Reducing cultural and structural barriers to treatment: feasibility, efficacy, and acceptability of an Internet-delivered cognitive behavioural therapy program for Chinese Australians with depression

Abstract

iCBT has the potential to overcome barriers and improve access to depression treatment among Chinese migrants. The aim of this thesis was to examine the feasibility, efficacy, and acceptability of culturally adapted Internet-delivered cognitive behavioural therapy (iCBT) depression treatment for Chinese Australians. The first study described the process of modifying an existing iCBT depression treatment for use by Chinese migrants based on cultural adaptation guidelines. Results suggest the adaptations to the iCBT program were relevant to the Chinese participants regardless of acculturation level, but further modifications may improve cultural relevance. Chinese Australian participants with depression were then randomly allocated to receiving the iCBT depression program (n=25) or deferred-treatment waitlist control (n=30) in a CONSORT compliant RCT design. Treatment group participants reported significantly reduced symptoms of depression compared to controls, with moderate to large between-group effect sizes, and gains were maintained at three-month follow-up. A matched samples study comparing Chinese- (n=55) and English- speaking iCBT depression program participants (n=55) found that iCBT reduced structural barriers, and encouraged Chinese participants who had not sought treatment to seek help early, while it was an additional source of help for English-speaking participants. A survey found that Chinese (n=289) and Caucasian Australian primary-care patients (n=106) perceived Internet treatment to reduce treatment barriers, but face-to-face treatment was preferred across symptom severity. However, only 12% of the entire sample refused to try Internet treatment for depression. The overall findings support the feasibility of modifying iCBT for a cultural group and show that guided iCBT treatments for Chinese migrants is efficacious and acceptable. This research supports iCBT reduces treatment barriers and can improve access among Chinese and other cultural groups.