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Representation of racial and ethnic minorities in U.S. depression trials comparing psychotherapy vs. controls: A meta-analysis using state population benchmarks
Journal article   Peer reviewed

Representation of racial and ethnic minorities in U.S. depression trials comparing psychotherapy vs. controls: A meta-analysis using state population benchmarks

Lisa Segre, Lingyao Tong, Esra Kaya Aglio, Clara Miguel, Nino de Ponti, Mathias Harrer, Guldehan Durman, Jennifer Deberg, Eirini Karyotaki and Pim Cuijpers
Journal of affective disorders, Vol.415(15 December 2026), 122391
09/01/2026
DOI: 10.1016/j.jad.2026.122391
PMID: 42637147

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Abstract

Psychotherapies for depression are effective. To generalize to the diverse U.S. population, clinical trials must adequately represent racial/ethnic minority groups. Prior reviews of diversity of clinical trial participants are limited by incomplete reporting of race/ethnicity, use of national rather than state-level comparators, and pooling practices where a few diverse trials skew estimates. We evaluated racial/ethnic representation in U.S. randomized trials comparing psychotherapy with an inactive control in depressed adults using meta-analysis with state-specific population benchmarks. We assessed reporting of race/ethnicity and, using meta-analysis, evaluated minority representation relative to state population benchmarks. Analyses included sensitivity and subgroup tests (through 2001 and 2002 onward) and meta-regressions assessing links between minority representation and treatment effectiveness. Seventy-six trials (98 comparisons; 8819 participants) were included. Race/ethnicity was not reported in 29.1% of studies. The "total minority" estimate suggested slight overrepresentation (+2%) but was inconsistent across sensitivity analyses and obscured subgroup differences in representation and temporal patterns. Subgroup analyses showed uneven representation, with Black participants overrepresented and Hispanic/Latino, Asian, and multiracial participants persistently underrepresented. Psychotherapy showed a moderate effect (g = 0.62). The apparent association between greater minority representation and lower treatment effectiveness was no longer significant after adjustment for trial characteristics or exclusion of high-risk-of-bias trials. Incomplete reporting limits evaluation of representativeness. Aggregate "total minority" estimates obscures important subgroup differences, including persistent underrepresentation of some racial/ethnic groups. More complete reporting and subgroup-specific analyses are needed to evaluate racial/ethnic representation in depression treatment clinical trials.
 Psychotherapy Depression Minority groups Ethnic and racial minorities 73 treatment outcome Meta-analysis

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