Treating depression in Muslim communities: Meta-analysis of three trials of culturally adapted behavioural activation...

Faith-sensitive depression therapies address a core aspect of cultural values but are not specifically promoted within global mental health policy. This study evaluated a culturally adapted Behavioural Activation intervention for Muslim patients (BA-M) compared with standard treatments across diverse settings. A patient-level meta-analysis combined data from two randomised controlled trials and one feasibility trial, comparing BA-M with cognitive behavioural therapy (CBT) and, in the UK, social interventions. The primary outcome was post-treatment depression severity (PHQ-9) and retention was analysed using Poisson regression alongside qualitative evaluation. A total of 266 participants were recruited (Turkey: 22; Pakistan: 103; UK: 141), with no baseline differences in depression severity between groups. BA-M produced significantly greater reductions in PHQ-9 scores, with an adjusted mean difference of -2.72 (95% CI: -3.93 to -1.51). Engagement was also higher in BA-M (IRR: 1.30; 95% CI: 1.18-1.44). Qualitative findings (n = 66) indicated strong support among patients, therapists and service managers, highlighting increased patient motivation and engagement in both Muslim majority and minority contexts. Participants emphasised the importance of religious identity in recovery from depression. The faith-adapted therapy BA-M demonstrates superior effectiveness to CBT and social interventions, supporting the integration of faith-sensitive approaches into global mental health practice.