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).

中文翻译：

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互联网提供的认知行为疗法与拉丁美洲大学生焦虑和抑郁的常规治疗：一项随机临床试验。


目的 未经治疗的精神障碍在拉丁美洲的中低收入国家 （LMIC） 大学生中很重要，那里的治疗障碍很高。需要可扩展的干预措施。这项研究比较了跨诊断自我指导和指导互联网提供的认知行为疗法 （i-CBT） 与常规治疗 （TAU） 对哥伦比亚和墨西哥本科生有临床意义的焦虑和抑郁的影响。方法 1,319 焦虑，由广泛性焦虑症 7 （GAD-7） = 10+ 确定和/或抑郁，由患者健康问卷 9 （PHQ-9） 确定 = 10+，本科生（平均 [SD] 年龄 = 21.4 [3.2]）;78.7% 为女性;来自哥伦比亚和墨西哥 7 所大学的 55.9% 的第一代大学生）被随机分配到自我指导的 i-CBT （n = 439）、指导的 i-CBT （n = 445） 或常规治疗 （TAU; n = 435） 的文化适应版本。所有随机分组的参与者在随机分组后 3 个月重新评估。主要结局是焦虑 （GAD-7 = 0-4） 和抑郁 （PHQ-9 = 0-4） 的缓解。我们假设引导式 i-CBT 的缓解率高于其他干预措施。结果意向治疗分析发现，随机接受指导 i-CBT 的参与者调整后（大学和失访）缓解率 （ARD） 显著高于自我指导的 i-CBT （ARD = 13.1%，χ12 = 10.4，p = .001） 或 TAU （ARD = 11.2%，χ12 = 8.4，p = .004），但自我指导 i-CBT 和 TAU 之间没有显着差异 （ARD = -1.9%，χ12 = 0.2，p = .63）。符合方案的敏感性分析和尺寸结果分析产生了相似的结果。 结论 引导式 i-CBT 可以显着降低 LMIC 大学生的焦虑和抑郁，尽管需要进一步的研究来确定哪些学生最有可能从这种干预中受益。（PsycInfo 数据库记录 （c） 2023 APA，保留所有权利）。