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«The Mediating Effect of Acculturation on the Effectiveness of Culturally Adapted Cognitive Behavioral Therapy with Mexican Americans Suffering From ...»

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Model 4 tested the direct effect of selected clinical predictors, controlling for acculturation and age. The predictor for acculturation and age (40-49) remained in the model and the predictors for use of psychotropic medication and previous therapy were added to the model. Model 4 shows that acculturation, age (40-49), and selected clinical predictors do not significantly improve the amount of variance explained in pretest depression scores (R2=0.14, F=2.82). The main finding from Model 4 is that previous therapy has a significant effect on depression score. The depression score of participants who had received previous therapy was on average 4.36 points lower than that of participants who had not received previous therapy (p.05).

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Note. The unstandardized regression coefficients (Standard Error) provided for the each variable. Coefficients that were marginally significant at the.10 critical value were reported for all regression analyses to take into account the small sample size.

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Table 5-6 shows results from independent t-test comparing mean depression scores for treatment and comparison group. The results show that there were no statistically significant difference in depression scores at pretest between treatment group and comparison group (t(df=81)=.541, p=.825). This establishes that one group was not more depressed than the other and thus makes the groups comparable for analyses.

Similarly, results from independent t test shows that there was no statistically significant difference in depression scores at posttest between treatment group and comparison group (t(df=81)=.085, p=.739). This answers research question #2 which states: Is CACBT effective in reducing depression scores among Mexican Americans? These results do not support the proposal that CACBT is more effective in reducing depression scores among Mexican Americans.

Table 5-6. Results of Independent t test on pretest and posttest depression scores

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treatment group and comparison group from pretest to posttest. Table 5-7 shows there was a statistically significant difference in depression scores for the treatment group from pretest to posttest t(df=81) =.541, p.000, ES =.95, as well as, for the comparison group t(df=81) =.085, p.000, ES =.97. These significant relationships suggest that treatment group participants had approximately on average a six-point decrease in depression scores from pretest to posttest, while comparison group participants had approximately on average a five-point decrease in depression scores. A large effect size was found in depression score changes from pretest to posttest for both the treatment and comparison group participants (Cohen, 1992). As a result, because most of the cutoff intervals for the PHQ-9 have a four-point difference, these significant relationships suggest that on average participants from both the treatment group and the comparison group moved to the next lowest depression category from pretest to posttest.

Table 5-7. Results of Paired t test on depression scores from pretest to posttest

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depression scores. Model 1 shows there was no significant relationship between group assignment and depression scores. In fact, this model does not explain any of the variance in posttest depression scores (R2=0.00, F=0.87).

Model 2 includes the variable for group assignment and demographic predictors age (40-49) and marital status (married). These demographic predictors were selected for inclusion due to the significance found in the correlation matrix. For the predictors age and marital status, only the category that was found to have a significant relationship was loaded into the model. In this model age (40-49) was the only significant predictor of posttest depression scores (b=3.33, p.05). The addition of these selected demographic predictors to the main independent variable for group in Model 2 does not significantly improves the amount of variance explained in posttest depression scores (R2=0.06, F=1.72). That is, group assignment is not significantly related to depression, controlling for selected demographic predictors.

Model 3 tested the direct effect of selected cultural predictors, controlling for group assignment, age (40-49) and marital status. Model 3 included the main independent variable for group assignment, the demographic predictors age (40-49) and marital status (married), and the cultural precdictors generation status (First Gen) and language preference (English). For the predictors generation status and language preference, only the category that was significantly correlated was loaded into the model due to limited space for predictors. In this model age (40-49) was the only significant predictor of

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scores (R2=0.09, F=1.46).

Model 4 tested the direct effect of selected clinical variables, controlling for group assignment and age. The variable for group assignment and age (40-49) remained in the model and the predictors for use of psychotropic medications and previous therapy were added to the model. Model 4 shows that group assignment, age (40-49), and clinical predictors significantly improve the amount of variance explained in posttest depression scores (R2=0.14, F=2.85). However, after controlling for selected demographic and clinical predictors, group assignment is not significantly related to posttest depression scores. The main finding from this analysis is that there is a significant relationship between psychotropic medications and depression scores. The depression score of participants who used psychotropic medications was on average 3.38 points higher than that of participants who did not use psychotropic medications. Age (40-49) also had a significant effect (b=3.11, p.10). Participants who were 40-49 years of age had a depression score 3.11 higher than participants in the other age groups.





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Table 5-9 considers the direct effect between group assignment and acculturation to posttest depression scores. Model 1 shows there was no significant relationship between group assignment and acculturation to depression scores. In fact, this model explains a very small amount of the variance in posttest depression scores (R2=0.02, F=0.59).

Model 2 includes the variable for group assignment and acculturation, as well as, demographic predictors age (40-49) and marital status (married). These demographic predictors were selected for inclusion due to the significance found in the correlation matrix. For the predictors age and marital status, only the category that was found to have a significant relationship was loaded into the model. The addition of these selected demographic predictors does not significantly improve the amount of variance explained in posttest depression scores (R2=0.10, F=2.01).

Model 3 tested the direct effect of selected cultural predictors, controlling for group assignment, acculturation, age and marital status. Model 3 included the main independent variable of group assignment and acculturation, the demographic predictors age (40-49) and marital status (married), and the cultural predictors generation status (First Gen) and language preference (English). For the cultural predictors generation status and language preference, only the category that was significantly related was loaded into the model due to the limited number of allowable predictors. The inclusion of

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explained in posttest depression scores (R2=0.10, F=1.37).

Model 4 tested the direct effect of selected clinical variables, controlling for group assignment, acculturation and age. The variable for group assignment, acculturation and age (40-49) remained in the model and the predictors for use of psychotropic medications and previous therapy were added to the model. Model 4 shows that group assignment, acculturation, age (40-49), use of psychotropic medications, and previous therapy significantly improves the amount of variance explained in posttest depression scores (R2=0.17, F=2.92, p.05). In addition, acculturation was significantly related to depression. In fact, increased acculturation level is associated with a.79 increase in posttest depression scores, after controlling for group assignment, age (40-49), use of psychotropic medications and previous therapy (p.10).

Model 5 shows that when age (40-49), use of psychotropic medications, previous therapy and the interaction effect between acculturation and group assignment are added, age (40-49) significantly predicts posttest depression (p.05). That is, participants who were 40-49 years of age had on average a posttest depression score 3.80 points higher than participants in other age groups. In addition, this model shows that use of psychotropic medications was significantly related to posttest depression scores (b=3.50, p.05). The depression score of participants who used psychotropic medications was on average 3.50 points higher than that of participants who did not use psychotropic medications. The interaction effect between acculturation and group assignment is

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depression scores (R2=0.17, F=3.61, p.05). In fact, the interaction between acculturation and group assignment was associated with an average increase of.55 points in posttest depression score. Thus, the effect of CACBT varied according to acculturation level. This answers research question #3: “Does acculturation level mediate the effectiveness of CACBT treatment?” These finding are consistent with findings from previous research studies. First, they are consistent with findings that there is a relationship between the use of psychotropic medications and outcomes for treatment for depression (American Psychiatric Association, 2000; Hollon et al., 1992; Murphy et al., 1984). Second, a significant interaction effect is consistent with findings from previous studies that found a significant relationship between acculturation and mental health (Burnam et al., 1987;

Escobar et al., 2000).

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SUMMARY OF THE STUDY

This chapter includes a summary of the project, implications of the findings, and an integration of the findings with past literature. In addition, theoretical, research and practice implications, as well as, the limitations of the study are discussed. The chapter ends with recommendations for future direction.

The purpose of this dissertation was to examine the role of cultural variation due to acculturation in how Mexican Americans respond to culturally adapted treatment. In this study, an investigation was conducted on the effect of a culturally adapted version of cognitive behavioral therapy for depression.

In order to address this issue, this study investigated three research questions:

1. Is there a relationship between acculturation level and depression scores among

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2. Is CACBT effective in reducing depression scores among Mexican Americans?

3. Does acculturation level mediate the effectiveness of CACBT treatment?

The objective of the study was to further understand how culturally adapting evidence-based practices can enhance treatment for Mexican Americans. It was hypothesized that higher acculturated Mexican Americans would have higher depression scores than would lower acculturated Mexican Americans. Moreover, it was hypothesized that low acculturated treatment group participants would have a

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counterparts.

A rationale for examining the role of cultural variation due to acculturation in how Mexican Americans respond to culturally adapted treatment was justified by summarizing how current interventions in mental health result in disparities for this group. This study addressed the third disparity mentioned in the supplement to the Surgeon General’s report that states minorities in treatment often receive poorer quality of mental health care. The study was designed with the premise that in order to effectively culturally adapt any intervention for Mexican Americans, acculturation must be considered. Findings from this study confirmed that acculturation is an active part of how Mexican Americans respond to treatment for depression.

The theoretical framework used to support culturally adapting mental health treatment was the culturally grounded perspective. The theoretical frameworks used in the understanding of the acculturation process were Bronfenbrenner’s ecological framework and Gitterman and Germain’s Life Model. Findings from previous research that used acculturation as an independent variable in examining mental health treatment found the role of acculturation in predicting mental health was not linear, but rather complex in its interaction. This study supports these findings.

Research question one explored whether there was a relationship between acculturation level and depression scores among Mexican Americans. No significant relationship was found between acculturation and depression scores at onset of treatment

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higher depression scores as compared to lower acculturated Mexican Americans. It also does not support what has been written in the literature previously that acculturation has a direct effect on predicting depression scores (Burnam et al., 1987; Escobar et al., 2000).

Moreover, this finding does not support the hypothesis that higher acculturated Mexican Americans would have higher depression scores as compared to lower acculturated Mexican Americans. One possible cause for this finding is the lack of variability in the measure of acculturation. This lack of variability may be due to the setting of the study, given that it was conducted in a border city mental health agency that provides services to predominantly low acculturated Mexican Americans.



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