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

项目摘要/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LMIC中患有严重抑郁障碍和/或全身性抑郁症的大学生 焦虑症伴或不伴常见精神障碍(CMD)。检测和参与将是 基于基于廉价互联网的自我报告调查和对廉价e-CBT的干预来解决 LMIC的资源贫乏。向LMIC主要合作机构(墨西哥国家)转让知识 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 到拉丁美洲各地的LMIC学院/大学。这项研究将建立在合作者先前研究的基础上 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) 记录大学中CMDs的高患病率、损害和未得到满足的治疗需求的倡议 世界各地的学生和e-CBT在高收入国家治疗这些疾病方面的显著效果。 具体目标/设计/方法：首先，我们将开展务实的临床试验，让学生寻求 在哥伦比亚和墨西哥四所大学的学生诊所为慢性精神疾病患者提供治疗。等待入学的学生名单上的学生 学生诊所服务将提供即时接受指导的e-cbt的可能性，同时留在 单子。50%表示有兴趣的患有CMD的学生将被随机分配到引导式e-CBT和其他 50%为常规治疗(TAU)。短期综合干预效果将在60天后进行评估 随机化及随机化后12个月的长期疗效。然后我们将使用合奏机器 预测指导性e-CBT与TAU治疗效果异质性的学习方法 精确治疗规则(PTR)，用于预测哪些学生对哪种干预措施反应最好。到时候我们会的 实施一种智能设计，我们将50%随机分配到预测为最佳的治疗臂 PTR和其他50%的人进行跨部门随机化。此外，我们还将开展年度WMH-ICS 基于互联网的心理健康需求测评调查用概率抽样的学生进行估计 未得到满足的治疗需求和治疗障碍。不在学校的学生筛查出CMD阳性 治疗和报告的个人治疗耐药性将被随机分配到指导的e-CBT中，以确定是否 获得指导的e-CBT减少了未得到满足的慢性精神疾病学生的治疗需求，这些学生没有寻求 在学生健康诊所接受治疗。最后，筛选、交付e-CBT和更新 最初由哈佛医学院实施的精准治疗模式将转移到INPRFM进行 传播到拉丁美洲各大中等收入国家的大学。许多老年人区域心理健康 政策制定者在INPRFM接受培训，并定期返回参加政策峰会，同时密切合作 INPRFM与泛美卫生组织的关系，对这种传播努力来说是个好兆头。

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.