title: Systematic review of interventions for Indigenous adults with mental and substance use disorders in Australia, Canada, New Zealand and the United States.
abstract: OBJECTIVE
  The aim of this study was to systematically review the evidence-base for the effectiveness of culturally unadapted, culturally adapted and culture-based interventions for Indigenous adults with mental or substance use disorders.
  
  
  METHODS
  We conducted a systematic search of scientific databases, government websites and web-based Indigenous research repositories. We sought studies using designs comparing an intervention group to a control/comparator group or pre- and post-test designs, published between 2000 and 2015 examining interventions to improve individual-level outcomes (e.g. remission, symptoms, quality of life, functioning) or service-level outcomes (e.g. number of interventions delivered) for Indigenous adults with mental or substance use disorders in Australia, Canada, New Zealand or the United States.
  
  
  RESULTS
  A total of 16 studies met inclusion criteria. Virtually all North American studies (6 US and 1 Canadian) evaluated culturally unadapted interventions, all of which were interventions for substance use. Two-thirds of Australian and New Zealand studies evaluated culturally adapted interventions and included samples with mental disorders. Of eight culturally unadapted psychological/psychosocial, pharmacological and educational intervention studies, seven reported significant improvements on at least one measure of psychological well-being, mental health problem severity, or significantly reduced alcohol or illicit drug use. Of seven culturally adapted psychological/psychosocial intervention studies, all reported significant improvement on at least one measure of symptoms of mental illness, functioning, and alcohol use. One culture-based psychological/psychosocial intervention study significantly reduced problem severity in medical and psychiatric domains.
  
  
  CONCLUSIONS
  There remains inconclusive evidence regarding interventions due to a small and methodologically weak evidence-base. The literature would be enhanced by intervention replication and outcome standardisation, validating the outcome instruments used in Indigenous populations, including sample size calculations and using stronger research designs (e.g. interrupted time-series designs). Robust implementation and outcomes research is needed to further progress evidence-based practice in Indigenous mental health.
authors: School of Public Health, The University of Queensland, Herston, QLD, Australia.
authors: Stuart
authors: S
authors: Leske
authors: School of Public Health, The University of Queensland, Herston, QLD, Australia meredith_harris@qcmhr.uq.edu.au.|Policy and Epidemiology Group, Queensland Centre for Mental Health Research, The Park - Centre for Mental Health, Brisbane, QLD, Australia.
authors: Meredith G
authors: MG
authors: Harris
authors: School of Public Health, The University of Queensland, Herston, QLD, Australia.|Policy and Epidemiology Group, Queensland Centre for Mental Health Research, The Park - Centre for Mental Health, Brisbane, QLD, Australia.|Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
authors: Fiona J
authors: FJ
authors: Charlson
authors: School of Public Health, The University of Queensland, Herston, QLD, Australia.|Policy and Epidemiology Group, Queensland Centre for Mental Health Research, The Park - Centre for Mental Health, Brisbane, QLD, Australia.|Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
authors: Alize J
authors: AJ
authors: Ferrari
authors: School of Public Health, The University of Queensland, Herston, QLD, Australia.|Policy and Epidemiology Group, Queensland Centre for Mental Health Research, The Park - Centre for Mental Health, Brisbane, QLD, Australia.
authors: Amanda J
authors: AJ
authors: Baxter
authors: School of Public Health, The University of Queensland, Herston, QLD, Australia.|Princess Alexandra Hospital, Queensland Health, Brisbane, QLD, Australia.
authors: Jacquie M
authors: JM
authors: Logan
authors: Rural Clinical School, School of Medicine, The University of Queensland, Toowoomba, QLD, Australia.
authors: Maree
authors: M
authors: Toombs
authors: School of Public Health, The University of Queensland, Herston, QLD, Australia.|Policy and Epidemiology Group, Queensland Centre for Mental Health Research, The Park - Centre for Mental Health, Brisbane, QLD, Australia.|Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
authors: Harvey
authors: H
authors: Whiteford
mesh_terms: D000328:Adult; D001315:Australia; D002170:Canada; D065246:Culturally Competent Care / Q000379:methods*; D006801:Humans; D001523:Mental Disorders / Q000208:ethnology / Q000628:therapy*; D009520:New Zealand; D044382:Population Groups / Q000208:ethnology*; D019966:Substance-Related Disorders / Q000208:ethnology / Q000628:therapy*; D014481:United States
keywords: Aboriginal; Indigenous; Indigenous Canadian; Māori; Native American; Systematic review; interventions; mental disorder; mental health; substance use disorder