Assessment of Transcultural Psychotherapy in Child Major Depressive Disorder
Assessment of Transcultural Psychotherapy in Child Major Depressive Disorder
The symptomatic and clinical expression of psychiatric disorders in children and adolescents
 is strongly influenced by the cultural setting they are growing up in. These cultural
 variations complicate psychiatric care, especially for migrant children, for whom appropriate
 care must be designed.

 Transcultural psychotherapy is an original psychotherapeutic technique developed to meet
 these specific requirements in France and in different European and American countries. Its
 theoretical and methodological foundations rest on the works of George Devereux in
 ethnopsychiatry (1970). A psychotherapeutic technique intended for first-generation migrants
 was developed by Tobie Nathan and coll (1986). Marie-Rose Moro and colleagues (1990) have
 adapted this technique to second-generation migrants.

 Indicated as a second-line treatment after the failure of standard management, this technique
 is fully formalized today. It comprises group consultations for the child and the family as a
 one-hour session each month, directed by a principal therapist, assisted by a group of
 co-therapists (of diverse cultural origins and occupations) and an interpreter in the
 family's mother tongue. The concept of culture is used to establish the therapeutic alliance,
 decode the symptoms, and propose treatment.

 The children and adolescents receiving this treatment have varied psychopathological
 profiles, mostly involving depressive and/or anxiety disorders. Specifically, migrants'
 children are especially vulnerable to depression, their psychiatric care is generally longer
 and less effective than in the general population, and their rate of treatment failure
 higher.

 Transcultural psychotherapy has demonstrated its value in these situations in numerous
 qualitative studies, but its efficacy has not yet been assessed by a method providing a high
 level of evidence, such as randomized controlled trials.
Mixed method study using a multicenter, Bayesian randomized clinical trial with blinded
 evaluation of the primary outcome. Two parallel groups of 40 children or adolescents from 6
 to 20 years-old and their family will be included. In the experimental group, patients will
 attend six sessions of transcultural therapy in addition to usual care. The improved Clinical
 Global Impression scale scores at 6 months will be compared across groups. Qualitative
 analysis of families and therapists' interviews will allow to specify the therapeutic
 processes and acceptability of the therapy.
Inclusion Criteria:

 -  Be a child aged or an adolescent aged 6-20 years-old (this may be a declaratory age at
 the time of the consultation or based on a document for a residence request if no
 other identity documents are available)

 -  Be a first or second-generation migrant (born abroad or born from at least one parent
 who is born abroad)

 -  Have a psychological and/or psychiatric follow-up by a first-line care

 -  Have been referred for transcultural psychotherapy by their first line care to treat
 depression resistant to standard management.

 -  Present a depression according to the clinician who proposes the transcultural
 treatment (first line therapist), based on usual as well as cultural symptoms criteria
 of the below list:

 -  Sadness

 -  Diminish interest or pleasure in most of the usual activities

 -  Insomnia or hypersomnia

 -  Psychomotor agitation

 -  Asthenia, loss of energy

 -  Feeling of worthlessness or excessive guilt

 -  Recurrent throughs of death

 -  School problems (school failure, drop in grades, aggressivity with adult, school
 refusal…)

 -  Mutism, and selective mutism

 -  Runaways

 -  Aggressivity

 -  Impulsivity

 -  Violence and delinquency

 -  Conflicts with parents and adults from the community

 -  Exclusion from family

 -  Somatic pains

 -  Massive separation anxiety

 -  Regressive symptoms - loosing of an already acquired function such as speech,
 walk, stay alone for a sufficient time in relation to age, manage stress or
 anxiety for reasonable situations…

 -  Denial of medical care for a chronic disease with no evident reasons

 -  Cultural designation such as possessed by a spirit, being a child witch, or other
 cultural designations

 -  State of trance The list is not exhaustive, and some other symptoms may be
 accepted if the first line clinician as well as the referent agree. The patients
 will be well characterized after inclusion.

 -  Present a score >= 4 on the iCGI - Severity at inclusion.

 -  Present transcultural issues confirmed by the referent (usual procedure of indirect
 pre-selection based on the presentation of the situation by referring physician)

 -  Have an informed consent signed by both parents/ one parent / tutor / adult patient
 (cf. 14.1 paragraph)

 Exclusion Criteria:

 -  Patient or family has previously had transcultural psychotherapy

 -  Patient presents an acute psychiatric disorder which hinders the realization of the
 transcultural therapy - for example, excited delirium with great psychic
 disorganization, or high suicidal risk patients. These situations will be excluded
 during the screening time based on the first line therapist evaluation

 -  Patient presents an acute somatic disease which may hinder the well organization of
 the therapy

 -  Patient addressed for a legal expertise

 -  Child's/Adolescent's refusal

 -  Pregnant or breastfeeding (for women for young women of childbearing age)

 -  Participation in another interventional study

 -  Patient under guardianship or curatorship