Effects of a culturally adapted counselling service for low-income ethnic minorities experiencing mental distress: a pragmatic randomised clinical trial

Abstract

Background Culturally competent early mental health interventions for ethnic minorities (EMs) with no formal diagnoses are needed. Objectives To determine whether 8–12 weeks culturally adapted counselling (CAC) is better than waiting (waitlist (WL) group) to reduce depressive and anxiety symptoms and stress levels among EMs with elevated mental distress. Methods Hong Kong EMs with mild and above-mild mental distress were randomly assigned to CAC or WL in this pragmatic, randomised, WL-controlled trial. The CAC group received the intervention after randomisation and the WL group received the intervention after 8–12 weeks (T1). The prespecified primary outcomes were depressive and anxiety symptoms and stress levels measured by the Depression, Anxiety and Stress subscales of the Depression, Anxiety and Stress Scale (DASS-D, DASS-A and DASS-S, respectively) at postintervention (T1, 8–12 weeks). Findings A total of 120 participants were randomly assigned to either CAC (n=60) or WL (n=60), of whom 110 provided primary outcome data. At T1, CAC led to significantly lower depressive and anxiety symptom severity and stress levels compared with waiting, with unstandardised regression coefficients of −8.91 DASS-D points (95% CI −12.57 to −5.25; d=−0.90),–6.33 DASS-A points (95% CI −9.81 to −2.86; d=−0.68) and −8.60 DASS-S points (95% CI −12.14 to −5.06; d=−0.90). Conclusions CAC clinically outperformed WL for mild and above-mild levels of mental distress in EMs. Clinical implications Making CAC routinely available for EMs in community settings can reduce healthcare burden. Trial registration number NCT04811170.