Review articleLatino immigrants, depressive symptoms, and cognitive behavioral therapy: A systematic review

- Latino immigrants have high rates of depressive symptoms and face unique stressors.
- Cognitive behavioral therapy is widely used to treat depression but its effectiveness among Latino immigrants is unclear.
- Latino immigrant participation in clinical trials is low, and numbers are often too few to analyze.
- Cultural adaptations may enhance recruitment, retention, and acceptability of cognitive behavioral therapy treatment.
- This study reviews effectiveness of cognitive behavioral therapy for depression among Latino immigrants and cultural adaptations.

BackgroundIn order to address the needs of the growing Latino immigrant population, this study aimed to systematically review peer-reviewed articles of intervention studies that used cognitive behavioral therapy to treat depressive symptoms among Latino immigrants in the U.S.MethodsWe searched PsycINFO, PubMed, and Medline databases from January 1995 through July 2016 as part of a registered review protocol (PROSPERO) following PRISMA guidelines. Inclusion criteria were intervention studies that used cognitive behavioral techniques to treat depressive symptoms among a predominantly U.S. Latino immigrant sample -- or subsample with disaggregated results, and the use of standardized measures of depression. We used the National Heart, Lung, and Blood Institute quality assessment tools for systematic reviews to assess risk of bias.ResultsWe identified 11 studies that met inclusion criteria. Nine of the included studies reported a reduction of depressive symptoms. Each study used a least one cultural adaptation to deliver the intervention. Using an existing content model, cultural adaptations were categorized as (a) cognitive-informational adaptations, (b) affective-motivational adaptations, and (c) environmental adaptations.LimitationsHeterogeneity of articles in terms of sample size, cultural adaptations, methodological rigor, and setting limited comparability of effectiveness across studies.ConclusionsCulturally adapted CBT to address depressive symptoms among Latino immigrants appears promising but further research is needed. The most commonly used cultural adaptations included language, inclusion of migration experience, and adjusting for literacy level. Study design elements and adaptations were often responsive to geographic characteristics and available resources.