A Systematic Review of Ethnoracial Participation in Randomized Clinical Trials of Behavioral Activation

As of the last available NIH report, people of color (POC) constituted 28.1% of enrollment across all U.S. domestic clinical trials. The literature on prevalence rates of depression among POC is mixed. While the prevalence rates of depression may vary across POC, it remains unknown to what degree POC have been included in outcome clinical trials of depression since NIH's mandates for inclusion of minorities in clinical outcome research. Following PRISMA guidelines, the present review identified randomized controlled trials of behavioral activation from 1989 to 2021 using the following search engines: PsycINFO, EMBASE, and Cochrane Central Register of Controlled Trials. We reviewed 5,247 articles and included 28 articles that met full inclusion criteria (n = 5,169 participants). Across studies included in this review, 70% were non-Latinx White, 14.1% were African American, 8.9% were Latinx, 0.5% were Asian, 2.9% were other, and 3.7% were unknown. Results indicated an increase in representation of ethnoracial inclusion rates across time and that recruitment method was not associated with adequate inclusion of POC. However, the university setting was associated with inadequate representation of POC.