JMIR Publications

ABSTRACT

Background:

Internet-delivered treatments for depressive symptoms have proved successful in high-income Western countries. There may be potential for implementing such treatments in low and middle-income countries (LMIC) such as Colombia, where access to mental health services is limited.

Objective:

The overall study aimed to assess the efficacy of a culturally adapted cognitive behavioural internet-delivered treatment for college students with depressive symptoms in Colombia.

Methods:

A randomised controlled trial (RCT) and with 3-months follow-up. The programme consisted of 7-modules. Two hundred and fourteen Colombian college students were recruitment by email and through the SilverCloud platform were assessed and randomly assigned to either the treatment group (n= 107) or a waiting list control group (n=107). Participants received weekly support from a trained supporter. The primary outcomes were symptoms of depression as measured by the Patient Health Questionnaire (PHQ-9) and the secondary outcomes were anxiety symptoms assessed by the Generalised Anxiety Disorder questionnaire (GAD-7). Other measure included satisfaction with treatment SAT, used after 7 weeks.

Results:

Research attrition and treatment drop out were high in this study. An average of 7.6 sessions was completed per user. The mean time spent on the programme was 3 h and 18 min. Repeated measures within group showed significant reductions in depressive symptoms. The Linear mixed model (LMM) showed significant effects post-treatment (t= -5.189, df = 197.54, p= <0.00) for the treatment group and these effects were maintained at 3-month follow up (t= 4.668, df =39.62, p=<.000). Results within groups for the treatment group yielded a large effect size post-treatment (d=1.44, p=<.001) and this was maintained at a 3-month follow-up (d=1.81, p=<.001). Also, the LMM showed significant differences between the groups (t=-5.189, df =197.54, p=<.00). The results showed a large effect size between the groups (d=.91, p=<.001). In the treatment group, 76% (n=16) achieved reliable change compared to 32% (n=17) in the waiting list group. The differences between groups was statistically significant, X2(2) = 10.519 p = .001.

Conclusions:

This study was a first contribution to investigating the potential impact of a culturally adapted internet-delivered treatment on depressive symptoms for college students as compared to a WL control group in South America. Future research should focus on identifying variables associated both with premature dropout and treatment withdrawal and at follow-up. Clinical Trial: Clinical trials NCT03062215; https://clinicaltrials.gov/ct2/show/NCT03062215