Quiñonez-Freire Carlos, Vara M Dolores, Herrero Rocío, Mira Adriana, García-Palacios Azucena, Botella Cristina, Baños Rosa M
Department of Personality, Evaluation and Psychological Treatments, University of Valencia, Valencia, Spain.
Mental Health Unit, Hospital Dr, Gustavo Dominguez Z, Santo Domingo, Ecuador.
Internet Interv. 2020 Nov 28;23:100352. doi: 10.1016/j.invent.2020.100352. eCollection 2021 Mar.
Depression is one of the world's major health problems. Due to its high prevalence, it constitutes the first cause of disability among the Americas, where only a very low percentage of the population receives the adequate evidence-based psychological treatment. Internet-Based Interventions (IBIs) are a great alternative to reduce the treatment gap for mental disorders. Although there are several studies in low-and middle-income countries proving IBIs' feasibility and acceptability, there is still little evidence of the effectiveness in diverse social and cultural contexts such as Latin America.
Two studies will be described: Study 1 is focused on the cultural adaptation of a cognitive-behavioral IBI (Botella et al. 2012, 2015) for Ecuadorian population with depression based on the procedure by Salamanca-Sanabria et al. (2018). Study 2 describes the design of a randomized controlled trial to test the preliminary efficacy of the culturally adapted intervention in a Public Health Care setting. A total of 153 patients with mild to moderate degree of depression as assessed with the Mini-International Neuropsychiatric Interview (M.I.N.I.) and the Patient Health Questionnaire-9 (PHQ-9) will be randomly assigned to either an IBI group using only automated support by the system; an IBI group including also minimal human support; or a waiting list group. The primary outcome (depression) and secondary outcomes (e.g., anxiety, affect, quality of life) will be collected at baseline, 3, 6 and 12 months. Mixed-model analyses with no ad hoc imputations will be conducted.
This paper is pioneering in exploring the role of an Internet-based culturally adapted intervention for depression in a public care context in Ecuador. Results obtained will offer new insights into the viability and effectiveness of digital technologies for the psychological treatment of mental illnesses in developing countries.
抑郁症是全球主要的健康问题之一。因其高患病率，它是美洲地区残疾的首要原因，而该地区只有极低比例的人口接受了基于充分证据的心理治疗。基于互联网的干预措施（IBIs）是缩小精神障碍治疗差距的一个很好的选择。尽管在低收入和中等收入国家有多项研究证明了IBIs的可行性和可接受性，但在拉丁美洲等不同社会和文化背景下，其有效性的证据仍然很少。
将描述两项研究：研究1专注于根据萨拉曼卡 - 萨纳布里亚等人（2018年）的程序，对一种针对厄瓜多尔抑郁症患者的认知行为IBI（博特拉等人，2012年、2015年）进行文化调适。研究2描述了一项随机对照试验的设计，以测试在公共卫生保健环境中经过文化调适的干预措施的初步疗效。使用迷你国际神经精神病学访谈（M.I.N.I.）和患者健康问卷 - 9（PHQ - 9）评估为轻度至中度抑郁症的总共153名患者将被随机分配到仅使用系统自动支持的IBI组；还包括最少人力支持的IBI组；或等待名单组。主要结局（抑郁症）和次要结局（例如焦虑、情感、生活质量）将在基线、3个月、6个月和12个月时收集。将进行不进行特别插补的混合模型分析。
本文率先探索了在厄瓜多尔公共护理环境中基于互联网的针对抑郁症的文化调适干预措施的作用。获得的结果将为发展中国家数字技术用于心理治疗精神疾病的可行性和有效性提供新的见解。
