Refinement and Pilot Testing of a Culturally Enhanced Treatment for Depressed African-Americans

Abstract

A multitude of evidence suggests that while African Americans are adversely impacted by depression, they still experience significant health disparities in the receipt and acceptability of treatments for the disorder. This study, conducted in two phases, was an initial attempt to address some of these disparities. Phase 1 explored the acceptability and feasibility of implementing a group behavioral activation psychotherapy that incorporated culturally adapted components to address specific risk and protective factors for depression experienced by African Americans. Overall, adequate levels of feasibility were obtained for the organic recruitment of participants from community nursing centers in Milwaukee and the administration of therapy groups at these sites. Participants also reported adequate levels of acceptability for treatment components. Modifications were made to the initial treatment manual from participant feedback and analysis of feasibility data, and this manual was tested in a small, waitlist randomized controlled trial at one of the nursing centers. It was hypothesized that those receiving treatment would experience significant reductions in depression across the trial relative to waitlist controls, and that active group members would experience significantly greater change in variables targeted by the culturally adapted components. High levels of attrition from both groups, however, ruled out meaningful comparisons of groups. Uncontrolled post-hoc analyses of changes in Phase 1 depression groups, however, showed reductions in depression symptoms for both groups. Only one of the groups, however, experienced significant reductions in depression across time. Implications and future directions are discussed.