A Precision Treatment Model for Internet-Delivered Cognitive Behavioral Therapy for Anxiety and Depression Among University Students: A Secondary Analysis of a Randomized Clinical Trial.

Importance: Guided internet-delivered cognitive behavioral therapy (i-CBT) is a low-cost way to address high unmet need for anxiety and depression treatment. Scalability could be increased if some patients were helped as much by self-guided i-CBT as guided i-CBT. Objective: To develop an individualized treatment rule using machine learning methods for guided i-CBT vs self-guided i-CBT based on a rich set of baseline predictors. Design, Setting, and Participants: This prespecified secondary analysis of an assessor-blinded, multisite randomized clinical trial of guided i-CBT, self-guided i-CBT, and treatment as usual included students in Colombia and Mexico who were seeking treatment for anxiety (defined as a 7-item Generalized Anxiety Disorder [GAD-7] score of ≥10) and/or depression (defined as a 9-item Patient Health Questionnaire [PHQ-9] score of ≥10). Study recruitment was from March 1 to October 26, 2021. Initial data analysis was conducted from May 23 to October 26, 2022. Interventions: Participants were randomized to a culturally adapted transdiagnostic i-CBT that was guided (n = 445), self-guided (n = 439), or treatment as usual (n = 435). Main Outcomes and Measures: Remission of anxiety (GAD-7 scores of ≤4) and depression (PHQ-9 scores of ≤4) 3 months after baseline. Results: The study included 1319 participants (mean [SD] age, 21.4 [3.2] years; 1038 women [78.7%]; 725 participants [55.0%] came from Mexico). A total of 1210 participants (91.7%) had significantly higher mean (SE) probabilities of joint remission of anxiety and depression with guided i-CBT (51.8% [3.0%]) than with self-guided i-CBT (37.8% [3.0%]; P = .003) or treatment as usual (40.0% [2.7%]; P = .001). The remaining 109 participants (8.3%) had low mean (SE) probabilities of joint remission of anxiety and depression across all groups (guided i-CBT: 24.5% [9.1%]; P = .007; self-guided i-CBT: 25.4% [8.8%]; P = .004; treatment as usual: 31.0% [9.4%]; P = .001). All participants with baseline anxiety had nonsignificantly higher mean (SE) probabilities of anxiety remission with guided i-CBT (62.7% [5.9%]) than the other 2 groups (self-guided i-CBT: 50.2% [6.2%]; P = .14; treatment as usual: 53.0% [6.0%]; P = .25). A total of 841 of 1177 participants (71.5%) with baseline depression had significantly higher mean (SE) probabilities of depression remission with guided i-CBT (61.5% [3.6%]) than the other 2 groups (self-guided i-CBT: 44.3% [3.7%]; P = .001; treatment as usual: 41.8% [3.2%]; P < .001). The other 336 participants (28.5%) with baseline depression had nonsignificantly higher mean (SE) probabilities of depression remission with self-guided i-CBT (54.4% [6.0%]) than guided i-CBT (39.8% [5.4%]; P = .07). Conclusions and Relevance: Guided i-CBT yielded the highest probabilities of remission of anxiety and depression for most participants; however, these differences were nonsignificant for anxiety. Some participants had the highest probabilities of remission of depression with self-guided i-CBT. Information about this variation could be used to optimize allocation of guided and self-guided i-CBT in resource-constrained settings. Trial Registration: ClinicalTrials.gov Identifier: NCT04780542.

La gestión del conocimiento en instituciones de atención primaria de salud en el noroeste de México

Introducción: La búsqueda de la eficiencia en la atención a la salud de la población representa una prioridad para cada uno de los niveles de atención, por lo que es vital identificar los elementos que permitan una mejora continua en las instituciones. La gestión del conocimiento es utilizada para tal fin y se ha estudiado a la par de otras variables como: la cultura organizacional, el liderazgo y la disponibilidad y el uso de tecnologías de la información y comunicación. Objetivo: El objetivo del estudio fue analizar la relación de la gestión del conocimiento con estas variables en centros de atención primaria a las adicciones del noroeste de México. Métodos: Se aplicó un cuestionario (α = .977) a 80 profesionales de la salud que laboraban en esas instituciones. Se encontraron relaciones positivas, grandes y significativas entre la gestión del conocimiento y el liderazgo (r = .816, p <. 001) y entre la gestión del conocimiento y la cultura organizacional (r =. 802, p <. 001). Sin embargo, se encontró una correlación positiva y moderada con la variable tecnologías de la información y comunicación. Conclusiones: Se concluye que en los centros de atención primaria a las adicciones del noroeste de México la cultura organizacional y el liderazgo se consideran los factores más importantes para contribuir al éxito de la gestión del conocimiento, principalmente en la adquisición y la transferencia del conocimiento. Es importante considerar en estudios futuros los beneficios sociales y económicos de emplear la gestión del conocimiento en la toma de decisiones organizacionales.

Introduction: The search for efficiency in health care for the population signifies a priority for each level of care, so it is vital to identify the elements allowing continuous improvement in institutions. Knowledge management is used for this purpose and it has been studied along with other variables such as organizational culture, leadership and the availability and use of information and communication technologies. Objective: The objective of the study was to analyze the relationship of knowledge management with these variables in primary addiction care centers in Northwest Mexico. Methods: A questionnaire (α = .977) was applied to 80 health professionals who worked in these institutions. Positive, large and significant relationships were found among knowledge management and leadership (r = .816, p < .001) and among knowledge management and organizational culture (r = .802, p < .001). However, positive and moderate correlation was found with the information and communication technologies variable. Conclusions: It is concluded that in primary addiction care centers in Northwest Mexico, organizational culture and leadership are considered the most important factors to contribute to the success of knowledge management, mainly in the acquisition and transfer of knowledge. It is important to consider in future studies the social and economic benefits of using knowledge management in organizational decision making.

Práctica Basada en Evidencia en Adicciones: Conocimientos y Habilidades de Psicoterapeutas del Noroeste de México / Evidence-Based Practice in Addictions Area: Knowledge and Skills of Therapists from Northwestern Mexico

Resumen La Práctica Basada en Evidencia (PBE) es un proceso que inicia con el conocimiento de las evidencias disponibles y concluye con la selección de la mejor intervención para su implementación en escenarios clínicos lo cual impacta la efectividad de las intervenciones. Objetivo. Caracterizar el perfil de los terapeutas que laboran en 17 centros de tratamiento ambulatorio en adicciones del noroeste de México, además de sus conocimientos y habilidades en el uso de la PBE (fuentes de consulta, uso de manuales) y percepción de su autoeficacia. Método. Participaron 102 terapeutas, se contemplaron dos etapas: cuantitativa basada en la aplicación del CUTEA y cualitativa con aplicación de entrevista semi-estructurada, buscando contrastar las respuestas. Resultados. La mayoría de los participantes tuvo dificultad para describir el concepto de PBE, solo el 37.25% logró una adecuada definición sin embargo, reportaron altos niveles (95.91%) de autoeficacia para implementarla. En relación a las fuentes de consulta el 50% reportó utilizar cualquier buscador comercial en internet, mientras que el 46.08% referían usar los manuales de la institución. Al ingreso a su trabajo, no contaban con capacitación en adicciones ni en el área clínica. Discusión. Se aborda la necesidad del entrenamiento en la PBE y no solo en la implementación de tratamientos específicos.

Abstract Introduction. Evidence-Based Practice (EBP) is a process which starts with the knowledge of available evidence and concludes with the evaluation and selection of the best intervention for the implementation in clinical settings, this process impact the efficacy of the interventions. The variables which can impact on the EBP could be: personal and institutional variables and therapist skills and variables of the interventions. However, to make decisions in the clinical context, it has prevailed a position based on the risks and needs of the clients, which would justify using any treatment, regardless of its effectiveness, which makes the professional psychologist a passive subject who is dedicated only to implementing interventions that institutions request. Therefore, EBP demands that the psychologist be critical of the research and this allows the identification of the best evidence available and also must have the skills to adapt that evidence to their particular context. The objective is to characterize the profile of therapists working in 17 outpatient treatment centers in Mexico, as well as the skills related to the use of EBP (sources of consultation and use of manuals, transfer of knowledge to the population and other therapists) and perception of their self-efficacy. Method. This is a cross-sectional research in which 102 therapists participated. Two stages were considered: quantitative, based on the application of a questionnaire, and the second was qualitative, seeking to contrast the responses. Results. Most of the participants had difficulties in explaining EBP, but reported high levels of self-efficacy to implement it. At the beginning of their work, they had no training in addictions or in the clinical area. Discussion. The need for training in EBP from undergraduate studies is addressed so that future therapists will find it more natural to implement it in clinical settings, through the analysis of scientific articles and, if possible, its application.

DSM-5 Internet gaming disorder among a sample of Mexican first-year college students.

BACKGROUND AND AIMS: DSM-5 includes Internet gaming disorder (IGD) as a condition for further study. While online and offline gaming may produce undesired negative effects on players, we know little about the nosology of IGD and its prevalence, especially in countries with emerging economies. METHODS: A self-administered survey has been employed to estimate prevalence of DSM-5 IGD and study the structure and performance of an instrument in Spanish to measure DSM-5 IGD among 7,022 first-year students in 5 Mexican universities that participated in the University Project for Healthy Students (PUERTAS), part of the World Health Organization's World Mental Health International College Student Initiative. RESULTS: The scale for IGD showed unidimensionality with factor loadings between 0.694 and 0.838 and a Cronbach's α = .816. Items derived from gaming and from substance disorders symptoms mixed together. We found a 12-month prevalence of IGD of 5.2% in the total sample; prevalence was different for males (10.2%) and females (1.2%), but similar for ages 18-19 years (5.0%) and age 20+ (5.8%) years. Among gamers, the prevalence was 8.6%. Students with IGD were more likely to report lifetime psychological or medical treatment [OR = 1.8 (1.4-2.4)] and any severe role impairment [OR = 2.4 (1.7-3.3)]. Adding any severe role impairment to the diagnostic criteria decreased the 12-month prevalence of IGD to 0.7%. DISCUSSION AND CONCLUSIONS: Prevalence of DSM-5 IGD and the performance of diagnostic criteria in this Mexican sample were within the bounds of what is reported elsewhere. Importantly, about one in every seven students with IGD showed levels of impairment that would qualify them for treatment under DSM-5.

Impact of a brief intervention programs in clinical practice: Barriers and adaptations.

INTRODUCTION: The present study analyzes the main barriers and adaptations to brief interventions that focus on addictive behavior treatments carried out in clinical settings by 756 health professionals during their adoption process in 350 Primary Attention Units in Mexico. METHOD: A descriptive cross-sectional study was conducted and consisted in the application of an instrument that explored diverse aspects, such as knowledge about evidence based brief intervention (BI) programs, barriers during the execution, and adaptations of the BI. RESULTS: the main barriers were related to the implementation of sessions and the user's characteristics such as educational level. As a consequence, the main adaptations were related to the increase in the number of sessions, modifying their length and changing the sequence as well as the proposed material in the manuals. CONCLUSIONS: We discuss the possibility of systematizing the adaptations made by health professionals in order to evaluate their effectiveness.

INTRODUCCIÓN: Este estudio analiza las barreras y adaptaciones realizadas en la práctica por 756 profesionales de la salud a Intervenciones breves para conductas adictivas durante el proceso de transferencia y adopción en 350 Unidades de Atención Primaria de México. MÉTODO: Estudio descriptivo transeccional en el cual se aplicó un instrumento que exploró los conocimientos sobre las IB basadas en evidencia, barreras en la implementación y adaptaciones realizadas a las IB. RESULTADOS: las principales barreras son las relacionadas con la impartición de las sesiones y características de los usuarios como el nivel de escolaridad y por tanto, las principales adaptaciones tienen que ver con mayor número de sesiones, cambios en la duración y en el orden de las mismas así como en los materiales que se proponen en los manuales. CONCLUSIÓN: Se analiza la posibilidad de sistematizar las adaptaciones realizadas por los profesionales de la salud para evaluar su eficacia.