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: 10203815
• 负责人: Corina L. Benjet
• 金额: $ 60.7万
• 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/10203815
• 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; implementation intervention; 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：该提案是针对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）的影响 在两个拉丁美洲LMIC中治疗大学生患有严重抑郁症和/或广义的大学生 带有合并常见精神障碍（CMD）的焦虑症。检测和参与将是 基于廉价的基于Internet的自我报告调查以及廉价的E-CBT的干预 LMIC的资源低。知识转移到主要LMIC合作机构（墨西哥国家 精神病学研究所拉蒙·德拉·福恩特·穆尼兹（Ramon de la Fuente Muniz）[INPRFM]将是一个旨在促进传播的目标 向整个拉丁美洲的LMIC学院/大学致。该研究将在合作者先前的研究基础上进行 在世界卫生组织心理健康（WMH）调查联盟和WMH国际学院研究（WMH-ICS）中 倡议记录了大学中CMD的高患病率，障碍和未满足的需求 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重大影响。 具体目的/设计/方法：首先，我们将对寻求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的CMD治疗。等待名单的学生 学生诊所服务将有可能立即接收指导的E-CBT 列表。有50％的表达兴趣的CMD学生将被随机分配给指导E-CBT和其他 像往常一样治疗50％（tau）。短期总干预效果将在60天后评估 随机分组12个月后的随机性和长期影响。然后，我们将使用合奏机器 预测指导E-CBT与TAU治疗效应的异质性的学习方法并发展 精确治疗规则（PTR），以预测哪些学生将对哪种干预做出最好的反应。然后我们会 实施一个智能设计，我们将50％随机为预测的治疗部门将是最佳的 PTR和其他50％跨武器随机分组。此外，我们将进行年度WMH-ICS 基于Internet的心理健康需求评估调查和学生的概率样本可以估算 未满足的治疗需求和治疗障碍。学生对不在的CMD筛选呈阳性 治疗和报告对面对面治疗的抵抗力将被随机分配给指导E-CBT，以确定是否是否 访问指导的E-CBT减少了未能寻求的CMD学生对治疗的需求 学生健康诊所的治疗。最后，用于筛选，交付E-CBT和更新的技术 哈佛医学院最初实施的精密治疗模型将转移到INPRFM 向整个拉丁美洲的LMIC大学传播。许多高级地区心理健康 政策制定者接受了INPRFM的培训，并返回定期政策峰会，再加上近距离工作 INPRFM与PAN American Health组织的关系，Bode很好地进行了这种传播工作。