Internet-delivered cognitive behavior therapy versus treatment as usual for anxiety and depression among Latin American university students: A randomized clinical trial.

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).

La gestión del conocimiento en instituciones de atención primaria de salud en el noroeste de México

Introducción: La búsqueda de la eficiencia en la atención a la salud de la población representa una prioridad para cada uno de los niveles de atención, por lo que es vital identificar los elementos que permitan una mejora continua en las instituciones. La gestión del conocimiento es utilizada para tal fin y se ha estudiado a la par de otras variables como: la cultura organizacional, el liderazgo y la disponibilidad y el uso de tecnologías de la información y comunicación. Objetivo: El objetivo del estudio fue analizar la relación de la gestión del conocimiento con estas variables en centros de atención primaria a las adicciones del noroeste de México. Métodos: Se aplicó un cuestionario (α = .977) a 80 profesionales de la salud que laboraban en esas instituciones. Se encontraron relaciones positivas, grandes y significativas entre la gestión del conocimiento y el liderazgo (r = .816, p <. 001) y entre la gestión del conocimiento y la cultura organizacional (r =. 802, p <. 001). Sin embargo, se encontró una correlación positiva y moderada con la variable tecnologías de la información y comunicación. Conclusiones: Se concluye que en los centros de atención primaria a las adicciones del noroeste de México la cultura organizacional y el liderazgo se consideran los factores más importantes para contribuir al éxito de la gestión del conocimiento, principalmente en la adquisición y la transferencia del conocimiento. Es importante considerar en estudios futuros los beneficios sociales y económicos de emplear la gestión del conocimiento en la toma de decisiones organizacionales.

Introduction: The search for efficiency in health care for the population signifies a priority for each level of care, so it is vital to identify the elements allowing continuous improvement in institutions. Knowledge management is used for this purpose and it has been studied along with other variables such as organizational culture, leadership and the availability and use of information and communication technologies. Objective: The objective of the study was to analyze the relationship of knowledge management with these variables in primary addiction care centers in Northwest Mexico. Methods: A questionnaire (α = .977) was applied to 80 health professionals who worked in these institutions. Positive, large and significant relationships were found among knowledge management and leadership (r = .816, p < .001) and among knowledge management and organizational culture (r = .802, p < .001). However, positive and moderate correlation was found with the information and communication technologies variable. Conclusions: It is concluded that in primary addiction care centers in Northwest Mexico, organizational culture and leadership are considered the most important factors to contribute to the success of knowledge management, mainly in the acquisition and transfer of knowledge. It is important to consider in future studies the social and economic benefits of using knowledge management in organizational decision making.

One-year incidence, predictors, and accuracy of prediction of suicidal thoughts and behaviors from the first to second year of university.

BACKGROUND: Research is scarce on the prospective predictors of first onset suicidal thoughts and behaviors (STB) and the accuracy of these predictors in university students, particularly in low-and-middle income countries. Therefore, we assessed the 1-year incidence of STB among first-year students, a broad range of prospective predictors of STB incidence, and evaluated the prediction accuracy of a baseline multivariate risk prediction model to identify students at highest risk for STB onset over the subsequent 12 months. METHODS: Students (n = 3238) from 13 universities in Mexico completed an online survey developed for the World Mental Health International College Student Surveys in their first year and again 12 months after. We ran generalized linear models and receiver operator curves. RESULTS: The 1-year incidence of suicidal ideation, plan and attempt was 8.53%, 3.75%, and 1.16%, respectively. Predictors in final models were female sex (ideation only), minority sexual orientation (ideation only), depression, eating disorders, ADHD (ideation and plan), ongoing arguments or breakup with a romantic partner (ideation only), emotional abuse (ideation only), parental death (ideation, plan), not Catholic/Christian (ideation, plan), not having someone to rely on, psychotic experiences (plan only), and insufficient sleep (attempt only). Prediction accuracy for ideation, plan and attempt was area under the curve = 0.76, 0.81 and 0.78, respectively. Targeting the top 10% of students at highest risk could reduce STB in the subsequent year up to 36%. CONCLUSIONS: By assessing these risk/protective factors in incoming students we identified students at greatest risk for developing STB to whom suicide prevention strategies could be targeted.

Práctica Basada en Evidencia en Adicciones: Conocimientos y Habilidades de Psicoterapeutas del Noroeste de México / Evidence-Based Practice in Addictions Area: Knowledge and Skills of Therapists from Northwestern Mexico

Resumen La Práctica Basada en Evidencia (PBE) es un proceso que inicia con el conocimiento de las evidencias disponibles y concluye con la selección de la mejor intervención para su implementación en escenarios clínicos lo cual impacta la efectividad de las intervenciones. Objetivo. Caracterizar el perfil de los terapeutas que laboran en 17 centros de tratamiento ambulatorio en adicciones del noroeste de México, además de sus conocimientos y habilidades en el uso de la PBE (fuentes de consulta, uso de manuales) y percepción de su autoeficacia. Método. Participaron 102 terapeutas, se contemplaron dos etapas: cuantitativa basada en la aplicación del CUTEA y cualitativa con aplicación de entrevista semi-estructurada, buscando contrastar las respuestas. Resultados. La mayoría de los participantes tuvo dificultad para describir el concepto de PBE, solo el 37.25% logró una adecuada definición sin embargo, reportaron altos niveles (95.91%) de autoeficacia para implementarla. En relación a las fuentes de consulta el 50% reportó utilizar cualquier buscador comercial en internet, mientras que el 46.08% referían usar los manuales de la institución. Al ingreso a su trabajo, no contaban con capacitación en adicciones ni en el área clínica. Discusión. Se aborda la necesidad del entrenamiento en la PBE y no solo en la implementación de tratamientos específicos.

Abstract Introduction. Evidence-Based Practice (EBP) is a process which starts with the knowledge of available evidence and concludes with the evaluation and selection of the best intervention for the implementation in clinical settings, this process impact the efficacy of the interventions. The variables which can impact on the EBP could be: personal and institutional variables and therapist skills and variables of the interventions. However, to make decisions in the clinical context, it has prevailed a position based on the risks and needs of the clients, which would justify using any treatment, regardless of its effectiveness, which makes the professional psychologist a passive subject who is dedicated only to implementing interventions that institutions request. Therefore, EBP demands that the psychologist be critical of the research and this allows the identification of the best evidence available and also must have the skills to adapt that evidence to their particular context. The objective is to characterize the profile of therapists working in 17 outpatient treatment centers in Mexico, as well as the skills related to the use of EBP (sources of consultation and use of manuals, transfer of knowledge to the population and other therapists) and perception of their self-efficacy. Method. This is a cross-sectional research in which 102 therapists participated. Two stages were considered: quantitative, based on the application of a questionnaire, and the second was qualitative, seeking to contrast the responses. Results. Most of the participants had difficulties in explaining EBP, but reported high levels of self-efficacy to implement it. At the beginning of their work, they had no training in addictions or in the clinical area. Discussion. The need for training in EBP from undergraduate studies is addressed so that future therapists will find it more natural to implement it in clinical settings, through the analysis of scientific articles and, if possible, its application.