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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

dc.creatorBenjet, Corinaes_ES
dc.creatorHani Zainal, Nures_ES
dc.creatorAlbor, Yesicaes_ES
dc.creatorAlvis-Barranco, Libiaes_ES
dc.creatorCarrasco-Tapias, Nayibes_ES
dc.creatorContreras-Ibáñez, Carlos C.es_ES
dc.creatorCudris-Torres, Lorenaes_ES
dc.creatorde la Peña, Francisco R.es_ES
dc.creatorGonzález, Noées_ES
dc.creatorGuerrero-López, José Benjamínes_ES
dc.creatorGutierrez-Garcia, Raúl A.es_ES
dc.creatorJiménez-Peréz, Ana Lucíaes_ES
dc.creatorMedina-Mora, María Elenaes_ES
dc.creatorPatiño, Pamelaes_ES
dc.creatorCuijpers, Pimes_ES
dc.creatorGildea, Sarah M.es_ES
dc.creatorKazdin, Alan E.es_ES
dc.creatorKennedy, Chris J.es_ES
dc.creatorLuedtke, Alexes_ES
dc.creatorSampson, Nancy A.es_ES
dc.creatorPetukhova, Maria V.es_ES
dc.creatorKessler, Ronald C.es_ES
dc.date2023
dc.date.accessioned2025-02-11T16:19:32Z
dc.date.available2025-02-11T16:19:32Z
dc.date.issued2023
dc.identifierJC01DIEP23es_ES
dc.identifier.issn2168-622X
dc.identifier.urihttp://repositorio.inprf.gob.mx/handle/123456789/8210
dc.identifier.urihttp://doi.org/10.1001/jamapsychiatry.2023.1675
dc.descriptionImportance: 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.es_ES
dc.formatPDFes_ES
dc.language.isoenges_ES
dc.publisherAmerican Medical Associationes_ES
dc.relation80(8):768-777
dc.rightsAcceso Cerradoes_ES
dc.titleA precision treatment model for internet-delivered cognitive behavioral therapy for anxiety and depression among university students: a secondary analysis of a randomized clinical triales_ES
dc.typeArtículoes_ES
dc.contributor.affiliationCenter for Global Mental Health, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico
dc.contributor.emailkessler@hcp.med.harvard.edu (Ronald C.Kessler)
dc.relation.jnabreviadoJAMA PSYCHIATRY
dc.relation.journalJAMA Psychiatry
dc.identifier.placeEstados Unidos
dc.date.published2023
dc.identifier.organizacionInstituto Nacional de Psiquiatría Ramón de la Fuente Muñiz
dc.identifier.eissn2168-6238
dc.identifier.doi10.1001/jamapsychiatry.2023.1675


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