Assessment of transcultural psychotherapy to treat resistant major depressive disorder in children and adolescents from migrant families: Protocol for a randomized controlled trial using mixed method and Bayesian approaches

Abstract

Objectives: Cultural variations complicate psychiatric care, especially for migrant children. Transcultural psychotherapy (TCP) is an original psychotherapeutic technique developed to address complex situations of resistant mental disorders in the context of migration. This research will aim to assess the efficacy, the acceptability, and describe the therapeutic processes of TCP for the treatment of depression in first or second generation of migration children and adolescents. Method: Mixed method study using a multicenter, Bayesian randomized clinical trial with blinded evaluation of the primary outcome. Two parallel groups of 40 children or adolescents from 6 to 20 years old and their family will be included. In the experimental group, patients will attend six sessions of transcultural therapy in addition to usual care. Results: The improved Clinical Global Impression scale scores at 6 months will be compared across groups. Qualitative analysis of families and therapists' interviews will allow to specify the therapeutic processes and acceptability of the therapy. Conclusion: The findings will encourage the development and routinization of TCP for second-line use and its adaption as a first-line technique in this population. K E Y W O R D S child, depression, mixed method, transcultural, treatment 1 | INTRODUCTION Migrant children represent 9.4% (47.3 million) of the European population and come, for a large part, from low-and middle-income countries. In France, one in three children born has at least one parent who comes from elsewhere and 17% of children under 18 are migrants (INSEE, 2016). This proportion continues to rise and as they may differ in physical appearance, language, religion, and culture from the nonmigrant population (Hernandez, 2010), psychiatric care of immigrated families constitutes a growing challenge in many

Multimodal co-therapy for unaccompanied minors: a qualitative study

“…Transcultural psychotherapy is an essential component of MUCTUM, highlighting UMs’ skills acquired in native countries, cultural affiliations to one’s host country, culturally meaningful symptoms, and traditional care if valued by the patient [ 39 ]. Transcultural psychotherapy for children and adolescents is currently being assessed with randomized controlled trials [ 40 ]. Our results show that UM can give great importance to talking therapy, as proposed in MUCTUM.…”

Major challenges in youth psychopathology: treatment-resistant depression. A narrative review

“…Another not negligible influence is represented by cultural and societal determinants, since the development of depression may be affected by specific factors, e.g., belonging to a minority or being culturally vulnerable in challenging environments, such as huge urban contexts ( 60 , 61 ). This is a crucial points if we consider the progressive increase of migrant families belonging to ethnic minorities in European countries and the high prevalence of mood disorders in this population ( 62 ), with major challenges for psychiatric care. Indeed, symptom presentation significantly vary across cultures, as demonstrated for most psychiatric disorders, and thus require more time to be adequately identified.…”

Prise en charge d’une dépression chez une adolescente migrante de seconde génération. La place des étiologies culturelles

“…On retrouve, chez les enfants migrants, des vulnérabilités psychologiques particulières, pouvant s'expliquer par différents éléments: le stress du processus migratoire, la position minoritaire occupée par ces jeunes dans la société d'accueil, parfois le manque d'outils langagiers pouvant conduire à de moins bonnes habiletés sociales et résultats scolaires, les différences culturelles, ou encore la difficulté dans la recherche identitaire et l'affiliation culturelle [1].…”

“…La prévalence vie entière des troubles psychiatriques est très variable mais estimée dans un récent article comme étant 35% plus élevée chez les enfants migrants de deuxième génération versus les enfants et adolescents de population générale [3]. Et ceci serait particulièrement important pour la dépression (30%) [1,3,4].…”