Reporting and representation of racial and ethnic diversity in randomized controlled trials of internet-based cognitive-behavioral therapy (iCBT) for depression

There is a growing interest in developing scalable interventions, including internet-based cognitive-behavioral therapy (iCBT), to meet the increasing demand for mental health services. Given the growth in diversity worldwide, it is essential that the clinical trials of iCBT for depression include diverse samples or, at the very least, report information on the racial-ethnic composition of their samples. Unfortunately, the field lacks data on how well racial-ethnic diversity is currently reported and represented in the iCBT literature. Therefore, we conducted a systematic review to examine the overall reporting of racial and ethnic identities in published clinical trials of iCBT for depression. We also reviewed the representation of specific racial and ethnic minority groups. We used a database of randomized controlled trials focusing on iCBT studies. A total of 62 iCBT randomized control trials and 17,210 participants are summarized in this study. Only 27.4% of the trials reported race, and only 17.7% reported ethnicity. Reporting outside of the United States (U.S.) was very poor, with the U.S. accounting for 88.2% of studies that reported race and 81.8% for ethnicity. Within and without the United States, the most reported race was White (74.9%), followed by Black (7.5%), and Asian (5.7%). Furthermore, when translating this to individual participants, 13,587 (78.9%) participants had no reported race, and 14,810 (86.0%) had no reported ethnicity. These findings suggest that reporting on race-ethnicity is very poor outside the U.S. Furthermore, while studies in the U.S. tend to report on racial-ethnic representation, the representation itself is quite poor.