Skip to main content Accessibility help

The methods and outcomes of cultural adaptations of psychological treatments for depressive disorders: a systematic review

  • N. Chowdhary (a1), A. T. Jotheeswaran (a2), A. Nadkarni (a3), S. D. Hollon (a4), M. King (a5), M. J. D. Jordans (a3) (a6), A. Rahman (a7), H. Verdeli (a8), R. Araya (a9) and V. Patel (a1)...



Cultural adaptations of evidence-based psychological treatments (PTs) are important to enhance their universal applicability. The aim of this study was to review systematically the literature on adaptations of PTs for depressive disorders for ethnic minorities in Western countries and for any population in non-Western countries to describe the process, extent and nature of the adaptations and the effectiveness of the adapted treatments.


Controlled trials were identified using database searches, key informants, previous reviews and reference lists. Data on the process and details of the adaptations were analyzed using qualitative methods and meta-analysis was used to assess treatment effectiveness.


Twenty studies were included in this review, of which 16 were included in the meta-analysis. The process of adaptation was reported in two-thirds of the studies. Most adaptations were found in the dimensions of language, context and therapist delivering the treatment. The meta-analysis revealed a statistically significant benefit in favor of the adapted treatment [standardized mean difference (SMD) −0.72, 95% confidence interval (CI) −0.94 to −0.49].


Cultural adaptations of PTs follow a systematic procedure and lead primarily to adaptations in the implementation of the treatments rather than their content. Such PTs are effective in the treatment of depressive disorders in populations other than those for whom they were originally developed.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the or variations. ‘’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      The methods and outcomes of cultural adaptations of psychological treatments for depressive disorders: a systematic review
      Available formats

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      The methods and outcomes of cultural adaptations of psychological treatments for depressive disorders: a systematic review
      Available formats

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      The methods and outcomes of cultural adaptations of psychological treatments for depressive disorders: a systematic review
      Available formats


The online version of this article is published within an Open Access environment subject to the conditions of the Creative Commons Attribution licence .

Corresponding author

* Address for correspondence: Professor V. Patel, MRCPsych., Ph.D., F.Med.Sci., Sangath Centre, 841/1 Alto Porvorim, Goa 403521, India. (Email:


Hide All
Afuwape, SA, Craig, TK, Harris, T, Clarke, M, Flood, A, Olajide, D, Cole, E, Leese, M, McCrone, P, Thornicroft, G (2010). The Cares of Life Project (CoLP): an exploratory randomised controlled trial of a community-based intervention for black people with common mental disorder. Journal of Affective Disorders 127, 370374.
Andrew, G, Dias-Saxena, F, Patel, V (2000). The development of a counselling treatment for common mental disorders in general health care settings. Indian Journal of Clinical Psychology 27, 7279.
Araya, R, Rojas, G, Fritsch, R, Gaete, J, Rojas, M, Simon, G, Peters, TJ (2003). Treating depression in primary care in low-income women in Santiago, Chile: a randomised controlled trial. Lancet 361, 9951000.
Barrera, M Jr., Castro, FG, Strycker, LA, Toobert, DJ (2013). Cultural adaptations of behavioral health interventions: a progress report. Journal of Consulting and Clinical Psychology 81, 196205.
Beeber, LS, Cooper, C, Van Noy, BE, Schwartz, TA, Blanchard, HC, Canuso, R, Robb, K, Laudenbacher, C, Emory, SL (2007). Flying under the radar: engagement and retention of depressed low-income mothers in a mental health intervention. ANS. Advances in Nursing Science 30, 220233.
Beeber, LS, Holditch-Davis, D, Perreira, K, Schwartz, TA, Lewis, V, Blanchard, H, Canuso, R, Goldman, BD (2010). Short-term in-home intervention reduces depressive symptoms in Early Head Start Latina mothers of infants and toddlers. Research in Nursing and Health 33, 6076.
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, 279289.
Bernal, G, Saez-Sanriago, E (2006). Culturally centered psychosocial interventions. Journal of Community Psychology 34, 121132.
Bernal, G, Scharrón-del-Río, MR (2001). Are empirically supported treatments valid for ethnic minorities? Toward an alternative approach for treatment research. Cultural Diversity and Ethnic Minority Psychology 7, 328342.
Bolton, P, Bass, J, Neugebauer, R, Verdeli, H, Clougherty, KF, Wickramaratne, P, Speelman, L, Ndogoni, L, Weissman, M (2003). Group interpersonal psychotherapy for depression in rural Uganda: a randomized controlled trial. Journal of the American Medical Association 289, 31173124.
Cape, J, Whittington, C, Buszewicz, M, Wallace, P, Underwood, L (2010). Brief psychological therapies for anxiety and depression in primary care: meta-analysis and meta-regression. BMC Medicine 8, 38.
Castro, FG, Barrera, M Jr., Holleran Steiker, LK (2010). Issues and challenges in the design of culturally adapted evidence-based interventions. Annual Review of Clinical Psychology 6, 213239.
Chatterjee, S, Chowdhary, N, Pednekar, S, Cohen, A, Andrew, G, Araya, R, Simon, G, King, M, Telles, S, Weiss, H, Verdeli, H, Clougherty, K, Kirkwood, B, Patel, V (2008). Integrating evidence-based treatments for common mental disorders in routine primary care: feasibility and acceptability of the MANAS intervention in Goa, India. World Psychiatry 7, 3946.
Chaudhry, N, Waheed, W, Husain, N, Hijazi, S, Creed, F (2009). Development and pilot testing of a social intervention for depressed women of Pakistani family origin in the UK. Journal of Mental Health 18, 504509.
Comas-Diaz, L (1981). Effects of cognitive and behavioral group treatment on the depressive symptomatology of Puerto Rican women. Journal of Consulting and Clinical Psychology 49, 627632.
Craig, P, Dieppe, P, Macintyre, S, Michie, S, Nazareth, I, Petticrew, M; Medical Research Council Guidance (2008). Developing and evaluating complex interventions: the new Medical Research Council guidance. British Medical Journal 337, a1655.
Crespo, MM (2006). Effects of culturally specific dynamically oriented group art therapy with immigrant Latinas. Doctoral dissertation, California Institute of Integral Studies, San Francisco, CA.
Cuijpers, P, van Straten, A, Andersson, G, van Oppen, P (2008). Psychotherapy for depression in adults: a meta-analysis of comparative outcome studies. Journal of Consulting and Clinical Psychology 76, 909922.
Dai, Y, Zhang, S, Yamamoto, J, Ao, M, Belin, TR, Cheung, F, Hifumi, SS (1999). Cognitive behavioral therapy of minor depressive symptoms in elderly Chinese Americans: a pilot study. Community Mental Health Journal 35, 537542.
Dwight-Johnson, M, Aisenberg, E, Golinelli, D, Hong, S, O'Brien, M, Ludman, E (2011). Telephone-based cognitive-behavioral therapy for Latino patients living in rural areas: a randomized pilot study. Psychiatric Services 62, 936942.
Egger, M, Davey Smith, G, Schneider, M, Minder, C (1997). Bias in meta-analysis detected by a simple, graphical test. British Medical Journal 315, 629634.
Ell, K, Katon, W, Xie, B, Lee, PJ, Kapetanovic, S, Guterman, J, Chou, CP (2010). Collaborative care management of major depression among low-income, predominantly Hispanic subjects with diabetes: a randomized controlled trial. Diabetes Care 33, 706713.
Falicov, CJ (2009). Commentary: On the wisdom and challenges of culturally attuned treatments for Latinos. Family Process 48, 292309.
Gater, R, Waheed, W, Husain, N, Tomenson, B, Aseem, S, Creed, F (2010). Social intervention for British Pakistani women with depression: randomised controlled trial. British Journal of Psychiatry 197, 227233.
Griner, D, Smith, TB (2006). Culturally adapted mental health intervention: a meta-analytic review. Psychotherapy (Chicago, Ill.) 43, 531548.
Grote, NK, Swartz, HA, Geibel, SL, Zuckoff, A, Houck, PR, Frank, E (2009). A randomized controlled trial of culturally relevant, brief interpersonal psychotherapy for perinatal depression. Psychiatric Services 60, 313321.
Grote, NK, Swartz, HA, Zuckoff, A (2008). Enhancing interpersonal psychotherapy for mothers and expectant mothers on low incomes: adaptations and additions. Journal of Contemporary Psychotherapy 38, 2333.
Hamdan-Mansour, AM, Puskar, K, Bandak, AG (2009). Effectiveness of cognitive-behavioral therapy on depressive symptomatology, stress and coping strategies among Jordanian university students. Issues in Mental Health Nursing 30, 188196.
Higgins, JP, Thompson, SG, Deeks, JJ, Altman, DG (2003). Measuring inconsistency in meta-analyses. British Medical Journal 327, 557560.
Hollon, SD, Ponniah, K (2010). A review of empirically supported psychological therapies for mood disorders in adults. Depression and Anxiety 27, 891932.
Huey, SJ Jr., Polo, AJ (2008). Evidence-based psychosocial treatments for ethnic minority youth. Journal of Clinical Child and Adolescent Psychology 37, 262301.
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.
Kohn, LP, Oden, T, Munoz, RF, Robinson, A, Leavitt, D (2002). Adapted cognitive behavioral group therapy for depressed low-income African American women. Community Mental Health Journal 38, 497504.
Lau, AS (2006). Making the case for selective and directed cultural adaptations of evidence-based treatments: examples from parent training. Clinical Psychology: Science and Practice 13, 295310.
Miranda, J, Azocar, F, Organista, KC, Dwyer, E, Areane, P (2003 a). Treatment of depression among impoverished primary care patients from ethnic minority groups. Psychiatric Services 54, 219225.
Miranda, J, Chung, JY, Green, BL, Krupnick, J, Siddique, J, Revicki, DA, Belin, T (2003 b). Treating depression in predominantly low-income young minority women: a randomized controlled trial. Journal of the American Medical Association 290, 5765.
Moher, D, Liberati, A, Tetzlaff, J, Altman, DG (2009). Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Journal of Clinical Epidemiology 62, 10061012.
Naeem, F, Waheed, W, Gobbi, M, Ayub, M, Kingdon, D (2011). Preliminary evaluation of culturally sensitive CBT for depression in Pakistan: findings from Developing Culturally-sensitive CBT Project (DCCP). Behavioural and Cognitive Psychotherapy 39, 165173.
Patel, V, Chisholm, D, Rabe-Hesketh, S, Dias-Saxena, F, Andrew, G, Mann, A (2003). Efficacy and cost-effectiveness of drug and psychological treatments for common mental disorders in general health care in Goa, India: a randomised, controlled trial. Lancet 361, 3339.
Patel, V, Simon, G, Chowdhary, N, Kaaya, S, Araya, R (2009). Packages of care for depression in low- and middle-income countries. PLoS Medicine 6, e1 000 159.
Patel, V, Weiss, HA, Chowdhary, N, Naik, S, Pednekar, S, Chatterjee, S, Bhat, B, Araya, R, King, M, Simon, G, Verdeli, H, Kirkwood, BR (2011). Lay health worker led intervention for depressive and anxiety disorders in India: impact on clinical and disability outcomes over 12 months. British Journal of Psychiatry 199, 459466.
Peng, XD, Huang, CQ, Chen, LJ, Lu, ZC (2009). Cognitive behavioural therapy and reminiscence techniques for the treatment of depression in the elderly: a systematic review. Journal of International Medical Research 37, 975982.
Rahman, A (2007). Challenges and opportunities in developing a psychological intervention for perinatal depression in rural Pakistan – a multi-method study. Archives of Women's Mental Health 10, 211219.
Rahman, A, Malik, A, Sikander, S, Roberts, C, Creed, F (2008). Cognitive behaviour therapy-based intervention by community health workers for mothers with depression and their infants in rural Pakistan: a cluster-randomised controlled trial. Lancet 372, 902909.
Rojas, G, Fritsch, R, Solis, J, Jadresic, E, Castillo, C, Gonzalez, M, Guajardo, V, Lewis, G, Peters, TJ, Araya, R (2007). Treatment of postnatal depression in low-income mothers in primary-care clinics in Santiago, Chile: a randomised controlled trial. Lancet 370, 16291637.
Smith, TB, Rodriguez, MD, Bernal, G (2011). Culture. Journal of Clinical Psychology 67, 166175.
Sue, S (2003). In defense of cultural competency in psychotherapy and treatment. American Psychologist 58, 964970.
Verdeli, H, Clougherty, K, Bolton, P, Speelman, L, Lincoln, N, Bass, J, Neugebauer, R, Weissman, MM (2003). Adapting group interpersonal psychotherapy for a developing country: experience in rural Uganda. World Psychiatry 2, 114120.
Wong, DF (2008 a). Cognitive and health-related outcomes of group cognitive behavioural treatment for people with depressive symptoms in Hong Kong: randomized wait-list control study. Australian and New Zealand Journal of Psychiatry 42, 702711.
Wong, DF (2008 b). Cognitive behavioral treatment groups for people with chronic depression in Hong Kong: a randomized wait-list control design. Depression and Anxiety 25, 142148.


Type Description Title
Supplementary materials

Choudhary supplementary material
Choudhary supplementary material

 Word (251 KB)
251 KB


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed