Abstract
BackgroundThe evidence for the effectiveness of e-mental health interventions among ethnic minorities is still preliminary. This mixed methods study investigates the feasibility of a culturally adapted, guided online intervention with the intention to understand how it works and for whom to inform refinement. It also examines its likely effectiveness in reducing suicidal ideation when compared with the treatment as usual.MethodsTurkish migrants with mild to moderate suicidal thoughts were recruited from the general population using social media and newspaper advertisements. The intervention group obtained direct access to a 6-week guided online intervention while participants in the waiting list condition had to wait for 6 weeks. The intervention is based on an existing online intervention and was culturally adapted. Participants in both conditions completed baseline, post-test, and follow-up questionnaires on suicidal ideation (primary outcome), depression, worrying, hopelessness, suicide attempt and self-harm, acculturation, quality of life, and usability. In addition, participants were interviewed to examine the feasibility and mechanisms of action in more depth. The responses were analysed by inductive thematic analysis.ResultsEighty-five people signed up via the study website, and we included 18 (10 intervention, 8 waitlist control). While the therapeutic benefits were emphasised (e.g. feeling connected with the intervention), the feasibility was judged to be low. The main reasons given were not having severe suicidal thoughts and not being represented by the culturally adapted intervention. No suicide attempts were recorded during the study. The suicidal ideation, depression, and hopelessness scores were improved in both groups.ConclusionAlthough intended to be a definitive trial, the current study became a feasibility study with process evaluation to understand the components and how they operate. The online intervention was not superior to the control condition. Future studies need to attend the implementation issues raised including measures of stigma, acculturation, and careful cultural adaptations alongside more attention to coaching and relational support. They should also consider how to improve engagement alongside selection of those who are motivated to use online interventions and offer alternatives for those who are not.Trial registrationNetherlands Trial Register, NTR5028. Registered on 1 March 2015
Highlights
The evidence for the effectiveness of e-mental health interventions among ethnic minorities is still preliminary
In Europe, Turkish populations are among the largest ethnic minority populations and they have disproportionate rates of suicidal behaviours compared to the ethnic majorities in their respective host countries [4]
As part of the feasibility, semistructured telephone interviews were held at 6 weeks with the intention to obtain in-depth information about how the intervention was implemented and the contextual factors related with the uptake of the intervention in daily life
Summary
The evidence for the effectiveness of e-mental health interventions among ethnic minorities is still preliminary This mixed methods study investigates the feasibility of a culturally adapted, guided online intervention with the intention to understand how it works and for whom to inform refinement. It examines its likely effectiveness in reducing suicidal ideation when compared with the treatment as usual. In Europe, Turkish populations are among the largest ethnic minority populations and they have disproportionate rates of suicidal behaviours compared to the ethnic majorities in their respective host countries [4]. In the Netherlands, there is an elevated risk of suicidal ideation in Turkish adolescents (38.1%) when compared with ethnic Dutch (17.9%) adolescents [5]. Others have stressed that people might encounter difficulties in their adaptation process to host countries, and interpersonal and structural discrimination within institutions, contributing to the elevated risk of suicidal behaviour [12, 13]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
