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

项目概要/摘要：目标：本提案是根据PAR-18-835提交的， 检测，参与和实验评估基于互联网的认知行为疗法（e-CBT）的效果 治疗两个拉丁美洲低收入国家的大学生， 焦虑症w/或w/o共病常见精神障碍（CMD）。侦查和参与将是 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，以解决 中低收入国家的低资源。向LMIC主要合作机构（墨西哥国家 Ramon de la Fuente Muniz精神病学研究所[INPRFM]）将是一个目标，旨在促进传播 拉丁美洲的LMIC学院/大学。这项研究将建立在合作者先前的研究基础上 世界卫生组织世界精神卫生（WMH）调查联盟和WMH国际学院研究（WMH-ICS） 记录大学生中CMD的高患病率、损害和未满足的治疗需求的倡议 在高收入国家，e-CBT在治疗这些疾病方面具有显著效果。 具体目的/设计/方法：首先，我们将进行一项务实的临床试验， 在哥伦比亚和墨西哥的四所大学的学生诊所治疗CMD。候补名单上的学生 学生诊所服务将提供一个可能性，接受指导e-CBT立即，而留在 名单50%表示有兴趣的CMD学生将被随机分配到指导e-CBT， 50%为正常治疗（TAU）。短期综合干预效果将在60天后评估。 随机化和随机化后12个月的长期效应。然后我们将使用合奏机 学习方法，以预测指导e-CBT与TAU治疗效果的异质性，并制定一个 精确治疗规则（PTR），以预测哪些学生将最好地响应哪种干预。然后我们将 实施SMART设计，其中我们将50%随机分配到预测为最佳的治疗组， PTR和其他50%的患者接受随机分组。此外，我们还将开展年度WMH-ICS 以互联网为基础的心理健康需求评估调查，以学生为概率样本进行估计 未满足的治疗需求和治疗障碍。非本地学生的CMD检测呈阳性 治疗并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减少了未寻求治疗的CMD学生的未满足的治疗需求 在学生健康诊所接受治疗。最后，用于筛选、提供e-CBT和更新 最初由哈佛医学院实施的精确治疗模式将转移到INPRFM， 向拉丁美洲中低收入国家的大学传播。许多高年级地区精神健康 政策制定者在INPRFM接受培训，并定期返回参加政策首脑会议， 此外，国家公共卫生和公共卫生研究所与泛美卫生组织的关系也为这类宣传工作带来了良好的前景。

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.