Computerized detection and internet-based treatment of common mental disorders among college students in two Latin American LMICs

拉丁美洲两个中低收入国家大学生常见精神障碍的计算机检测和网络治疗

• 批准号: 10053143
• 负责人: Corina L. Benjet
• 金额: $ 68万
• 依托单位: NATIONAL INSTITUTE OF PSYCHIATRY
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-07-01 至 2025-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10053143
• 关键词: Address; Administrator; Bipolar Disorder; Brain; California; Cities; Clinic; Cognitive Therapy; Colombia; Country; Coupled; Data; Detection; Diagnostic; Disease; Disease remission; Dropout; Effectiveness; Evidence based intervention; Generalized Anxiety Disorder; Goals; Government; Health; Health Surveys; Heterogeneity; High Prevalence; Impairment; Income; Infrastructure; Institutes; Institution; International; Internet; Intervention; Knowledge; Latin America; Latin American; Lead; Longevity; Major Depressive Disorder; Mental Health; Mental disorders; Methods; Mexican; Mexico; Modeling; Needs Assessment; Pan American Health Organization; Patient Self-Report; Periodicity; Persons; Policies; Policy Maker; Pragmatic clinical trial; Precision therapeutics; Probability Samples; Psychiatry; Public Health; Randomized; Recording of previous events; Reporting; Research; Research Personnel; Resistance; Resources; Sample Size; Sampling; Scheme; Schools; Sequential Multiple Assignment Randomized Trial; Services; Students; Suicide; Surveys; Technology; Technology Transfer; Therapeutic Intervention; Training; Universities; Update; Waiting Lists; Work; arm; barrier to care; base; college; common treatment; comorbidity; computerized; cost; design; epidemiology study; evidence base; follow-up; improved; interest; intervention effect; low and middle-income countries; machine learning method; medical schools; nervous system disorder; outreach; response; screening; success; symposium; treatment arm; treatment as usual; treatment effect; trial design; undergraduate student; university student

PROJECT SUMMARY/ABSTRACT: Objectives: This proposal is submitted in response to PAR-18-835 to detect, engage, and experimentally evaluate the effects of internet-based cognitive behavior therapy (e-CBT) to treat college students in two Latin American LMICs with major depressive disorder and/or generalized anxiety disorder w/ or w/o comorbid common mental disorders (CMDs). Detection and engagement will be based on inexpensive internet-based self-report surveys and the intervention on inexpensive e-CBT to address the low resources in LMICs. Knowledge transfer to the primary LMIC collaborating institution (Mexican National Institute of Psychiatry Ramon de la Fuente Muniz [INPRFM]) will be a goal designed to facilitate dissemination to LMIC colleges/universities throughout Latin America. The study will build on prior research by collaborators in the WHO World Mental Health (WMH) survey consortium and WMH International College Study (WMH-ICS) initiative documenting high prevalence, impairment, and unmet need for treatment of CMDs among college students around the world and significant effects of e-CBT in treating these disorders in high income countries. Specific aims/Design/Methods: First, we will carry out a pragmatic clinical trial with students seeking treatment for CMDs at student clinics in four universities in Colombia and Mexico. Students on waitlists for student clinic services will be offered a possibility of receiving guided e-CBT immediately while staying on the list. 50% of the students with CMD who express interest will be randomized to guided e-CBT and the other 50% to treatment as usual (TAU). Short-term aggregate intervention effects will be assessed 60 days after randomization and longer-term effects 12 months after randomization. We will then use ensemble machine learning methods to predict heterogeneity of treatment effects of guided e-CBT versus TAU and develop a precision treatment rule (PTR) to predict which students will respond best to which intervention. We will then implement a SMART design in which we randomize 50% to the treatment arm predicted to be optimal by the PTR and the other 50% to randomization across arms. Additionally, we will carry out annual WMH-ICS internet-based mental health needs assessment surveys with a probability sample of students to estimate unmet need for treatment and barriers to treatment. Students screening positive for CMD who are not in treatment and report resistance to in-person treatment will be randomized to guided e-CBT to determine if access to guided e-CBT reduces the unmet need for treatment among students with CMDs who fail to seek treatment at student health clinics. Finally, the technology for screening, delivering e-CBT, and updating the precision treatment model, implemented initially by Harvard Medical School, will be transferred to INPRFM for dissemination to universities in LMICs throughout Latin America. That many senior regional mental health policy makers are trained at INPRFM and return for periodic policy summits, coupled with the close working relationship of INPRFM with the Pan American Health Organization, bode well for such dissemination efforts.

项目摘要/摘要： 目标：本提案是根据 PAR-18-835 提交的 检测、参与并通过实验评估基于互联网的认知行为疗法 (e-CBT) 的效果 治疗两个拉丁美洲中低收入国家患有重度抑郁症和/或全身性抑郁症的大学生 伴有或不伴有常见精神障碍 (CMD) 的焦虑症。检测和参与将 基于廉价的基于互联网的自我报告调查和廉价的电子 CBT 干预来解决 中低收入国家资源匮乏。向主要中低收入国家合作机构（墨西哥国家 精神病学研究所 Ramon de la Fuente Muniz [INPRFM]）将是一个旨在促进传播的目标 拉丁美洲各地的 LMIC 学院/大学。该研究将建立在合作者之前的研究基础上 世界卫生组织世界心理健康 (WMH) 调查联盟和 WMH 国际大学研究 (WMH-ICS) 该倡议记录了大学中 CMD 的高患病率、损伤和未满足的治疗需求 世界各地的学生以及 e-CBT 在高收入国家治疗这些疾病方面的显着效果。 具体目标/设计/方法：首先，我们将与寻求帮助的学生进行务实的临床试验 哥伦比亚和墨西哥四所大学的学生诊所对 CMD 进行治疗。等候名单上的学生 学生诊所服务将有可能在留在学校期间立即接受指导性电子 CBT 列表。 50% 患有 CMD 且表示有兴趣的学生将被随机分配接受引导式 e-CBT 治疗和其他治疗 50% 照常治疗 (TAU)。短期综合干预效果将在 60 天后评估 随机分组和随机分组后 12 个月的长期影响。然后我们将使用合奏机 学习方法来预测引导式 e-CBT 与 TAU 治疗效果的异质性，并制定 精确治疗规则（PTR）来预测哪些学生对哪种干预反应最好。我们随后将 实施 SMART 设计，其中我们将 50% 随机分配给预测为最佳的治疗组 PTR 和其他 50% 进行跨臂随机化。此外，我们还将开展年度 WMH-ICS 基于互联网的心理健康需求评估调查，以学生的概率样本进行估计 未满足的治疗需求和治疗障碍。不在校的 CMD 筛查呈阳性的学生 治疗和报告对亲自治疗的抵抗将被随机分配到指导性 e-CBT，以确定是否 获得指导性电子 CBT 可以减少患有 CMD 且未能寻求治疗的学生的治疗需求未得到满足 在学生健康诊所接受治疗。最后，筛选、提供 e-CBT 和更新信息的技术 最初由哈佛医学院实施的精准治疗模式将转移至 INPRFM 进行 向整个拉丁美洲中低收入国家的大学传播。许多高级地区的心理健康 政策制定者在 INPRFM 接受培训，并返回参加定期政策峰会，并与密切合作 INPRFM 与泛美卫生组织的关系对于此类传播工作来说是个好兆头。