Advancement in the maturing science of cultural adaptations of evidence-based interventions.

OBJECTIVE: Concerns about the maturing science of cultural adaptation of evidence-based interventions (EBIs) have encompassed deficient standardization of theoretical frameworks and inefficiencies adapting multiple EBIs for multiple ethnic groups. Others argue that original EBIs applied with fidelity address universal processes applicable across ethnicity without adaptation. Study goals were to (1) establish a unifying data-driven framework for culturally adapting mental health EBIs for ethnic minorities, and (2) provide information for the fidelity debate by examining the extent to which fidelity to core EBI components is achieved in the cultural adaptation process. METHOD: A systematic review of primary research was conducted utilizing an inductive approach via thematic synthesis to code 20 years of cultural EBI adaptation studies for mental health problems in ethnic minorities. Studies were coded for adapted EBI components and extent of EBI modification. RESULTS: Results yielded the Cultural Treatment Adaptation Framework (CTAF), an overarching data-driven framework providing common concepts and language for adapted treatment components that unifies cultural adaption science. Findings also demonstrated patterns of adapted components. All adapted EBIs (100%) yielded changes in peripheral (engagement and treatment delivery) components. In contrast, only 11.11% of culturally adapted EBIs yielded core therapeutic component modifications. Instead, 60.0% required core additions that address sociocultural, cultural skill, and psychoeducation needs. CONCLUSION: Fidelity to core components is largely preserved in cultural adaptation, but core component addendums, delivery, and contextualization are substantially changed. The CTAF and its patterns represent a key step in advancement of a maturing cultural adaptation science. (PsycINFO Database Record

Ethnic variations in suicidal ideation and behaviors: a prominent subtype marked by nonpsychiatric factors among asian americans.

OBJECTIVE: Main objectives were to utilize multivariate rather than traditional regression approaches to capture the heterogeneity of subtypes of suicidal ideation and behaviors within ethnic minority groups. Mental illness is associated with suicidal ideation and behaviors in a vast majority of the general population, making psychopathology a common identifier of suicide risk. Yet recent studies suggest a need to better characterize suicidal ideation and behaviors among ethnic minorities and Asian Americans who do not exhibit the most commonly assessed risk factors. METHOD: The present study examined adults 18 years of age or older from the National Latino and Asian American Study and utilized latent class analysis to classify 191 Asian Americans with a history of serious suicidal ideation or attempts from a community sample into subtypes. RESULTS: Two main subtypes resulted, including 48% in a "psychiatric" and 52% in a "nonpsychiatric" subtype of suicidal ideation and behaviors. The nonpsychiatric subtype was predominantly characterized by sociocultural factors (discrimination, family conflict, and low acculturation), medical problems, and limited functioning. The nonpsychiatric was less likely than the psychiatric subtype to seek help for mental health but was no different in access to a medical doctor, highlighting possible points of outreach. CONCLUSIONS: Findings advance the culture and suicide literature by highlighting how current research and practice that characterize suicidal ideation and behaviors as a mental health phenomenon may not comprehensively identify suicidality among an ethnic minority group.