Internet‐based treatment of depressive symptoms in a Kurdish population: A randomized controlled trial

Abstract

Objective: Kurdish immigrants in Sweden have a doubled risk of mental health problems, and refugee and immigrant populations underutilize mental health services. The present study investigated the efficacy of culturally adapted guided internet-based cognitive behavior therapy (ICBT) for depressive symptoms in a Kurdish population. Method: We included 50 individuals who were randomized to either an 8-week treatment or a wait-list. The Beck Depression Inventory-II was the primary outcome measure, and measures of anxiety and insomnia were secondary outcomes. Results: Depressive symptoms were significantly reduced (intention-to-treat analysis) in the treatment group, with a between-group effect size at posttreatment of Cohen's d = 1.27. Moderate to large between-group effects were also observed on all secondary outcome measures. Treatment effects were sustained at 11-month follow-up. Conclusion: The results provide preliminary support for culturally adapted ICBT as a complement to other treatment formats for treating symptoms of depression in a Kurdish population. K E Y W O R D S culturally adapted psychotherapy, depression, internet-based cognitive behavior therapy J. Clin. Psychol. 2019;75:985-998.wileyonlinelibrary.com/journal/jclp

Significant reduction in depressive symptoms among patients with moderately-severe to severe depressive symptoms after participation in a therapist-supported, evidence-based mobile health program delivered via a smartphone app

“…Each of these effect sizes are similar to those found in prior studies that have tested other types of interventions for patients with higher severity levels of depression ( DeRubeis et al, 2005 ), including the “real world” STAR-D trial of flexible citalopram dosing that defined response as a 50% reduction in symptoms, which found rates of 36% after 8 weeks and 43% after 12 weeks ( Trivedi et al, 2006 ). Findings from the present study also mirror those from a trial testing an internet cognitive behavioral therapy intervention that included patients with moderately-severe and severe levels of depressive symptoms, which found significant reductions in depressive symptoms sustained up to 11 months post-treatment ( Lindegaard et al, 2019 ) and an observational study of a national digital mental health service in Australia that found similar effect sizes for their depressed patients ( Titov et al, 2020 ). Finally, the current study's finding of MHP having efficacy among those with moderately severe and severe depressive symptoms is similar to that determined by a study that found significant declines in depressive symptoms among patients who had a schizophrenia spectrum disorder, bipolar disorder, or major depressive disorders who each had at least moderately severe levels of depressive symptoms ( Ben-Zeev et al, 2019 ).…”

Experiences of internet-based cognitive behavioural therapy for depression and anxiety among Arabic-speaking individuals in Sweden: a qualitative study

“…Such adaptions have been found to increase treatment effects [24]. A number of randomized controlled trials (RCTs) of culturally adapted Internetdelivered cognitive behavior therapy (ICBT) targeting various populations have now been published with promising results [25][26][27][28][29]. These studies indicate that culturally adapted ICBT has moderate to large effects on symptoms of common mental health disorders compared to inactive control conditions.…”

Response and Remission Rates in Internet-Based Cognitive Behavior Therapy: An Individual Patient Data Meta-Analysis

“…Research suggests that therapist-supported ICBT—in contrast to unguided treatments (4)—can be as effective as face-to-face cognitive behavior therapy (5), yield long-term results (6), and work under clinically representative conditions (7). ICBT has also been tested for different target groups—for example, young persons (8), adults (9), older persons (10), and immigrants (11). Treatment programs have focused on specific problems, such as procrastination (12); diagnoses like post-traumatic stress disorder (PTSD) (13); or tailored according to a client’s specific problem profile (14).…”