Australian Indigenous model of mental healthcare based on transdiagnostic cognitive–behavioural therapy co-designed with the Indigenous community: protocol for a randomised controlled trial

Abstract

Background A four- to seven-fold increase in the prevalence of current mood, anxiety, substance use and any mental disorders in Indigenous adults compared with non-Indigenous Australians has been reported. A lifetime prevalence of major depressive disorder was 23.9%. High rates of comorbid mental disorders indicated a transdiagnostic approach to treatment might be most appropriate. The effectiveness of psychological treatment for Indigenous Australians and adjunct Indigenous spiritual and cultural healing has not previously been evaluated in controlled clinical trials. Aims This project aims to develop, deliver and evaluate the effectiveness of an Indigenous model of mental healthcare (IMMHC). Trial registration: ANZCTR Registration Number: ACTRN12618001746224 and World Health Organization Universal Trial Number: U1111-1222-5849. Method The IMMHC will be based on transdiagnostic cognitive–behaviour therapy co-designed with the Indigenous community to ensure it is socially and culturally appropriate for Indigenous Australians. The IMMHC will be evaluated in a randomised controlled trial with 110 Indigenous adults diagnosed with a current diagnosis of depression. The primary outcome will be the severity of depression symptoms as determined by changes in Beck Depression Inventory-II score at 6 months post-intervention. Secondary outcomes include anxiety, substance use disorder and quality of life. Outcomes will be assessed at baseline, 6 months post-intervention and 12 months post-intervention. Results The study design adheres to the Consolidated Standards of Reporting Trials (CONSORT) statement recommendations and CONSORT extensions for pilot trials. We followed the Standard Protocol Items for Randomised Trials statement recommendations in writing the trial protocol. Conclusions This study will likely benefit participants, as well as collaborating Aboriginal Medical Services and health organisations. The transdiagnostic IMMHC has the potential to have a substantial impact on health services delivery in the Indigenous health sector.

Mental Health Interventions for First Nation, Inuit, and Métis Peoples in Canada: A Systematic Review

“…In Australia, Aboriginal and Torres Strait Islander people were found to have incidence rates for anxiety and any mental disorder that are 3 times and 4 times higher, respectively, than the non-Indigenous population (Nasir et al, 2018). In 2020, a randomized controlled trial of a mental health intervention in four Aboriginal communities produced promising results that could inform future guidelines and treatment and care programs (Toombs et al, 2020). In New Zealand, Māori peoples also experience higher rates of poor mental health compared to non-Māori people in New Zealand (Baxter et al, 2006).…”

A community‐led design for an Indigenous Model of Mental Health Care for Indigenous people with depressive disorders

“…The IMMHC has been developed as a model of mental health care that is both effective and readily embraced by Indigenous people, which will be fundamental for its successful uptake and sustainability. Indigenous‐led design and development of a treatment model of mental health care will also guarantee empowerment, adaptability and transferability 26 . The outcomes from this study provide an essential overview to inform participants lived experiences towards the development of the IMMHC.…”

“…From these studies, major depressive disorder was identified as the issue most prevalent among Indigenous adults 4 . As a result, a randomised controlled trial (RCT) to design and develop an Indigenous Model of Mental Health Care (IMMHC) 26 for the treatment of depression was designed.…”

Arts-Based Compassion Skills Training (ABCST): Channelling Compassion Focused Therapy Through Visual Arts for Australia’s Indigenous Peoples

“…Modern Western psychotherapies such as CBT, ACT, and CFT are largely based on a set of evidence-based psychological principles that are considered to be generally applicable to human suffering. However, it is also well recognized that for these therapies to be effective in Indigenous (Nelson et al, 2014;Toombs et al, 2020) or other cultural contexts (Rathod and Kingdon, 2009;Iwamasa and Hays, 2019), they need to be culturally responsive. Moreover, in order to be culturally responsive, community engagement processes such as co-design workshops and reference groups with key stakeholders over an extended period of time are required (Singer et al, 2015;Toombs et al, 2020).…”