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).

中文翻译：

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互联网提供的认知行为疗法与常规疗法对拉丁美洲大学生焦虑和抑郁的治疗：一项随机临床试验。

目标 未经治疗的精神障碍对于拉丁美洲低收入和中等收入国家 (LMIC) 的大学生来说非常重要，因为那里的治疗障碍很高。需要可扩展的干预措施。这项研究比较了跨诊断自我指导和互联网指导的认知行为疗法（i-CBT）与常规治疗（TAU）对哥伦比亚和墨西哥本科生临床显着焦虑和抑郁的治疗。方法 1,319 名大学生，根据广泛性焦虑症 (GAD-7) = 10+ 确定为焦虑，和/或根据患者健康问卷 (PHQ-9) = 10+ 确定为抑郁，本科生（平均值 [SD]年龄 = 21.4 [3.2]）；78.7% 女性；来自哥伦比亚和墨西哥七所大学的 55.9% 的第一代大学生被随机分配到适应文化的自我引导 i-CBT (n = 439)、指导 i-CBT (n = 445) 或照常治疗 (TAU) ；n = 435）。所有随机参与者在随机分组后 3 个月进行重新评估。主要结局是焦虑（GAD-7 = 0-4）和抑郁（PHQ-9 = 0-4）的缓解。我们假设引导 i-CBT 的缓解率会高于其他干预措施。结果 意向治疗分析发现，随机接受指导 i-CBT 的参与者的调整后缓解率 (ARD) 显着高于自我指导 i-CBT（ARD = 13.1%，χ12 = 10.4，p = .001）或 TAU（ARD = 11.2%，χ12 = 8.4，p = .004），但自我引导 i-CBT 和 TAU 之间没有显着差异（ARD = -1.9%，χ12 = 0.2，p = .63）。每个方案的敏感性分析和维度结果分析产生了相似的结果。结论 通过指导 i-CBT 可以显着减少中低收入国家大学生的焦虑和抑郁，尽管需要进一步研究来确定哪些学生最有可能从这种干预中受益。（PsycInfo 数据库记录 (c) 2023 APA，保留所有权利）。