Associate Professor Nickolai Titov1
Ms Isabella Choi2
Dr Judy Zou1
Dr Blake Dear1
Associate Professor Caroline Hunt2
Dr Stephen Li3
Professor Gavin Andrews1
Mr Luke Johnston1
Centre for Emotional Health, Macquarie University (formerly CRUfAD, University of New South Wales/St Vincent's Hospital, Sydney)
Australian Chinese Medical Association and Westmead Hospital
Beyond Blue E-Health Research and Development
Project completion year
This project aimed to explore the potential of internet treatment as a way of reducing practical and cultural barriers to treatment for Chinese Australians with depression.
An existing internet-delivered treatment program for depression treatment (the Sadness Program) was translated and significantly modified for use with a Chinese-Australian population. This program (the Brighten Your Mood Program) was then evaluated using a CONSORT-revised compliant randomised controlled trial, comparing a treatment versus waitlist control group. Outcome variables included symptoms of depression and acceptability.
This project was successful in several ways:
- The Program was successfully translated. This included translating written content as well as the inclusion of cultural content relevant to Chinese cultural values. Examples of these changes included emphasis on the importance of family and less emphasis on individual values. Considerable consultations were undertaken with Chinese stakeholders to ensure the presented material was culturally sensitive and appropriate.
- Considerable community awareness raising occurred during the course of this project. This included providing multiple community talks, newspaper articles, radio and television interviews, contact with university counselling and Chinese student associations, as well as a large number of other organisations.
- Demand by applicants for this program was high. Applications were received from 168 people for 60 positions. However, the needs of most applicants were noticeably different to those who apply for other programs. In particular, the level of knowledge about mental health and emotional wellbeing was noticeably lower in applicants to this program, a large proportion (10 per cent) were at significant risk (suicidal), and an even larger proportion had subclinical symptoms which, while distressing, did not meet criteria for this trial.
- It is believed that this reflects problems that this group have accessing appropriate mental health services due to barriers that include language, not understanding local mental health systems, and lower mental health literacy. Thus many were excluded, although considerable effort was made to support these people to obtain more appropriate sources of support.
- 60 people were successfully recruited into the trial. All had access to the bilingual treatment resources and weekly telephone or email contact with Chinese speaking (Mandarin and Cantonese) support staff.
- Importantly, the Brighten Your Mood program was clinically efficacious. Compared to a waitlist control group, the treatment group obtained large effect sizes on Chinese language measures of depression. Large reductions in the number of participants who met diagnostic criteria for depression were also found at post-treatment.
- Importantly, evaluations at post-treatment indicate the program was acceptable to consumers.
Implications for policy and practice
- Culturally relevant CBT programs appear to be clinically effective for Chinese-Australians with depression.
- This population experiences considerable barriers to accessing treatment.
- The researchers’ experience is that there was considerable demand and interest in this program.
- Internet-delivered CBT programs have considerable potential for improving access to evidence-based treatments for culturally and linguistically diverse populations.
- The researchers’ experience of conducting this study indicates that online education programs, that aim to increase the mental health literacy of Chinese-Australians is an urgent priority, and probably also for other ethnic groups. The provision of online and self-guided education programs should be prioritised before the provision of online treatment programs, as the former require fewer resources to develop. Such education programs should aim to improve mental health literacy, teach self-help strategies, and provide information about how to recognise when to access specialised care, and information about how to do so.