J. Med. Internet Res. - Internet-based, culturally sensitive, problem-solving therapy for Turkish migrants with depression: randomized controlled trial.

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Resumo

CKGROUND: Turkish migrants living in the Netherlands have a high prevalence of depressive disorders, but experience considerable obstacles to accessing professional help. Providing easily accessible Internet treatments may help to overcome these barriers.OBJECTIVE: The aim of this study was to evaluate the effectiveness of a culturally sensitive, guided, self-help, problem-solving intervention through the Internet for reducing depressive symptoms in Turkish migrants.METHODS: A two-armed randomized controlled trial was conducted. The primary outcome measure was the severity of depressive symptoms; secondary outcome measures were somatic symptoms, anxiety, quality of life, and satisfaction with the treatment. Participants were assessed online at baseline, posttest (6 weeks after baseline), and 4 months after baseline. Posttest results were analyzed on the intention-to-treat sample. Missing values were estimated by means of multiple imputation. Differences in clinical outcome between groups were analyzed with a t test. Cohen's d was used to determine the between-groups effect size at posttreatment and follow-up.RESULTS: Turkish adults (N=96) with depressive symptoms were randomized to the experimental group (n=49) or to a waitlist control group (n=47). High attrition rates were found among the 96 participants of which 42% (40/96) did not complete the posttest (6 weeks) and 62% (59/96) participants did not complete the follow-up assessment at 4 months. No significant difference between the experimental group and the control group was found for depression at posttest. Recovery occurred significantly more often in the experimental group (33%, 16/49) than in the control group (9%, 4/47) at posttest (P=.02). Because of the high attrition rate, a completers-only analysis was conducted at follow-up. The experimental group showed significant improvement in depression compared to the control group both at posttest (P=.01) and follow-up (P=.01).CONCLUSIONS: The results of this study did not show a significant effect on the reduction of depressive symptoms. However, the effect size at posttest was high, which might be an indicator of the possible effectiveness of the intervention when assessed in a larger sample and robust trial. Future research should replicate our study with adequately powered samples.TRIAL REGISTRATION: Dutch Trial Register: NTR2303. http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=2303 (Archived by WebCite at http://www.webcitation.org/6IOxNgoDu).

Resumo Limpo

ckground turkish migrant live netherland high preval depress disord experi consider obstacl access profession help provid easili access internet treatment may help overcom barriersobject aim studi evalu effect cultur sensit guid selfhelp problemsolv intervent internet reduc depress symptom turkish migrantsmethod twoarm random control trial conduct primari outcom measur sever depress symptom secondari outcom measur somat symptom anxieti qualiti life satisfact treatment particip assess onlin baselin posttest week baselin month baselin posttest result analyz intentiontotreat sampl miss valu estim mean multipl imput differ clinic outcom group analyz t test cohen d use determin betweengroup effect size posttreat followupresult turkish adult n depress symptom random experiment group n waitlist control group n high attrit rate found among particip complet posttest week particip complet followup assess month signific differ experiment group control group found depress posttest recoveri occur signific often experiment group control group posttest p high attrit rate completerson analysi conduct followup experiment group show signific improv depress compar control group posttest p followup pconclus result studi show signific effect reduct depress symptom howev effect size posttest high might indic possibl effect intervent assess larger sampl robust trial futur research replic studi adequ power samplestri registr dutch trial regist ntr httpwwwtrialregisternltrialregadminrctviewasptc archiv webcit httpwwwwebcitationorgioxngodu

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