted to explore how cultural adaptation may contribute to improve the acceptability and effectiveness of minimally guided psychological interventions for common mental disorders.

Keywords: anxiety; bibliotherapy; cultural adaptation; depression; e-mental health; minimally guided intervention; self-help.

Conflict of interest statement

Conflicts of Interest: None declared.

Figures

Figure 1
Figure 1
Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) diagram with systematic search and selection process. RCT: randomized controlled trial.
Figure 2
Figure 2
Adaptation score assigned to the selected studies.
Figure 3
Figure 3
Random-effects meta-analysis of primary outcome measures in order of the study adaptation score. SMD: standardized mean difference.
Figure 4
Figure 4
Meta-regression of the standardized mean difference and adaptation score.

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