Internet-delivered cognitive behavior therapy versus treatment as usual for anxiety and depression among Latin American university students: A randomized clinical trial.

OBJECTIVE: Untreated mental disorders are important among low- and middle-income country (LMIC) university students in Latin America, where barriers to treatment are high. Scalable interventions are needed. This study compared transdiagnostic self-guided and guided internet-delivered cognitive behavioral therapy (i-CBT) with treatment as usual (TAU) for clinically significant anxiety and depression among undergraduates in Colombia and Mexico. METHOD: 1,319 anxious, as determined by the Generalized Anxiety Disorder-7 (GAD-7) = 10+ and/or depressed, as determined by the Patient Health Questionnaire-9 (PHQ-9) = 10+, undergraduates (mean [SD] age = 21.4 [3.2]); 78.7% female; 55.9% first-generation university student) from seven universities in Colombia and Mexico were randomized to culturally adapted versions of self-guided i-CBT (n = 439), guided i-CBT (n = 445), or treatment as usual (TAU; n = 435). All randomized participants were reassessed 3 months after randomization. The primary outcome was remission of both anxiety (GAD-7 = 0-4) and depression (PHQ-9 = 0-4). We hypothesized that remission would be higher with guided i-CBT than with the other interventions. RESULTS: Intent-to-treat analysis found significantly higher adjusted (for university and loss to follow-up) remission rates (ARD) among participants randomized to guided i-CBT than either self-guided i-CBT (ARD = 13.1%, χ12 = 10.4, p = .001) or TAU (ARD = 11.2%, χ12 = 8.4, p = .004), but no significant difference between self-guided i-CBT and TAU (ARD = -1.9%, χ12 = 0.2, p = .63). Per-protocol sensitivity analyses and analyses of dimensional outcomes yielded similar results. CONCLUSIONS: Significant reductions in anxiety and depression among LMIC university students could be achieved with guided i-CBT, although further research is needed to determine which students would most likely benefit from this intervention. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

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.

Impact of Facebook on Social Support and Emotional Wellbeing in Perinatal Women during Three Waves of the COVID-19 Pandemic in Mexico: A Descriptive Qualitative Study.

The COVID-19 pandemic affected the mental health of pregnant and postpartum women in unique, unprecedented ways. Given the impossibility of delivering face-to-face care, digital platforms emerged as a first-line solution to provide emotional support. This qualitative study sought to examine the role that a closed Facebook group (CFG) played in providing social support for Mexican perinatal women and to explore the concerns they shared during the COVID-19 pandemic. A thematic analysis of all the posts in the CFG yielded nine main categories: (1) COVID-19 infections in participants and their families; (2) fear of infection; (3) infection prevention; (4) health services; (5) vaccines; (6) concerns about non-COVID-19-related health care; (7) effects of social isolation; (8) probable mental health cases; and (9) work outside the home. Participants faced stressful situations and demands that caused intense fear and worry. In addition to household tasks and perinatal care, they were responsible for adopting COVID-19 preventive measures and caring for infected family members. The main coping mechanism was their religious faith. The CFG was found to be a useful forum for supporting perinatal women, where they could share concerns, resolve doubts, and obtain information in a warm, compassionate, and empathetic atmosphere. Health providers would be advised to seek new social media to improve the quality of their services.

Satisfaction and Acceptability Ratings of a Web-Based Self-help Intervention for Depression: Retrospective Cross-sectional Study From a Resource-Limited Country.

BACKGROUND: Web-based interventions are at an early stage in non-English-speaking low- and middle-income countries, where they remain scarce. Help for Depression (HDep) is one of the few unguided web-based interventions available in Latin America. The results of a use/usability analysis of the original version served as the basis for generating a more user-friendly second version. OBJECTIVE: The aim of this study is to explore participants' satisfaction and acceptability for the second version of HDep. METHODS: A retrospective cross-sectional design was used. An email invitation to complete a web-based survey was sent to all people who accessed HDep in 2018. The questionnaire included satisfaction and acceptability scales and open-ended questions. Complete questionnaires were retrieved from 191 participants: 35.1% (67/191) from those who visited only the home page (home page users [HPUs]) and 6.47% (124/1916) from those who registered to use the program (program users [PUs]). RESULTS: In all groups, users experienced high levels of depressive symptoms (189/191, 98.9%; Center for Epidemiological Studies Scale-Depression >16). Moderate levels of satisfaction (HPUs: mean 21.9, SD 6.7; PUs: mean 21.1, SD 5.8; range: 8-32) and acceptability (HPUs: mean 13.8, SD 3.9; PUs: mean 13.9, SD 3.2; range: 5-20) were found in both groups. Logistic regression analyses showed that among HPUs, women were more satisfied with HDep (odds ratio [OR] 3.4, 95% CI 1.1-10.0), whereas among PUs, older respondents (OR 1.04, 95% CI 1.01-1.08), those with paid work (OR 3.1, 95% CI 2.4-7.6), those who had not been in therapy (OR 2.42, 95% CI 1.09-5.98), and those who had not attempted suicide (OR 3.4, 95% CI 1.1-11.1) showed higher satisfaction. None of the sociodemographic/mental health variables distinguished the acceptability ratings among HPUs. Among PUs, those with paid work (OR 2.5, 95% CI 1.1-5.5), those who had not been in therapy (OR 3.1, 95% CI 1.3-7.3), those without disability (OR 2.9, 95% CI 1.3-6.6), and those who had not attempted suicide (OR 2.6, 95% CI 1.0-6.6) showed higher acceptability. CONCLUSIONS: HDep has good levels of satisfaction and acceptability for approximately half of its users, and the information provided by respondents suggested feasible ways to remedy some of the deficiencies. This qualitative-quantitative study from a low- to middle-income, non-English-speaking country adds to existing knowledge regarding acceptance and satisfaction with web-based interventions for depression in resource-limited countries. This information is important for the creation and adaptation of web-based interventions in low- and middle-income countries, where access to treatment is a major concern, and web-based prevention and treatment programs can help deliver evidence-based alternatives. It is necessary to document the pitfalls, strengths, and challenges of such interventions in this context. Understanding how users perceive an intervention might suggest modifications to increase adherence.

Association between depressive symptoms and psychosocial factors and perception of maternal self-efficacy in teenage mothers / Asociación entre sintomatología depresiva y factores psicosociales y percepción de eficacia materna en madres adolescentes

Abstract Introduction Teenage pregnancy is a national health priority. Having to deal with pregnancy during adolescence can cause the mother, at an already vulnerable age, to doubt her maternal capacity to cope with a challenge of this magnitude. The teenage mother's assessment of her maternal self-efficacy is associated with her performance, in other words, the way she relates and responds to the needs of her infant, which has major implications for the latter's development. Objective To study the association between personal (depressive symptoms, self-esteem) and environmental characteristics (social support, partner satisfaction) and those of the infant (problems with infant care, the infants's temperament) and the perception of maternal self-efficacy (PME) in adolescent mothers. Method Cross-sectional study. The following instruments were applied: Center for Epidemiologic Studies Depression Scale (CES-D), Post-partum Depression Predictors Inventory-Revised (PDPI-R), and Maternal Efficacy Questionnaire to 120 mothers under 20 during the first six months postpartum. Bivariate lineal regression and hierarchical linear regression analyses were used for the data analysis. Results When adjusting for other variables, symptoms of depression and difficult infant temperament were associated with lower PME. Social support was only associated with increased PME in the bivariate analysis. Discussion and conclusion These findings contribute to the limited literature on the subject and provide elements for designing strategies to improve adolescent mothers' PME to encourage behaviors that are more relevant and sensitive to infants' physical and emotional needs.

Resumen Introducción El embarazo adolescente es una prioridad nacional para la salud. Enfrentar un embarazo durante la adolescencia puede hacer que la madre, a una edad de por sí vulnerable, dude de su capacidad materna ante un reto de esta magnitud. La valoración que hace de su eficacia materna se asocia con su desempeño, esto es, con la manera de relacionarse y responder a las necesidades de su infante, misma que tiene consecuencias determinantes en el desarrollo de éste. Objetivo Estudiar la asociación entre características personales (síntomas depresivos, autoestima), ambientales (apoyo social, satisfacción con la pareja) y del infante (problemas con el cuidado del infante, temperamento infantil) con la percepción de eficacia materna (PEM) en madres adolescentes. Método Estudio transversal. Se aplicaron: Escala de Depresión del Centro de Estudios Epidemiológicos (CES-D), Inventario de Predictores de Depresión Posparto Revisado (PDPI-R) y Cuestionario de Eficacia Materna a 120 madres menores de 20 años durante el primer semestre posparto. Para los análisis de datos se usaron regresiones lineales bivariadas y análisis de regresión lineal jerárquica. Resultados Al ajustar por otras variables, los síntomas de depresión y el temperamento infantil difícil se asociaron con más baja PEM. El apoyo social se asoció con mayor PEM sólo en los análisis bivariados. Discusión y conclusión Estos hallazgos contribuyen a la escasa literatura sobre el tema y proveen elementos para el diseño de estrategias que mejoren la PEM en madres adolescentes para favorecer conductas más pertinentes y sensibles ante las necesidades físicas y emocionales de los infantes.

Síndrome de hipoventilación central / Congenital central hypoventilation syndrome

El Síndrome de Hipoventilación Central (SHC), conocido como Síndrome de Ondina, generalmente se presenta en el periodo neonatal y se caracteriza por hipoventilación alveolar en ausencia de enfermedades cardiopulmonares y neuromusculares. Se ha descrito que las mutaciones en el gen PHOX2B son las responsables de SHC. El principal objetivo del tratamiento del síndrome es asegurar una buena ventilación durante la vigilia y el sueño. Muchos de estos pacientes viven una vida plena.Se presenta el caso de un paciente de cinco meses de edad con diagnóstico de SHC, el cual presentó episodios cianozantes y desaturaciones de oxígeno persistentes, con buena respuesta al manejo médico con metilfenidato.

Central Hypoventilation Syndrome (SHC), known as Ondine syndrome, usually occurs during the neonatal period,this entity is characterized by alveolar hypoventilation in the absence of cardiopulmonary and neuromusculardiseases. It has been reported in mutations of PHOX2B gene. The primary goal of treatment for the SHC is to ensure good ventilation during wakefulness and sleep. Many of these patients live a full life.We report the case of a five-month-old baby diagnosed with SHC, which had episodes of persistent low oxygen saturations, with good response to medical treatment with methylphenidate.