Acculturative stress as a moderator of treatment engagement and retention in behavioral activation and treatment as usual for Latinos with depression.

Depression presents a significant public health burden for Latinos in the United States. Behavioral Activation for Latinos (BAL) has emerged as a promising treatment strategy for depressed Latinos. BAL has been shown to more successfully engage and retain clients in treatment compared with treatment-as-usual (TAU) when measured as session attendance. Cultural moderators of session attendance were explored using data obtained from a trial in which BAL was compared with TAU. Variables examined included familism and dimensions of acculturation and acculturative stress. The sample was comprised of Spanish-speaking Latinos who sought services at a community health center in a major urban center. Results suggested that a form of acculturative stress, pressure against acculturation (PAA) or stress that stems from conflict or criticism for preferring American over Latino practices, may moderate the relationship between treatment condition and number of sessions attended. Specifically, the number of sessions attended by a client receiving a given treatment may depend on the client's level of PAA. This finding suggests that PAA may represent an obstacle to retention for TAU. It may also suggest that BAL may not exacerbate or may successfully address this obstacle. Factors that may account for the impact of PAA on the relationship between treatment condition and number of sessions attended, and that may mediate this relationship, are discussed. Future research is needed to determine whether the current preliminary findings are robust.