Cognitive Behavioral Therapy Treatment for Depression Among First Generation Latinos/As: A Systematic Review

Background: According to the National Alliance on Mental Illness, the prevalence of depression among Latinos/as ranges from 20% to 46%; however, depression is often underdiagnosed and it often goes untreated. Key stressors among first generation U.S. immigrant Latinos include acculturation and language barriers, yet little is known about the degree to which such cultural adaptations have been incorporated into depression treatment with this group. Moreover, given that research shows first generation Latinos/as prefer counseling over medication, it is important to determine whether cognitive behavioral therapy (CBT), a common form of treatment for depression, is effective among this group and what cultural adaptations to CBT treatment, if any, have been evaluated.  

Methods: PsycInfo and PubMed databases were searched systematically for English-language peer-reviewed articles published between 1990 and 2013 that used CBT to treat depression among first generation Latinos/as. Search terms included “Cognitive Behavioral Therapy”, “depression”, “Hispanics”, “Latinos”, “immigrants” and combinations of these terms. Initially, 70 articles were identified; after eliminating duplicates and applying relevant filters, 39 articles met criteria for abstract review. Inclusion criteria were: face to face CBT intervention, majority of participants being first generation Latinos/as, any age group, experimental or quasi-experimental design, and an outcome measure of depressive symptomatology. Exclusion criteria were: non-experimental designs such as case studies, and CBT not conducted face to face. After abstracts were screened, full articles for 11 outcome studies were reviewed; 3 studies were eliminated that did not meet criteria, yielding 6 studies that met criteria for this review.

Results: Six intervention studies that used CBT to treat depression among first generation Latinos/as were found. All 6 interventions showed effectiveness in reducing depression and had adapted the interventions to be culturally sensitive. For example, all programs were offered in Spanish, and most included at least two of the following Latino constructs and values: personalismo (personalism), familismo (familism), respeto (respect), simpatia (sympathy) and confianza (trust). Culturally adapted techniques such as the “si, pero” (“yes, but”) method and adding dichos (sayings) were found to be useful when addressing cognitive distortions among this population. Finally, programs with the lowest attrition rates provided transportation and childcare.

Implications: This study is among the first to identify and review CBT depression interventions targeting first generation immigrant Latinos/as. Findings suggest that depression among this population can be alleviated when culturally adapted CBT approaches that include Latino constructs and values are used. A gap in the current literature is that most of these studies were conducted among adult women and included few men. Further research is needed to identify effective depression treatment strategies for first generation Latino males and adolescents. Finally, more research is needed to identify what other constructs may be beneficial to include when working with Latino populations and whether components should vary according to ethnicity.  Despite the promise of CBT treatment among first generation Latinos/as, the challenge of culturally sensitive depression screening, identification, and access to culturally appropriate care among this group remains.