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Evaluating the Outcome of Cultural Adaptations of Cognitive-Behavioural Therapy for Adult Depression: a Meta-Analysis of Treatment Studies in Developing Countries

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Abstract

Cognitive-behavioural therapy (CBT) is promoted as a treatment of choice for adult depression in the developed world. In low- and middle-income countries (LAMICS), the standard treatment protocol is often adapted to meet the socio-cultural needs of the context. The authors conducted a systematic review of all controlled studies of culturally-adapted CBT involving adults with depression resident in LAMICS. The pooled mean effect size from 11 studies (n = 1602) was large, suggesting that CBT appears efficacious in treating depression in impoverished contexts. Specifically, treatments implemented with individuals were more successful than those administered to groups. Interventions employed by lay workers proved similarly successful. These results are encouraging, as the widespread adoption of CBT may potentially contribute to reducing the treatment gap for depression in resource-poor LAMICS.

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References

An asterisk (*) denotes articles that were included in the meta-analysis.

  • Ali, B. S., Rahbar, M. H., Naeem, S., Tareen, A., Gul, A., & Samad, L. (2002). Prevalence of and factors associated with anxiety and depression among women in a lower middle class semi-urban community of Karachi, Pakistan. Journal of the Pakistan Medical Association, 52(11), 513–517.

    PubMed  Google Scholar 

  • *Arango-Lasprilla, J.C., Panyavin, I., Herrera Merchan, E.J., Perrin, P.B., Arroyo-Anllo’, E.M., Snipes, D.J., & Arabia, J. (2014). Evaluation of a group cognitive-behavioral dementia caregiver intervention in Latin America. American Journal of Alzheimer’s Disease & Other Dementias, 29(6), 548–555.

  • Beck, A. T., Ward, C. H., Mendelson, M., Mock, J., & Erbaugh, J. (1961). An inventory for measuring depression. Archives of General Psychiatry, 4, 561–571.

    Article  PubMed  Google Scholar 

  • Begg, C. B., & Mazumdar, M. (1994). Operating characteristics of a rank correlation test for publication bias. Biometrics, 50, 1088–1101.

    Article  PubMed  Google Scholar 

  • Beltman, M. W., Oude Voshaar, R. C., & Speckens, A. E. (2010). Cognitive-behavioural therapy for depression in people with a somatic disease: meta-analysis of randomised controlled trials. British Journal of Psychiatry, 197, 11–19.

    Article  PubMed  Google Scholar 

  • Bolton, P., Bass, J., Neugebauer, R., Verdeli, H., Clougherty, K., Wickramaratne, P., et al. (2003). Group interpersonal psychotherapy for depression in rural Uganda: a randomized controlled trial. JAMA, 289(3), 3117–3124.

    Article  PubMed  Google Scholar 

  • Borenstein, M., Hedges, L. V., Higgins, J. P. T., & Rothstein, H. (2009). Introduction to meta-analysis. Chichester: Wiley.

    Book  Google Scholar 

  • *Chetty, D., & Hoque, M.E. (2013). Effectiveness of a nurse facilitated cognitive group intervention among mild to moderately-depressed-women in KwaZulu-Natal, South Africa. African Journal of Psychiatry, 16, 29–34.

  • Cohen, J. (1977). Statistical power analysis for the behavioral sciences. New York: Academic.

    Google Scholar 

  • Cuijpers, P., Smit, F., Bohlmeijer, E., Hollon, S. D., & Andersson, G. (2010). Efficacy of cognitive-behavioural therapy and other psychological treatments for adult depression: meta-analytic study of publication bias. British Journal of Psychiatry, 196, 173–178.

    Article  PubMed  Google Scholar 

  • Cuijpers, P., Andersson, G., Donker, T., & Van Straten, A. (2011). Psychological treatment of depression: results of a series of meta-analyses. Nordic Journal of Psychiatry, 65, 354–364.

    Article  PubMed  Google Scholar 

  • Duval, S., & Tweedie, R. (2000). Trim and fill: a simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics, 56, 455–463.

    Article  PubMed  Google Scholar 

  • Egger, M., Smith, G. D., Schneider, M., & Minder, C. (1997). Bias in meta-analysis detected by a simple, graphical test. British Medical Journal, 315, 629–634.

    Article  PubMed Central  PubMed  Google Scholar 

  • *Faramarzi, M., Alipor, A., Esmaelzadeh, S., Kheirkhah, F., Poladi, K., & Pash, H. (2008). Treatment of depression and anxiety in infertile women: Cognitive behavioral therapy versus fluoxetine. Journal of Affective Disorders, 108, 159–164.

  • Field, A. P., & Gillett, R. (2010). How to do a meta-analysis. British Journal of Mathematical and Statistical Psychology, 63, 665–694.

    Article  PubMed  Google Scholar 

  • Gausia, K., Fisher, C., Ali, M., & Oosthuizen, J. (2009). Antenatal depression and suicidal ideation among rural Bangladeshi women: a community-based study. Archives of Women’s Mental Health, 12, 351–358.

    Article  PubMed  Google Scholar 

  • *Hamamci, Z. (2006). Integrating psychodrama and cognitive behavioral therapy to treat moderate depression. The Arts in Psychotherapy, 33, 199–207.

  • Hamilton, M. A. (1960). A rating scale for depression. Journal of Neurology, Neurosurgery, and Psychiatry, 23, 56–62.

    Article  PubMed Central  PubMed  Google Scholar 

  • Hartley, M., Tomlinson, M., Greco, E., Scott Comulada, W., Stewart, J., le Roux, I., Mbewu, M., & Rotherum-Borus, M. J. (2011). Depressed mood in pregnancy: prevalence and correlates in two Cape Town peri-urban settlements. Reproductive Health, 8, 9–15.

    Article  PubMed Central  PubMed  Google Scholar 

  • Hofmann, S. G., Asnaani, A., Vonk, I. J. J., Sawyer, A. T., & Fang, A. (2012). The efficacy of cognitive behavioral therapy: a review of meta-analyses. Cognitive Therapy and Research, 36, 427–440.

    Article  PubMed Central  PubMed  Google Scholar 

  • Huntley, A., Araya, R., & Salisbury, C. (2012). Group psychological therapies for depression in the community: systematic review and meta-analysis. British Journal of Psychiatry, 200, 184–190.

    Article  PubMed  Google Scholar 

  • Johnson, A. R., Edwin, S., Joachim, N., Mathew, G., Ajay, S., & Joseph, B. (2015). Postnatal depression among women availing maternal health services in a rural hospital in South India. Pakistan Journal of Medical Sciences, 31(2), 408–413.

    Article  PubMed Central  PubMed  Google Scholar 

  • Jorm, A. F., Morgan, A. J., & Hetrick, S. E. (2008). Relaxation for depression. Cochrane Database of Systematic Reviews, 4, CD007142.

    PubMed  Google Scholar 

  • Kaaya, S. F., Mbwambo, J. K., Kilonzo, G. P., van Den Borne, H., Leshabari, M. T., Smith Fawzi, M. C., & Schaalma, H. (2010). Socio-economic and partner relationship factors associated with antenatal depressive morbidity among pregnant women in Dar es Salaam, Tanzania. Tanzania Journal of Health Research, 12, 23–35.

    PubMed  Google Scholar 

  • Kagee, A., Suh, E. J., & Naidoo, A. V. (2004). South African counsellors’ attitudes towards cognitive behavioural techniques to ameliorate trauma: effects of a training workshop. International Journal for the Advancement of Counselling, 26(3), 313–320.

    Article  Google Scholar 

  • Kagee, A., & Lund, C. (2012). Psychology training directors’ reflections on evidence-based practice in South Africa. South Africa Journal of Psychology, 42(1), 103–113.

    Article  Google Scholar 

  • Kleintjies, S., Flisher, A. J., Fick, M., Railoun, A., Lund, C., Molteno, C., & Robertson, B. A. (2006). The prevalence of mental disorders among children, adolescents and adults in the Western Cape, South Africa. South African Psychiatry Review, 9, 157–160.

    Google Scholar 

  • Kroenke, K., Spitzer, R. L., & Williams, J. B. (2001). The PHQ-9: validity of a brief depression severity measure. Journal of General Internal Medicine, 16(9), 606–613.

    Article  PubMed Central  PubMed  Google Scholar 

  • *Lara, M.A., Navarro, C., Rubi, N.A., & Mondragón, L. (2003). Outcome results of two levels of intervention in low-income women with depressive symptoms. American Journal of Orthopsychiatry, 73(1), 35–43.

  • Linde, K., Sigterman, K., Kriston, L., Rücker, G., Jamil, S., Meissner, K., & Schneider, A. (2015). Effectiveness of psychological treatments for depressive disorders in primary care: systematic review and meta-analysis. Annals of Family Medicine, 13(1), 56–68.

    Article  PubMed Central  PubMed  Google Scholar 

  • Manikkam, L., & Burns, J. K. (2012). Antenatal depression and its risk factors: an urban prevalence study in KwaZulu-Natal. South African Medical Journal, 102(12), 940–944.

    PubMed  Google Scholar 

  • *Naeem, F., Waheed, W., Gobbi, M., Ayub, M., & Kingdon, D. (2011). Preliminary evaluation of culturally sensitive CBT for depression in Pakistan: findings from developing culturally-sensitive CBT project (DCCP). Behavioural and Cognitive Psychotherapy, 39, 165173.

  • *Naeem, F., Sarhandi, I., Gul, M., Khalid, M., Aslam, M., Anbrin, A., Saeed, S., Noor, M., Fatima, G., Minhas, F., Husain, N., & Ayub, M. (2014). A multicentre randomised controlled trial of a carer supervised culturally adapted CBT (CaCBT) based self-help for depression in Pakistan. Journal of Affective Disorders, 156, 224–227.

  • *Naeem, F., Gul, M., Irfan, M., Munshid, T., Asif, A., Rashid, S., Khan, M.N.S, Ghani, S., Malik, A., Aslam, A., Farooq, S., Husain, N., & Ayub, M. (2015). Brief culturally adapted CBT (CaCBT) for depression: A randomized controlled trial from Pakistan. Journal of Affective Disorders, 177, 101–107.

  • Nduna, M., Jewkes, R. K., Dunkle, K. L., Jama Shai, N. P., & Colman, I. (2013). Prevalence and factors associated with depressive symptoms among young women and men in the Eastern Cape Province, South Africa. Journal of Child and Adolescent Mental Health, 25(1), 43–54.

    Article  PubMed  Google Scholar 

  • Oei, T. P., & Dingle, G. (2008). The effectiveness of group cognitive behaviour therapy for unipolar depressive disorders. Journal of Affective Disorders, 107(1–3), 5–21.

    Article  PubMed  Google Scholar 

  • Patel, V. (2000). The need for treatment evidence for common mental disorders in developing countries. Psychological Medicine, 30, 743–746.

    Article  PubMed  Google Scholar 

  • Patel, V., Araya, R., & Bolton, P. (2004). Editorial: treating depression in the developing world. Tropical Medicine and International Health, 9(5), 539–541.

    Article  PubMed  Google Scholar 

  • Patel, V., Araya, R., Chatterjee, S., Chisholm, D., Cohen, A., De Silva, M., Hosman, C., McGuire, H., Rojas, G., & van Ommeren, M. (2007). Treatment and prevention of mental disorders in low-income and middle-income countries. Lancet, 370, 991–1005.

    Article  PubMed  Google Scholar 

  • Pfeiffer, P. N., Heisler, M., Piette, J. D., Rogers, M. A. M., & Valenstein, M. (2011). Efficacy of peer support interventions for depression: a meta-analysis. General Hospital Psychiatry, 33, 29–36.

    Article  PubMed Central  PubMed  Google Scholar 

  • Radloff, L. (1977). The CES-D scale: a self-report depression scale for research in the general population. Applied Psychological Measurement, 1, 385–401.

    Article  Google Scholar 

  • *Rahman, A., Malik, A., Sikander, S., Roberts, C., & Creed, F. (2008). Cognitive behaviour therapy-based intervention by community health workers for mothers with depression and their infants in rural Pakistan: a cluster-randomised controlled trial. Lancet, 372, 902–09.

  • Rochat, T. J., Tomlinson, M., Bärnighausen, T., Newel, M. L., & Stein, A. (2011). The prevalence and clinical presentation of antenatal depression in rural South Africa. Journal of Affective Disorders, 135, 362–373.

    Article  PubMed Central  PubMed  Google Scholar 

  • Tomlinson, M., Grimsrud, A. T., Stein, D. J., Williams, D. J., & Myer, L. (2009). The epidemiology of major depression in South Africa: results from the South African stress and health study. South African Medical Journal, 99(5), 368–373.

    Google Scholar 

  • *Tshabalala, J., & Visser, M. (2011). Developing a cognitive behavioural therapy model to assist women to deal with HIV and stigma. South African Journal of Psychology, 41(1), 17–28.

  • Van Straten, A., Geraedts, A., Verdonck-de Leeuw, I., Andersson, G., & Cuijpers, P. (2010). Psychological treatment of depressive symptoms in patients with medical disorders: a meta-analysis. Journal of Psychosomatic Research, 69, 23–32.

    Article  PubMed  Google Scholar 

  • *Wong, D.F.K. (2008). Cognitive behavioral treatment groups for people with chronic depression in Hong Kong: a randomized wait-list control design. Depression and Anxiety, 25, 142–148.

  • Zigmond, A. S., & Snaith, R. P. (1983). The hospital anxiety and depression scale. Acta Psychiatrica Scandinavica, 67, 361–370.

    Article  PubMed  Google Scholar 

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Correspondence to Zahir Vally.

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Vally, Z., Maggott, C. Evaluating the Outcome of Cultural Adaptations of Cognitive-Behavioural Therapy for Adult Depression: a Meta-Analysis of Treatment Studies in Developing Countries. Int J Adv Counselling 37, 293–304 (2015). https://doi.org/10.1007/s10447-015-9244-5

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