Culturally attuned Internet treatment for depression amongst Chinese Australians: a randomised controlled trial.

INTRODUCTION Although depression can be treated effectively with Cognitive Behaviour Therapy (CBT), only a small percentage of Chinese Australians access evidence-based treatment due to practical and cultural barriers. The present study examined the efficacy and acceptability of an Internet delivered CBT (iCBT) program to treat Chinese Australians with depression. METHODS The Chinese depression iCBT program (the Brighten Your Mood Program) is a culturally adapted version of the clinically efficacious Sadness iCBT Program. Fifty-five Chinese Australians with depression were randomly allocated to either an immediate treatment group or to a waitlist control group. Treatment consisted of an 8 week program with 6 CBT online educational lessons, homework assignments, additional resources presented in Chinese and English, and weekly telephone support with Mandarin/Cantonese-speaking support personnel. An intention-to-treat model was used for data analyses. RESULTS Seventeen of twenty-five (68%) treatment group participants completed all lessons within the timeframe. Compared to controls, treatment group participants reported significantly reduced symptoms of depression on the Chinese versions of the Beck Depression Inventory (CBDI) and Patient Health Questionnaire-9 item (CB-PHQ-9). The within- and between-group effect sizes (Cohen's d) were 1.41 and 0.93 on the CBDI, and 0.90 and 0.50 on the CB-PHQ-9, respectively. Participants rated the procedure as acceptable, and gains were sustained at three-month follow-up. LIMITATIONS The study included several subclinical participants and some measures that have not been previously validated with Chinese Australians. CONCLUSIONS Results provide preliminary support for the efficacy and acceptability of an iCBT program at reducing symptoms of depression in Chinese Australians.

[1]  Ronald C Kessler,et al.  The global burden of mental disorders: An update from the WHO World Mental Health (WMH) Surveys* , 2009, Epidemiologia e Psichiatria Sociale.

[2]  Michelle G. Craske,et al.  Computer Therapy for the Anxiety and Depressive Disorders Is Effective, Acceptable and Practical Health Care: A Meta-Analysis , 2010, PloS one.

[3]  P. Cuijpers,et al.  Brief self-rated screening for depression on the Internet. , 2010, Journal of Affective Disorders.

[4]  T Fassaert,et al.  Psychometric properties of an interviewer‐administered version of the Kessler Psychological Distress scale (K10) among Dutch, Moroccan and Turkish respondents , 2009, International journal of methods in psychiatric research.

[5]  N. Titov,et al.  Depression is very disabling , 2007, The Lancet.

[6]  R. M. Suinn,et al.  The Suinn-Lew Asian Self-Identity Acculturation Scale: An Initial Report , 1987 .

[7]  N. Titov,et al.  Clinician-Assisted Internet-Based Treatment is Effective for Panic: A Randomized Controlled Trial , 2009, The Australian and New Zealand journal of psychiatry.

[8]  Nickolai Titov,et al.  Internet-delivered psychotherapy for depression in adults , 2011, Current opinion in psychiatry.

[9]  G. Parker,et al.  Depression in the Chinese: the impact of acculturation , 2005, Psychological Medicine.

[10]  Jos Dekker,et al.  Potential barriers to the use of health services among ethnic minorities: a review. , 2006, Family practice.

[11]  Benjamin F. Rodriguez,et al.  Psychometric Properties , 2009 .

[12]  W. Kung Chinese Americans’ Help Seeking for Emotional Distress , 2003, Social Service Review.

[13]  S. Sue,et al.  Lifetime and twelve-month prevalence rates of major depressive episodes and dysthymia among Chinese Americans in Los Angeles. , 1998, The American journal of psychiatry.

[14]  L. Baker,et al.  Internet use and stigmatized illness. , 2005, Social science & medicine.

[15]  R. Kessler,et al.  Short screening scales to monitor population prevalences and trends in non-specific psychological distress , 2002, Psychological Medicine.

[16]  R. Spitzer,et al.  The PHQ-9: validity of a brief depression severity measure. , 2001, Journal of general internal medicine.

[17]  D. Wong Cognitive behavioral treatment groups for people with chronic depression in Hong Kong: a randomized wait‐list control design , 2008, Depression and anxiety.

[18]  N. Zwar,et al.  Anxiety and depression in Chinese patients attending an Australian GP clinic. , 2009, Australian family physician.

[19]  Vince Ponzio,et al.  A Qualitative Study of Barriers to Mental Health Services Utilisation Among Migrants From Mainland China in South-East Sydney , 2008, The International journal of social psychiatry.

[20]  S. Bannister,et al.  A Qualitative Study , 2009 .

[21]  G. Devilly,et al.  Psychometric properties of the credibility/expectancy questionnaire. , 2000, Journal of behavior therapy and experimental psychiatry.

[22]  JianLi Wang,et al.  Ethnic differences in mental health service use among White, Chinese, South Asian and South East Asian populations living in Canada , 2008, Social Psychiatry and Psychiatric Epidemiology.

[23]  C. Wong,et al.  Applicability of the Chinese Beck Depression Inventory. , 1988, Comprehensive psychiatry.

[24]  M. Fava,et al.  Prevalence of major depressive disorder among Chinese-Americans in primary care. , 2004, General hospital psychiatry.

[25]  The International Journal of Social Psychiatry , 1996 .

[26]  D. Moher,et al.  CONSORT 2010 Explanation and Elaboration: updated guidelines for reporting parallel group randomised trials , 2010, BMJ : British Medical Journal.

[27]  H. Garb Computer-administered interviews and rating scales. , 2007, Psychological assessment.

[28]  A. Vickers Analysis of variance is easily misapplied in the analysis of randomized trials: a critique and discussion of alternative statistical approaches. , 2005, Psychosomatic medicine.

[29]  M. Alegría,et al.  Use of mental health-related services among immigrant and US-born Asian Americans: results from the National Latino and Asian American Study. , 2007, American journal of public health.

[30]  H. González,et al.  The epidemiology of major depression and ethnicity in the United States. , 2010, Journal of psychiatric research.

[31]  N. Titov,et al.  Clinician-Assisted Internet-Based Treatment is Effective for Depression: Randomized Controlled Trial , 2009, The Australian and New Zealand journal of psychiatry.

[32]  T. M. Ng-Tse A Life Satisfaction Questionnaire for Chinese Women with Schizophrenia , 2003 .

[33]  J. Rosenberg,et al.  Community Mental Health: Challenges for the 21st Century , 2006 .

[34]  G. Andersson,et al.  Please Scroll down for Article Cognitive Behaviour Therapy Internet-based and Other Computerized Psychological Treatments for Adult Depression: a Meta-analysis , 2022 .

[35]  L. Alden,et al.  Clinical observations of a Cantonese cognitive-behavioral treatment program for Chinese immigrants. , 2006, Psychotherapy.

[36]  N. Titov,et al.  An RCT Comparing Effect of Two Types of Support on Severity of Symptoms for People Completing Internet-Based Cognitive Behaviour Therapy for Social Phobia , 2009 .

[37]  Gavin Andrews,et al.  Internet Treatment for Generalized Anxiety Disorder: A Randomized Controlled Trial Comparing Clinician vs. Technician Assistance , 2010, PloS one.

[38]  A. Beck,et al.  The empirical status of cognitive-behavioral therapy: a review of meta-analyses. , 2006, Clinical psychology review.

[39]  H. Riper,et al.  primary care: randomised trial cognitive-behavioural therapy without support for depression in Economic evaluation of online computerised , 2011 .

[40]  Andrew C. Leon,et al.  Assessing Psychiatric Impairment in Primary Care with the Sheehan Disability Scale , 1997, International journal of psychiatry in medicine.

[41]  A. Nierenberg,et al.  Screening for major depression in Asian‐Americans: a comparison of the Beck and the Chinese Depression Inventory , 2002, Acta psychiatrica Scandinavica.

[42]  G. Parker,et al.  Depression in the planet's largest ethnic group: the Chinese. , 2001, The American journal of psychiatry.

[43]  T. Oei,et al.  Would Confucius benefit from psychotherapy? The compatibility of cognitive behaviour therapy and Chinese values. , 2007, Behaviour research and therapy.

[44]  Andrew J Vickers,et al.  Parametric versus non-parametric statistics in the analysis of randomized trials with non-normally distributed data , 2005, BMC medical research methodology.

[45]  D. Sheehan,et al.  The Anxiety Disease , 1984 .

[46]  M. Fava,et al.  Validation of the Patient Health Questionnaire-9 for depression screening among Chinese Americans. , 2008, Comprehensive psychiatry.

[47]  W. Kung CULTURAL AND PRACTICAL BARRIERS TO SEEKING MENTAL HEALTH TREATMENT FOR CHINESE AMERICANS , 2004 .

[48]  C. Hunt,et al.  Patterns of help-seeking behavior for anxiety disorders among the Chinese speaking Australian community , 2008, Social Psychiatry and Psychiatric Epidemiology.

[49]  D. Wong Cognitive and health-related outcomes of group cognitive behavioural treatment for people with depressive symptoms in Hong Kong: randomized wait-list control study. , 2008, The Australian and New Zealand journal of psychiatry.

[50]  D. Moher,et al.  CONSORT 2010 explanation and elaboration: updated guidelines for reporting parallel group randomised trials. , 2012, International journal of surgery.

[51]  Gavin Andrews,et al.  Internet Treatment for Depression: A Randomized Controlled Trial Comparing Clinician vs. Technician Assistance , 2010, PloS one.

[52]  P. Lovibond,et al.  The structure of negative emotional states: comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. , 1995, Behaviour research and therapy.

[53]  D. Richards,et al.  Improving access to psychological therapies: phase IV prospective cohort study. , 2009, The British journal of clinical psychology.

[54]  Janet B W Williams,et al.  Diagnostic and Statistical Manual of Mental Disorders , 2013 .

[55]  G. Andrews,et al.  Interpreting scores on the Kessler Psychological Distress Scale (K10) , 2001, Australian and New Zealand journal of public health.

[56]  N. Titov,et al.  Characteristics of Adults with Anxiety or Depression Treated at an Internet Clinic: Comparison with a National Survey and an Outpatient Clinic , 2010, PloS one.

[57]  Nickolai Titov,et al.  Status of Computerized Cognitive Behavioural Therapy for Adults , 2007, The Australian and New Zealand journal of psychiatry.

[58]  Per Carlbring,et al.  Guided self-help via internet for panic disorder: Dissemination across countries , 2010, Comput. Hum. Behav..

[59]  R. Spitzer,et al.  The PHQ-9 , 2001, Journal of General Internal Medicine.

[60]  H. Jeon,et al.  Cross-national difference in the prevalence of depression caused by the diagnostic threshold. , 2008, Journal of affective disorders.

[61]  Zhening Liu,et al.  The Chinese-bilingual SCID-I/P Project: Stage 1 — Reliability for Mood Disorders and Schizophrenia , 2003 .