Evaluation of existing experimental evidence for treatment of depression in indigenous populations: A systematic review

Abstract

Objective: To review available literature and identify the experimental evidence for effective treatment of depression in Indigenous populations worldwide. Method: MEDLINE, EMBASE, PsychInfo, Informit, Psychology, and Behavioural Sciences databases were systematically searched for intervention studies from each database's inception to November 2016. Randomised controlled trials were included if they examined the effects of therapy for depression as primary or secondary outcome with Indigenous participants of any age group. Results: This review found a total of four experimental trials (152 participants) worldwide studying the effect of behavioural and pharmacological interventions for depression in Indigenous populations. The quality of evidence was low to moderate. Results from three diverse interventions suggest that culturally specific cognitive and behavioural therapy may have the potential to reduce depressive symptoms in Indigenous young people. However, the evidence base is currently insufficient to offer sound conclusions. One trial studied the effect of dosage differences (75 vs 125 mg) of a tricyclic antidepressant, clomipramine, finding that Indigenous African patients may respond to treatment regimens at a lower dosage than recommended standard in western textbooks. Conclusions: Findings from this review indicate potential for the use of culturally adapted behavioural interventions to target depression in Indigenous populations; however, current evidence is insufficient to confirm their effectiveness. Similarly, there is insufficient evidence to propose recommendations for effective pharmacological treatment for Indigenous people. A tentative finding, that lower doses of antidepressants might be effective for the Indigenous, compared to the general population, requires further investigation as it holds important implications for clinical practice. More rigorous experimental research with adequate sample sizes needs to be conducted to provide conclusive recommendations for adoption into standard care.

Improving the Wellbeing of Female Prisoners via Psychological Skills Training: A Feasibility Study

“…This method may be particularly relevant for the Aboriginal context, as this approach enabled the intervention to align with proposed principles of Aboriginal Prisoner Health and Wellbeing models of care (Sivak et al., 2017). It also allowed for the training to be delivered in a culturally appropriate manner without the need for extensive cultural adaptation that is thought to be needed when applying Western psychological interventions to the Aboriginal setting (Pollok et al., 2018).…”

“…The ability for psychological interventions to improve mental health outcomes has been found to be larger for people with a more impaired mental health status (Driessen et al, 2010). For instance, the impact of positive psychological interventions is higher for people who have moderate or low wellbeing at baseline, compared to those with high baseline wellbeing (Proyer et al, 2015;van Agteren et al, 2018).…”

“…The training program was based on the TechWerks Resilience Training program (www.technologywerks.com and www.4-9-north.com), which combines content derived from positive psychology interventions (Bolier et al, 2013;Hone et al, 2015) and psychological treatment methods such as Cognitive Behavioural Therapy (A. C. and Mindfulness (Gu et al, 2015). The training is a multi-component program comprising of a set of techniques designed to increase one's sense of wellbeing and resilience and has been tested in a range of populations including older aged carers, health services staff, and disadvantaged youth (Bartholomaeus et al, 2019;Raymond et al, 2018;van Agteren et al, 2018). See Table 1 for the exact wellbeing and resilience skills taught in this study.…”

Systematic review of Indigenous involvement and content in mental health interventions and their effectiveness for Indigenous populations

“…Among the four reviews, four unique articles overlapped (Beckstead et al, 2015;Dickerson et al, 2014;Mathieson et al, 2012;Nagel et al, 2009). Pollok et al (2018) evaluated experimental studies of behavioral and pharmacological interventions for depression in any setting, whereas Leske et al (2016) examined pharmacological, psychological and educational interventions for both mental and substance use disorders in Australia, Canada, New Zealand and the United States. Pomerville et al (2016) aimed to understand the landscape of empirical work on psychotherapies for Indigenous populations in Australia, Canada, New Zealand and the United States, specifically understanding how much research exists, the types of research and their key findings.…”

“…While existing systematic reviews have examined mental health interventions for Indigenous populations, the most recent publications in these reviews are from 2015 ( Antonio and Chung-Do, 2015 ; Leske et al, 2016 ; Pollok et al, 2018 ; Pomerville et al, 2016 ). Furthermore, none have conducted an extensive assessment to examine Indigenous involvement and content.…”