title: Internet-based, culturally sensitive, problem-solving therapy for Turkish migrants with depression: randomized controlled trial.
abstract: BACKGROUND
  Turkish migrants living in the Netherlands have a high prevalence of depressive disorders, but experience considerable obstacles to accessing professional help. Providing easily accessible Internet treatments may help to overcome these barriers.
  
  
  OBJECTIVE
  The aim of this study was to evaluate the effectiveness of a culturally sensitive, guided, self-help, problem-solving intervention through the Internet for reducing depressive symptoms in Turkish migrants.
  
  
  METHODS
  A two-armed randomized controlled trial was conducted. The primary outcome measure was the severity of depressive symptoms; secondary outcome measures were somatic symptoms, anxiety, quality of life, and satisfaction with the treatment. Participants were assessed online at baseline, posttest (6 weeks after baseline), and 4 months after baseline. Posttest results were analyzed on the intention-to-treat sample. Missing values were estimated by means of multiple imputation. Differences in clinical outcome between groups were analyzed with a t test. Cohen's d was used to determine the between-groups effect size at posttreatment and follow-up.
  
  
  RESULTS
  Turkish adults (N=96) with depressive symptoms were randomized to the experimental group (n=49) or to a waitlist control group (n=47). High attrition rates were found among the 96 participants of which 42% (40/96) did not complete the posttest (6 weeks) and 62% (59/96) participants did not complete the follow-up assessment at 4 months. No significant difference between the experimental group and the control group was found for depression at posttest. Recovery occurred significantly more often in the experimental group (33%, 16/49) than in the control group (9%, 4/47) at posttest (P=.02). Because of the high attrition rate, a completers-only analysis was conducted at follow-up. The experimental group showed significant improvement in depression compared to the control group both at posttest (P=.01) and follow-up (P=.01).
  
  
  CONCLUSIONS
  The results of this study did not show a significant effect on the reduction of depressive symptoms. However, the effect size at posttest was high, which might be an indicator of the possible effectiveness of the intervention when assessed in a larger sample and robust trial. Future research should replicate our study with adequately powered samples.
  
  
  BACKGROUND
  Dutch Trial Register: NTR2303. http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=2303 (Archived by WebCite at http://www.webcitation.org/6IOxNgoDu).
authors.affiliation: Department of Clinical Psychology, Faculty of Psychology and Education, VU University Amsterdam, Amsterdam, Netherlands. b.unlu@vu.nl.
authors.forename: Burçin
authors.initials: B
authors.lastname: Ünlü Ince
authors.forename: Pim
authors.initials: P
authors.lastname: Cuijpers
authors.forename: Edith
authors.initials: E
authors.lastname: van 't Hof
authors.forename: Wouter
authors.initials: W
authors.lastname: van Ballegooijen
authors.forename: Helen
authors.initials: H
authors.lastname: Christensen
authors.forename: Heleen
authors.initials: H
authors.lastname: Riper
mesh_terms: D000328:Adult; D003466:Cultural Characteristics; D003863:Depression / Q000208:ethnology / Q000628:therapy*; D004641:Emigration and Immigration; D005260:Female; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011340:Problem Solving; D014421:Turkey
keywords: Internet; depression; ethnic groups; psychotherapy; randomized controlled trial