Cognitive-Behavioral Interventions for Anxiety Disorders: Rapid Review Suggestion of Larger Effects among Hispanic than Non-Hispanic White People

Abstract

ABSTRACTAnxiety disorders are common among Hispanic people. Evidence-based guidelines indicate cognitive-behavioral interventions (CBI), but they were developed primarily with non-Hispanic white (NHW) people. This rapid scoping review and meta-analysis clarified the relative effectiveness of CBI with Hispanics and NHW people with anxiety disorders and explored the clinical effects of cultural modifications among Hispanic people. Evidence from nine studies in the United States and one in Puerto Rico was synthesized. Meta-analysis of four randomized controlled trials (RCT) found no statistically or practically significant differences between Hispanic and NHW participants on anxiety alleviation. Both groups enjoyed large clinical benefits. However, a significantly greater drop-out rate among Hispanic participants was found. Meta-analytic adjustment for this study characteristic of loss to follow-up suggested a somewhat larger clinical benefit among NHW people. Scoping synthesis of six non-RCTs suggested that deep cultural adaptations of CBI would substantially improve outcomes among Hispanic people. Consistent with Hispanic-paradox and barrio advantage theories such culturally sensitive interventions may well take beneficial Hispanic outcomes beyond those of NHW people. This field's synthetic knowledge, therefore, essentially consists of two competing hypotheses that will require rigorous testing with a necessarily larger and better controlled RCT than has been represented in this field thus far.