Lara María Asunción, Tiburcio Marcela, Aguilar Abrego Araceli, Sánchez-Solís Alejandro
Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico City, Mexico,
Rev Panam Salud Publica. 2014 May-Jun;35(5-6):399-406.
To describe a four-year descriptive, naturalistic study monitoring the use of HDep (Help for Depression or Ayuda para depression (ADep)in Spanish), an open-access/free Web-based, psycho-education, cognitive-behavioral intervention program produced in Mexico consisting of seven self-help modules that include feedback-generating assessments of depressive symptoms, vignettes, recorded messages, a relaxation exercise, a personal workbook, blogs, and user discussion forums.
Data were collected on all individuals who entered the HDep site since the program's launching in 2009. Those who entered the site two or more times and also registered as "users" or "participants." The user data consisted of 1) user profiles; 2) scores for the CES-D (Center for Epidemiological Studies Depression Scale), for users who completed the feedback-generating assessments of depressive symptoms; 3) user evaluations of the usefulness of HDep; and 4) transcripts of HDep discussion forum posts. The raw user data were obtained through Moodle (Modular Object-Oriented Dynamic Learning Environment, a free software e-learning platform) and analyzed quantitatively (using SPSS) and qualitatively (using ATLAS.ti).
A total of 28 078 individuals accessed HDep and 17 318 of those (61.6%) qualified as users. Of all users, 84.4% were women, 64.6% used the workbook, and 60.9% entered the discussion forums (of whom 16.3% added a post). Depressive symptoms (CES-D score ≥ 16) were observed in 97.1% of the users who completed the feedback-generating assessment (n = 16 564). User retention dropped across the seven modules (from 12 366 users for Module 1 to 626 for Module 7). However, all seven modules were rated very high for "helpfulness/usefulness," with mean scores all above 4 on a 1 - 5 scale. The HDep discussion forums showed a rich social interaction. Predictors of entering at least one module (based on stepwise logistic regression analysis) included being a woman, being ≥ 30 years old, reporting disability, and having attempted suicide. Of the 72 participants who completed the final user evaluation of HDep, 97.5% said it had an enormous influence on helping them to identify and transform negative thoughts.
Despite the high attrition among users, and the need for further structure adaptation, HDep can be considered a potentially useful mental health tool in Mexico for 1) detecting depression (via the CES-D assessments) and 2) providing a means of social support to those with depression. The high levels of depressive symptoms detected among users suggest that the role of free-access, self-help, Web-based interventions in public mental health programs should be further investigated. The effectiveness of HDep in reducing depressive symptoms and providing a support system has yet to be assessed and should be examined in future research.
描述一项为期四年的描述性、自然主义研究，该研究监测了HDep（西班牙语为“Help for Depression或Ayuda para depression (ADep)”）的使用情况。HDep是一个基于网络的开放获取/免费心理教育、认知行为干预项目，由墨西哥制作，包含七个自助模块，包括对抑郁症状的反馈生成评估、案例、录音信息、放松练习、个人工作手册、博客和用户讨论论坛。
收集自该项目2009年启动以来进入HDep网站的所有个体的数据。那些进入网站两次或更多次并注册为“用户”或“参与者”的个体。用户数据包括：1）用户资料；2）完成抑郁症状反馈生成评估的用户的CES-D（流行病学研究中心抑郁量表）得分；3）用户对HDep有用性的评价；4）HDep讨论论坛帖子的记录。原始用户数据通过Moodle（模块化面向对象动态学习环境，一个免费软件电子学习平台）获得，并进行定量（使用SPSS）和定性（使用ATLAS.ti）分析。
共有28078人访问了HDep，其中17318人（61.6%）符合用户资格。在所有用户中，84.4%为女性，64.6%使用了工作手册，60.9%进入了讨论论坛（其中16.3%发布了帖子）。在完成反馈生成评估的用户中（n = 16564），97.1%观察到有抑郁症状（CES-D得分≥16）。用户留存率在七个模块中逐渐下降（从模块1的12366名用户降至模块7的626名用户）。然而，所有七个模块在“帮助性/有用性”方面的评分都非常高，在1 - 5分的量表上平均得分均高于4分。HDep讨论论坛显示出丰富的社交互动。进入至少一个模块的预测因素（基于逐步逻辑回归分析）包括女性、年龄≥30岁、报告有残疾以及曾尝试自杀。在完成HDep最终用户评估的72名参与者中，97.5%表示它对帮助他们识别和转变消极想法有巨大影响。
尽管用户流失率较高，且需要进一步进行结构调整，但HDep可被视为墨西哥一种潜在有用的心理健康工具，用于：1）检测抑郁症（通过CES-D评估）；2）为抑郁症患者提供社会支持手段。在用户中检测到的高抑郁症状水平表明，应进一步研究免费获取、自助式基于网络的干预措施在公共心理健康项目中的作用。HDep在减轻抑郁症状和提供支持系统方面的有效性尚未评估，应在未来研究中进行检验。
