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The nature and efficacy of culturally-adapted psychosocial interventions for schizophrenia: a systematic review and meta-analysis

Published online by Cambridge University Press:  23 August 2017

A. Degnan*
Affiliation:
Division of Psychology & Mental Health, Faculty of Biology, Medicine & Health, The University of Manchester, Manchester, UK
S. Baker
Affiliation:
Division of Psychology & Mental Health, Faculty of Biology, Medicine & Health, The University of Manchester, Manchester, UK
D. Edge
Affiliation:
Division of Psychology & Mental Health, Faculty of Biology, Medicine & Health, The University of Manchester, Manchester, UK
W. Nottidge
Affiliation:
Division of Psychology & Mental Health, Faculty of Biology, Medicine & Health, The University of Manchester, Manchester, UK
M. Noke
Affiliation:
Division of Psychology & Mental Health, Faculty of Biology, Medicine & Health, The University of Manchester, Manchester, UK
C. J. Press
Affiliation:
Division of Psychology & Mental Health, Faculty of Biology, Medicine & Health, The University of Manchester, Manchester, UK
N. Husain
Affiliation:
Division of Psychology & Mental Health, Faculty of Biology, Medicine & Health, The University of Manchester, Manchester, UK Lancashire Care NHS Foundation Trust, Sceptre Point, Sceptre Way, Walton Summit, Preston, UK
S. Rathod
Affiliation:
Southern Health NHS Foundation Trust, Clinical Trials Facility, Tom Rudd Unit, Moorgreen Hospital, West End, Southampton, UK
R. J. Drake
Affiliation:
Division of Psychology & Mental Health, Faculty of Biology, Medicine & Health, The University of Manchester, Manchester, UK Greater Manchester Mental Health NHS Foundation Trust, Park House, Delaunays Road, Manchester, UK
*
*Address for correspondence: A. Degnan, Division of Psychology & Mental Health, Faculty of Biology, Medicine & Health, The University of Manchester, Room 3.306 Jean McFarlane Building, Manchester M13 9PL, UK. (Email: amy.degnan@manchester.ac.uk)

Abstract

Background

Evidence-based psychosocial treatments for schizophrenia founded on Western belief systems and values may not be efficacious in different cultures without adaptation. This systematic review analyses the nature and outcomes of culturally-adapted psychosocial interventions in schizophrenia, examining how interventions have been adapted, their efficacy and what features drive heterogeneity in outcome.

Method

Articles identified by searching electronic databases from inception to 3 March 2016, reference lists and previous reviews were independently screened by two authors for eligible controlled trials. Data on the nature of adaptations was analysed inductively using thematic analyses. Meta-analyses were conducted using random effects models to calculate effect sizes (Hedges’ g) for symptoms.

Results

Forty-six studies with 7828 participants were included, seven adapted for minority populations. Cultural adaptations were grouped into nine themes: language, concepts and illness models, family, communication, content, cultural norms and practices, context and delivery, therapeutic alliance, and treatment goals. Meta-analyses showed significant post-treatment effects in favour of adapted interventions for total symptom severity (n = 2345, g: −0.23, 95% confidence interval (CI) −0.36 to −0.09), positive (n = 1152, g: −0.56, 95% CI −0.86 to −0.26), negative (n = 855, g: −0.39, 95% CI −0.63 to −0.15), and general (n = 525, g: −0.75, CI −1.21 to −0.29) symptoms.

Conclusions

The adaptation process can be described within a framework that serves as a benchmark for development or assessment of future adaptations. Culturally adapted interventions were more efficacious than usual treatment in proportion to the degree of adaptation. There is insufficient evidence to show that adapted interventions are better than non-adapted interventions. Features of context, intervention and design influenced efficacy. Investigating whether adaptation improves efficacy, most importantly amongst ethnic minorities, requires better designed trials with comparisons against unadapted interventions.

Type
Review Article
Copyright
Copyright © Cambridge University Press 2017 

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References

Barrera, M, Castro, FG (2006). A heuristic framework for the cultural adaptation of interventions. Clinical Psychology: Science and Practice 13, 311316.Google Scholar
Benish, SG, Quintana, S, Wampold, BE (2011). Culturally adapted psychotherapy and the legitimacy of myth: a direct-comparison meta-analysis. Journal of Counseling Psychology 58, 279.Google Scholar
Bernal, G, Sáez-Santiago, E (2006). Culturally centered psychosocial interventions. Journal of Community Psychology 34, 121132.Google Scholar
Bhugra, D, Leff, J, Mallett, R, Der, G, Corridan, B, Rudge, S (1997). Incidence and outcome of schizophrenia in Whites, African-Caribbeans and Asians in London. Psychological Medicine 27, 791798.Google Scholar
Bhui, K, Aslam, W, Palinski, A, McCabe, R, Johnson, M, Weich, S, Singh, S, Knapp, M, Ardino, V, Szczepura, A (2015). Interventions to improve therapeutic communications between Black and minority ethnic patients and professionals in psychiatric services: systematic review. British Journal of Psychiatry 207, 95103.Google Scholar
Bhui, K, Bhugra, D (2004). Communication with patients from other cultures: the place of explanatory models. Advances in Psychiatric Treatment 10, 474478.Google Scholar
Bhui, K, Stansfeld, S, Hull, S, Priebe, S, Mole, F, Feder, G (2003). Ethnic variations in pathways to and use of specialist mental health services in the UK. Systematic review. British Journal of Psychiatry 182, 105116.Google Scholar
Bradley, GM, Couchman, D, Psych, GM, Perlesz, A, Nguyen, AT, Singh, B, Riess, C (2006). Multiple-family group treatment for English-and Vietnamese-speaking families living with schizophrenia. Psychiatric Services 57, 521530.Google Scholar
Braun, V, Clarke, V (2006). Using thematic analysis in psychology. Qualitative Research in Psychology 3, 77101.Google Scholar
Brockwell, SE, Gordon, IR (2001). A comparison of statistical methods for meta-analysis. Statistics in Medicine 20, 825840.Google Scholar
Brown, G, Marshall, M, Bower, P, Woodham, A, Waheed, W (2014). Barriers to recruiting ethnic minorities to mental health research: a systematic review. International Journal of Methods in Psychiatric Research 23, 3648.CrossRefGoogle ScholarPubMed
Cantor-Graae, E (2007). Ethnic minority groups, particularly African-Caribbean and Black African groups, are at increased risk of psychosis in the UK. Evidence Based Mental Health 10, 9595.CrossRefGoogle ScholarPubMed
Cantor-Graae, E, Selten, JP (2005). Schizophrenia and migration: a meta-analysis and review. American Journal of Psychiatry 162, 1224.CrossRefGoogle ScholarPubMed
Carrà, G, Montomoli, C, Clerici, M, Cazzullo, CL (2007). Family interventions for schizophrenia in Italy: randomized controlled trial. European Archives of Psychiatry and Clinical Neuroscience 257, 2330.CrossRefGoogle ScholarPubMed
Carter, L, Read, J, Pyle, M, Morrison, AP (2016). The impact of causal explanations on outcome in people experiencing psychosis: a systematic review. Clinical Psychology & Psychotherapy 2, 332347.Google Scholar
Chan, SW-C, Yip, B, Tso, S, Cheng, B-S, Tam, W (2009). Evaluation of a psychoeducation program for Chinese clients with schizophrenia and their family caregivers. Patient Education and Counseling 75, 6776.Google Scholar
Chien, WT (2008). Effectiveness of psychoeducation and mutual support group program for family caregivers of Chinese people with schizophrenia. Open Nursing Journal 2, 2829.Google Scholar
Chien, WT, Chan, SWC (2004). One-year follow-up of a multiple-family-group intervention for Chinese families of patients with schizophrenia. Psychiatric Services 55, 12761284.CrossRefGoogle ScholarPubMed
Chien, WT, Chan, SWC (2013). The effectiveness of mutual support group intervention for Chinese families of people with schizophrenia: a randomised controlled trial with 24-month follow-up. International Journal of Nursing Studies 50, 13261340.Google Scholar
Chien, WT, Chan, SWC, Thompson, DR (2006). Effects of a mutual support group for families of Chinese people with schizophrenia: 18-month follow-up. British Journal of Psychiatry 189, 4149.Google Scholar
Chien, WT, Lee, IYM (2010). The schizophrenia care management program for family caregivers of Chinese patients with schizophrenia. Psychiatric Services 61, 317320.CrossRefGoogle ScholarPubMed
Chien, WT, Norman, I, Thompson, DR (2004). A randomized controlled trial of a mutual support group for family caregivers of patients with schizophrenia. International Journal of Nursing Studies 41, 637649.Google Scholar
Chien, WT, Thompson, DR (2013). An RCT with three-year follow-up of peer support groups for Chinese families of persons with schizophrenia. Psychiatric Services 64, 9971005.Google Scholar
Chien, WT, Thompson, DR, Norman, I (2008). Evaluation of a peer-led mutual support group for Chinese families of people with schizophrenia. American Journal of Community Psychology 42, 122134.Google Scholar
Chowdhary, N, Jotheeswaran, A, Nadkarni, A, Hollon, S, King, M, Jordans, M, Rahman, A, Verdeli, H, Araya, R, Patel, V (2014). The methods and outcomes of cultural adaptations of psychological treatments for depressive disorders: a systematic review. Psychological Medicine 44, 11311146.Google Scholar
Concato, J, Shah, N, Horwitz, RI (2000). Randomized, controlled trials, observational studies, and the hierarchy of research designs. New England Journal of Medicine 342, 18871892.Google Scholar
Department of Health (2005). Delivering Race Equality in Mental Health Care: An Action Plan for Reform Inside and Outside Services and the Government's Response to the Independent Inquiry Into the Death of David Bennett. Department of Health: London, UK.Google Scholar
Dixon, L, Dickerson, F, Bellack, AS, Bennett, M, Dickinson, D, Goldberg, RW, Lehman, A, Tenhula, WN, Calmes, C, Pasillas, RM (2010). The 2009 schizophrenia PORT psychosocial treatment recommendations and summary statements. Schizophrenia Bulletin 36, 4870.Google Scholar
Edge, D, Degnan, A, Cotterill, S, Berry, K, Drake, R, Baker, J, Barrowclough, C, Hughes-Morley, A, Grey, P, Bhugra, D (2016). Culturally-adapted family intervention (CaFI) for African-Caribbeans diagnosed with schizophrenia and their families: a feasibility study protocol of implementation and acceptability. Pilot and Feasibility Studies 2, 239.Google Scholar
Egger, M, Smith, GD, Schneider, M, Minder, C (1997). Bias in meta-analysis detected by a simple, graphical test. British Medical Journal 315, 629634.Google Scholar
Fearon, P, Kirkbride, J, Morgan, C, Dazzan, P, Morgan, K, Lloyd, T, Hutchinson, G, Tarrant, J, Fung, W, Holloway, J, Mallett, R, Harrison, G, Leff, J, Jones, P, Murray, R (2006). Incidence of schizophrenia and other psychoses in ethnic minority groups: results from the MRC AESOP study. Psychological Medicine 36, 15411550.CrossRefGoogle ScholarPubMed
Feigin, V (2016). Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980–2015: a systematic analysis for the global burden of disease study 2015. Lancet 388, 14591544.Google Scholar
Gohar, SM, Hamdi, E, Lamis, A, Horan, WP, Green, MF (2013). Adapting and evaluating a social cognitive remediation program for schizophrenia in Arabic. Schizophrenia Research 148, 1217.Google Scholar
Griner, D, Smith, TB (2006). Culturally adapted mental health intervention: a meta-analytic review. Psychotherapy: Theory, Research, Practice, Training 43, 531548.CrossRefGoogle ScholarPubMed
Guo, X, Zhai, J, Liu, Z, Fang, M, Wang, B, Wang, C, Hu, B, Sun, X, Lv, L, Lu, Z (2010). Effect of antipsychotic medication alone vs combined with psychosocial intervention on outcomes of early-stage schizophrenia: a randomized, 1-year study. Archives of General Psychiatry 67, 895904.CrossRefGoogle ScholarPubMed
Habib, N, Dawood, S, Kingdon, D, Naeem, F (2015). Preliminary evaluation of culturally adapted CBT for psychosis (CA-CBTp): findings from developing culturally-sensitive CBT project (DCCP). Behavioural and Cognitive Psychotherapy 43, 200208.CrossRefGoogle ScholarPubMed
Hedges, LV, Olkin, I (2014). Statistical Methods for Meta-Analysis. Academic press: Orlando, Florida.Google Scholar
Higgins, J, Altman, D, Gøtzsche, P, Jüni, P, Moher, D, Oxman, A, Savović, J, Schulz, K, Weeks, L, Sterne, J (2011). The cochrane collaboration's tool for assessing risk of bias in randomised trials. British Medical Journal 343, d5928.Google Scholar
Higgins, J, Green, S (2008). Cochrane Handbook for Systematic Reviews of Interventions. John Wiley and Sons: New Jersey, USA.Google Scholar
Higgins, J, Thompson, S (2002). Quantifying heterogeneity in a meta-analysis. Statistics in Medicine 21, 15391558.Google Scholar
Huey, SJ Jr., Polo, AJ (2008). Evidence-based psychosocial treatments for ethnic minority youth. Journal of Clinical Child Adolescent Psychology 37, 262301.CrossRefGoogle ScholarPubMed
Hussain-Gambles, M, Atkin, K, Leese, B (2004). Why ethnic minority groups are under-represented in clinical trials: a review of the literature. Health & Social Care in the Community 12, 382388.Google Scholar
Hwang, WC (2009). The formative method for adapting psychotherapy (FMAP): a community-based developmental approach to culturally adapting therapy. Professional Psychology Research and Practice 40, 369377.Google Scholar
Kay, SR, Fiszbein, A, Opler, LA (1987). The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophr Bull 13, 261276.CrossRefGoogle ScholarPubMed
Keating, F, Robertson, D, McCulloch, A, Francis, E (2002). Breaking the Circles of Fear: A Review of the Relationship Between Mental Health Services and African and Caribbean Communities. The Sainsbury Centre for Mental Health: London, UK.Google Scholar
Kontopantelis, E, Reeves, D (2010). Performance of statistical methods for meta-analysis when true study effects are non-normally distributed: a simulation study. Statistical Methods in Medical Research 21, 409426.Google Scholar
Koolaee, AK, Etemadi, A (2009). The outcome of two family interventions for the mothers of schizophrenia patients in Iran. International Journal of Social Psychiatry 56, 634646.Google Scholar
Kopelowicz, A, Zarate, R, Smith, VG, Mintz, J, Liberman, RP (2003). Disease management in Latinos with schizophrenia: a family-assisted, skills training approach. Schizophrenia Bulletin 29, 211227.Google Scholar
Kopelowicz, A, Zarate, R, Wallace, CJ, Liberman, RP, Lopez, SR, Mintz, J (2012). The ability of multifamily groups to improve treatment adherence in Mexican Americans with schizophrenia. Archives of General Psychiatry 69, 265273.CrossRefGoogle ScholarPubMed
Kulhara, P, Chakrabarti, S, Avasthi, A, Sharma, A, Sharma, S (2009). Psychoeducational intervention for caregivers of Indian patients with schizophrenia: a randomised-controlled trial. Acta Psychiatrica Scandinavica 119, 472483.Google Scholar
Kumar, D, Zia Ul Haq, M, Dubey, I, Dotivala, KN, Veqar Siddiqui, S, Prakash, R, Abhishek, P, Nizamie, SH (2010). Effect of meta-cognitive training in the reduction of positive symptoms in schizophrenia. European Journal of Psychotherapy and Counselling 12, 149158.Google Scholar
Kung, WW, Tseng, Y-F, Wang, Y, Hsu, P-C, Chen, D (2012). Pilot study of ethnically sensitive family psychoeducation for Chinese-American patients with schizophrenia. Social Work in Mental Health 10, 384408.Google Scholar
Lak, DC, Tsang, HW, Kopelowicz, A, Liberman, RP (2010). Outcomes of the Chinese basic conversation skill module (CBCSM) for people with schizophrenia having mild to moderate symptoms and dysfunction in Hong Kong. International Journal of Psychiatry in Clinical Practice 14, 137144.CrossRefGoogle ScholarPubMed
Li, Z, Arthur, D (2005). Family education for people with schizophrenia in Beijing, China. British Journal of Psychiatry 187, 339345.Google Scholar
Lin, EC-L, Chan, CH, Shao, W-C, Lin, M-F, Shiau, S, Mueser, KT, Huang, S-C, Wang, H-S (2013). A randomized controlled trial of an adapted illness management and recovery program for people with schizophrenia awaiting discharge from a psychiatric hospital. Psychiatric Rehabilitation Journal 36, 243249.Google Scholar
Mann, SKF, Chong, BBW (2004). The effect of symptoms coping program in reducing psychotic symptoms and enhancing functions in Chinese with schizophrenia. American Journal of Psychiatric Rehabilitation 7, 6982.Google Scholar
Mausbach, BT, Bucardo, J, McKibbin, CL, Goldman, SR, Jeste, DV, Patterson, TL, Cardenas, V, Barrio, C (2008). Evaluation of a culturally tailored skills intervention for Latinos with persistent psychotic disorders. American Journal of Psychiatric Rehabilitation 11, 6175.Google Scholar
Moher, D, Liberati, A, Tetzlaff, J, Altman, DG, Group, P (2009). Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. British Medical Journal 339, b2535.Google Scholar
Naeem, F, Saeed, S, Irfan, M, Kiran, T, Mehmood, N, Gul, M, Munshi, T, Ahmad, S, Kazmi, A, Husain, N (2015). Brief culturally adapted CBT for psychosis (CaCBTp): a randomized controlled trial from a low income country. Schizophrenia Research 164, 143148.Google Scholar
National Institute for Health and Care Excellence (2014). Psychosis and Schizophrenia in Adults: Treatment and Management. NICE clinical guidelines. Department of Health: London, UK.Google Scholar
Overall, JE, Gorham, DR (1962). The brief psychiatric rating scale. Psychological Reports 10, 799812.Google Scholar
Patterson, TL, Bucardo, J, McKibbin, CL, Mausbach, BT, Moore, D, Barrio, C, Goldman, SR, Jeste, DV (2005). Development and pilot testing of a new psychosocial intervention for older Latinos with chronic psychosis. Schizophrenia Bulletin 31, 922930.Google Scholar
Pfammatter, M, Junghan, UM, Brenner, HD (2006). Efficacy of psychological therapy in schizophrenia: conclusions from meta-analyses. Schizophrenia Bulletin 32, S64S80.Google Scholar
Pharoah, F, Mari, J, Rathbone, J, Wong, W (2010). Family Intervention for Schizophrenia. Cochrane Database of Systematic Reviews. Issue 12. doi: 10.1002/14651858.CD000088.pub2.Google Scholar
Ran, M-S, Xiang, M-Z, Chan, CL-W, Leff, J, Simpson, P, Huang, M-S, Shan, Y-H, Li, S-G (2003). Effectiveness of psychoeducational intervention for rural Chinese families experiencing schizophrenia. Social Psychiatry and Psychiatric Epidemiology 38, 6975.Google Scholar
Rathod, S, Kingdon, D, Phiri, P, Gobbi, M (2010). Developing culturally sensitive cognitive behaviour therapy for psychosis for ethnic minority patients by exploration and incorporation of service users’ and health professionals’ views and opinions. Behavioural and Cognitive Psychotherapy 38, 511533.Google Scholar
Rathod, S, Phiri, P, Harris, S, Underwood, C, Thagadur, M, Padmanabi, U, Kingdon, D (2013). Cognitive behaviour therapy for psychosis can be adapted for minority ethnic groups: a randomised controlled trial. Schizophrenia Research 143, 319326.Google Scholar
Razali, SM, Hasanah, CI, Khan, AU, Subramaniam, M (2000). Psychosocial interventions for schizophrenia. Journal of Mental Health 9, 283289.CrossRefGoogle Scholar
Shin, S-K, Lukens, EP (2002). Effects of psychoeducation for Korean Americans with chronic mental illness. Psychiatric Services 53, 11251131.Google Scholar
Smith, TB, Rodríguez, MD, Bernal, G (2011). Culture. Journal of Clinical Psychology 67, 166175.Google Scholar
So, SH-W, Chan, AP, Chong, CS-Y, Wong, MH-M, Lo, WT-L, Chung, DW-S, Chan, SS (2015). Metacognitive training for delusions (MCTd): effectiveness on data-gathering and belief flexibility in a Chinese sample. Frontiers in Psychology 6, 215.CrossRefGoogle Scholar
Tarrier, N, Wykes, T (2004). Is there evidence that cognitive behaviour therapy is an effective treatment for schizophrenia? A cautious or cautionary tale? Behavior Research and Therapy 42, 13771401.Google Scholar
The Sainsbury Centre for Mental Health (2006). Policy Paper 6: The Cost of Race Inequality. The Sainsbury Centre for Mental Health: London, UK.Google Scholar
Tseng, W-S (2001). Handbook of cultural psychiatry. International Review of Psychiatry 14, 7173.Google Scholar
United Nations Educational Scientific and Cultural Organization (UNESCO) (2001). UNESCO Universal Declaration on Cultural Diversity . In UNESCO General Conference: Paris, France.Google Scholar
Valencia, M, Rascon, ML, Juarez, F, Escamilla, R, Saracco, R, Liberman, RP (2010). Application in Mexico of psychosocial rehabilitation with schizophrenia patients. Psychiatry 73, 248263.Google Scholar
Valencia, M, Rascón, ML, Juárez, F, Murow, E (2007). A psychosocial skills training approach in Mexican out-patients with schizophrenia. Psychological Medicine 37, 13931402.Google Scholar
Wahass, S, Kent, G (1997). The modification of psychological interventions for persistent auditory hallucinations to an Islamic culture. Behavioural and Cognitive Psychotherapy 25, 351364.CrossRefGoogle Scholar
Waheed, W, Woodham, A, Hughes-Morley, A, Allen, G, Bower, P (2015). Overcoming barriers to recruiting ethnic minorities to mental health research: a typology of recruitment strategies. BioMedCentral Psychiatry 15, 101.Google Scholar
Wang, Y, Roberts, DL, Xu, B, Cao, R, Yan, M, Jiang, Q (2013). Social cognition and interaction training for patients with stable schizophrenia in Chinese community settings. Psychiatry Research 210, 751755.Google Scholar
Weng, Y, Xiang, Y, Liberman, RP (2005). Rehab rounds: psychiatric rehabilitation in a Chinese psychiatric hospital. Psychiatric Services 56, 401403.Google Scholar
Wykes, T, Steel, C, Everitt, B, Tarrier, N (2008). Cognitive behavior therapy for schizophrenia: effect sizes, clinical models, and methodological rigor. Schizophrenia Bulletin 34, 523537.Google Scholar
Xiang, M, Ran, M, Li, S (1994). A controlled evaluation of psychoeducational family intervention in a rural Chinese community. British Journal of Psychiatry 165, 544548.Google Scholar
Xiong, W, Phillips, MR, Hu, X, Wang, R, Dai, Q, Kleinman, J, Kleinman, A (1994). Family-based intervention for schizophrenic patients in China. A randomised controlled trial. British Journal of Psychiatry 165, 239247.Google Scholar
Zhang, M, Yan, H (1993). Effectiveness of psychoeducation of relatives of schizophrenic patients: a prospective cohort study in five cities of China. International Journal of Mental Health 22, 4759.Google Scholar
Zhang, M, He, Y, Gittelman, M, Wong, Z, Yan, H. (1998). Group psychoeducation of relatives of schizophrenic patients: two-year experiences. Psychiatry and Clinical Neurosciences 52, S344S347.Google Scholar
Zimmer, M, Duncan, AV, Laitano, D, Ferreira, EE, Belmonte-de-Abreu, P (2007). A twelve-week randomized controlled study of the cognitive-behavioral integrated psychological therapy program: positive effect on the social functioning of schizophrenic patients. Revista brasileira de psiquiatria 29, 140147.CrossRefGoogle ScholarPubMed
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