Conclusions

Ethnic differences in the experience of psychopathology and the related manifestation of varied symptomatology necessitate that clinicians adopt a broader conceptualization of what it means to be depressed in African American and Latino communities. Furthermore, the unique and multifac-eted context in which individual patients experience psychological distress must also be taken into account in light of considerable within-group heterogeneity. Thus, the proper conceptualization and treatment of depression within ethnic/minority populations is intimately linked to the competent practice of thorough assessment protocol. More comprehensive assessment (including both standardized measures and individualized assessment information) is sorely needed to gauge the extent to which acculturative, socioeconomic, and discrimination-related factors, for example, may influence the clinical picture, as well as the resultant treatment plan.

As with any applied (nonmedical) intervention, CT for depression relies not only on the expertise of trained clinicians but also on their sensitivity to issues of racial and ethnic difference. Mental health professionals must take care to be aware of the interface between their own worldviews and those of patients. Culturally competent clinicians are adept at recognizing the point at which effective treatment may require deferral of expertise to the localized experiences of individual patients.

The available, if sparse, literature on ethnic/minority treatment outcomes indicates that cognitive-based intervention approaches are effective for mood disorders experienced by African American and Latinos, particularly when cultural adaptations or enhancements are included and potential barriers are addressed. The limited evidence for treatment outcomes among ethnic/minority patients suggests CT may be effective. However, it remains critically important that future treatment studies include substantial proportions of ethnic/minority participants to establish an evidence base from which more substantive conclusions may be drawn.

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