How to Improve Diversity in Antidepressant Trial Recruitment
How can clinicians and trial teams improve recruitment and retention of underrepresented groups in antidepressant trials?
Antidepressant trials may not adequately reflect the populations most affected by major depressive disorder or most likely to use these medications. When teams are planning or supporting recruitment, the article identifies practical strategies to reduce barriers and improve representation.
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Identify which groups need targeted recruitment
Use existing representation data to decide where recruitment efforts should be intensified rather than applying generic outreach to all groups equally. In this review, Asian, American Indian or Alaska Native, multiracial, and Hispanic or Latino participants were significantly underrepresented, and women were underrepresented relative to national antidepressant users despite appearing overrepresented relative to census population benchmarks.
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Use targeted outreach and transparent recruitment practices
Build recruitment plans that explicitly target underrepresented populations and make trial opportunities understandable and visible. The article links its findings to NIH guidance emphasizing targeted outreach and transparent trial recruitment to address inequitable participation.
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Deliver culturally competent and multilingual communication
Provide culturally competent communication and multilingual resources, and train research staff accordingly. The article states that these practices can help build trust with diverse participants and align with recommendations for improving recruitment and retention.
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Reduce logistical barriers to participation
Address practical obstacles that can prevent enrollment or continuation in the study. The article specifically names transportation support, caregiving assistance, reimbursement of travel costs, flexible visit schedules, and mobile health technologies as measures that may reduce logistical burden.
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Broaden eligibility when exclusions are unnecessary
Review study criteria to determine whether exclusions can be relaxed without compromising the trial's purpose or safety framework. The article cites FDA guidance emphasizing broader eligibility criteria and elimination of unnecessary exclusions as a way to increase diversity in clinical trials.
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Consider family-inclusive approaches when appropriate
Incorporate family-inclusive approaches into recruitment and retention efforts when they fit the trial setting and participant population. The article includes family-inclusive approaches among the recommendations aligned with its findings for improving participation of underrepresented groups.
Clinical Considerations
- The article recommends these recruitment and retention practices but does not test a specific intervention package or quantify the effect size of each strategy.
- Broader determinants of health disparities, including socioeconomic factors, were not captured in this study even though the article identifies them as important.
- The findings come from antidepressant trials in the United States and may not generalize to non-US recruitment settings.
Bottom Line
To improve diversity in antidepressant trials, focus recruitment on underrepresented groups and remove cultural and logistical barriers with transparent outreach, multilingual culturally competent communication, and practical participation support.
