Arundell, Laura-Louise C.; (2024) Investigating psychological treatment outcomes for women from minoritised ethnic groups and identifying service improvements. Doctoral thesis (Ph.D), UCL (University College London).

Text Laura-Louise Arundell_18158325_PhD Thesis_revised.pdf - Accepted Version Access restricted to UCL open access staff until 1 July 2025. Download (4MB)

Abstract

This thesis explores how mental health treatment can be improved to address inequalities and meet the needs of women from minoritised ethnic communities. A systematic review of studies exploring cultural adaptations to psychological treatment for minoritised ethnic communities informed the development of a conceptual typology of adaptations reported in existing literature. The typology was used to assess the effectiveness of adaptations for different minoritised ethnic groups through meta-analysis. Adapted interventions had significant effects on symptom reduction compared to non-adapted treatments and inclusion of organisation-level adaptations was associated with greater benefits. A large dataset comprising women from minoritised ethnic groups who accessed National Health Service (NHS) Talking Therapies for Anxiety and Depression (NHSTTad) services, was used to examine ethnic differences in outcomes. Multivariate logistic regression analyses explored factors associated with outcomes whilst controlling for clinical and socio-demographic variables. Whether organisation-level factors moderated differences in outcomes between ethnic groups was also explored. Women belonging to Asian, ‘Other’ and White-other groups showed poorer outcomes compared to White-British women and there was evidence of interactions between ethnic groups and organisation-level factors impacting outcomes. Two qualitative studies were conducted sampling female service users from minoritised ethnic groups, and NHSTTad therapists. Semi-structured interviews explored experiences of receiving or providing treatment, and derived suggestions for improvements from both perspectives. Ways to improve treatment and optimise outcomes included cultural sensitivity, providing flexible services responsive to individual needs, enabling outreach to underserved communities and fostering a diverse and representative workforce. Together, the findings from the research support the use of cultural adaptations to treatment for people from minoritised ethnic communities to optimise outcomes. Specifically, adaptations provided at the organisation level may provide additional benefits alongside cultural adaptations made to treatment content and delivery. Findings suggest there are improvements that could optimise treatment outcomes for women from minoritised ethnic communities.

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