A Systematic Review and Meta-Analysis of Culturally Adaptive Interventions for Latino Populations with Anxiety or Depression

Background and Purpose: The Hispanic population is projected to grow to 30% of the US population by 2060. Studies have reported up to 27% and 15.7% of depression and anxiety among Latinos, respectively (Wassertheil-Smoller et al, 2014; Algeria et al., 2008). Despite these troubling statistics, Latinos with mental health needs are less likely to use mental health services than their non-Latino White counterparts due to cultural, structural, and economic factors (Cabassa, Zayas, & Hansen, 2006). The use of culturally adapted interventions may be a solution for improving mental health service access, utilization, and outcomes among Latinos. Culturally adapted psychotherapeutic interventions have been developed and utilized to address Latino depression and anxiety. However, to our knowledge, no study has synthesized the overall effectiveness of these culturally adapted interventions for Latinos. Through a systematic review and meta-analysis of culturally adapted psychotherapeutic interventions for treating Latino depression or anxiety, this study aims to answer whether culturally adapted psychotherapeutic interventions are effective for treating Latino depression or anxiety.

Methods: A search of nine electronic databases and manual review of reference lists was conducted following the Cochrane Collaboration Guidelines. Nine studies (including 32 effect sizes) of randomized controlled trials were eligible and included for meta-analysis. Data extraction was conducted in Microsoft Excel and analyzed using R software in four stages: (1) conducting descriptive statistics of participants, providers, intervention characteristics and research design; (2) calculating small sample corrected Hedges’ g effect size; (3) synthesizing effect size estimates across studies and (4) moderator analysis using robust variance estimation in meta-regression with outcome indicators---Latino depression or anxiety.

Results: An overall non-significant treatment effect was identified for Latino depression or anxiety of d= .61, 95% CI (-.588, 1.81), p= .249. Univariate meta-regression indicated that outcome type (depression = 1 and anxiety = 2) significantly moderated treatment effect, b= 1.113, 95% CI (.097, 2.129), p= .039. Subgroup analysis of depression and anxiety did not result in a significant treatment effect.

Conclusions and Implications: This study represents the first meta-analysis to our knowledge that examined the effectiveness of culturally adapted interventions (not limited to a certain modality) for Latino depression or anxiety. Despite the limitations of a small sample size that may have caused low power to detect intervention effect, this research has added to the knowledge base and highlights the need for more research to determine if culturally adapted psychotherapeutic interventions for Latino anxiety or depression are overall effective. In addition to reporting more clinical trials of culturally adjusted interventions for Latinos’ depression and anxiety, researchers may want to further evaluate the difference between treatment effect for depression and anxiety outcomes and to reflect on its implication for culturally competent social work practice.