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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 ,
S. Baker ,
D. Edge ,
W. Nottidge ,
M. Noke ,
C. J. Press ,
N. Husain ,
S. Rathod  and
R. J. Drake
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: [email protected])
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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.

Keywords

Cultural-adaptationethnic minoritiespsychosispsychosocial interventionschizophrenia
Type
Review Article
Information
Psychological Medicine , Volume 48 , Issue 5 , April 2018 , pp. 714 - 727
Copyright
Copyright © Cambridge University Press 2017 

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