Background: University students with depression and anxiety do not easily receive or seek treatment; therefore, internet-based interventions have been suggested to be a promising way to improve treatment accessibility and availability. However, it has not been examined whether a guided, culturally adapted, transdiagnostic, internet-based intervention is effective for treating symptoms of depression, anxiety, or both among university students in Indonesia. Objective: This study aims to investigate the feasibility (acceptability and satisfaction, usability, and uptake) of a guided, culturally adapted, transdiagnostic, internet-based intervention among university students with symptoms of depression, anxiety, or both in Indonesia. Methods: Students from Universitas Gadjah Mada, Yogyakarta, Indonesia, were screened for symptoms of depression, anxiety, or both, and filled online informed consent, demographic questionnaires, and a quality of life measure at pretreatment assessment (T0). Subsequently, the participants started the intervention. Seven weeks after T0, the primary outcomes of this feasibility study were analyzed at posttreatment assessment (T1) using the 8-item Client Satisfaction Questionnaire (CSQ-8) and the System Usability Scale (SUS). Mean and SDs for the CSQ-8 and SUS were calculated to examine feasibility. Within-group secondary outcomes (depression, anxiety, and quality of life) were inspected for outliers and normal distribution. Paired-sample t tests were used to investigate differences between time points of secondary outcomes. A mixed-method approach of quantitative and qualitative analyses was adopted. Both the primary and secondary outcomes were additionally explored with an individual semistructured interview and synthesized descriptively. Results: A total of 50 participants completed the intervention. We found a moderate to high level of satisfaction and acceptability, a slightly below-average level of desirable usability (≥70), and an adherence rate of 52% which was higher than expected given the novelty of the intervention. Results for the secondary outcomes indicated a decrease in depression and anxiety. For depression, the overall mean difference between the 2 time points for depression was 3.92 (95% CI 2.75-5.1; Hedges g 1.15; P<.001). For anxiety, the overall mean difference between the 2 time points was 3.34 (95% CI 2.06-4.61; Hedges g 1.02; P<.001). Further, a moderate effect in improving quality of life was found (g=0.50). Overall, participants were positive about the online intervention and ECoaches (online guidance), and they found the intervention to be culturally appropriate. Conclusions: A culturally adapted, transdiagnostic, internet-based intervention appears to be acceptable and feasible for reducing symptoms of depression, anxiety, or both, and increasing quality of life in university students in Indonesia. Future studies should include a randomized controlled trial to assess the effectiveness of such interventions as they may supplement existing counseling services in universities, reduce the treatment costs, and maximize treatment accessibility in low-resourced settings.

中文翻译：

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印尼大学生抑郁和焦虑的经诊断性互联网干预：可行性和可接受性评估

背景：患有抑郁症和焦虑症的大学生不容易接受治疗。因此，基于互联网的干预措施被认为是改善治疗可及性和可用性的一种有前途的方法。但是，尚未检查基于互联网的指导性，适应文化的，经过诊断的，基于互联网的干预措施对于治疗印度尼西亚大学生的抑郁症，焦虑症或两者均有效。目的：本研究旨在调查在印度尼西亚患有抑郁症，焦虑症或两者兼有的大学生进行基于文化适应，经诊断，互联网诊断的指导性干预的可行性（可接受性和满意度，可用性和吸收性）。方法：对来自印度尼西亚日惹的加达玛达大学（Universitas Gadjah Mada）的学生进行了抑郁，焦虑或两者兼有的症状筛查，并在进行治疗前评估（T0）时填写了在线知情同意，人口统计学调查表和生活质量衡量标准。随后，参与者开始进行干预。T0后七周，使用8项客户满意度调查表（CSQ-8）和系统可用性量表（SUS）在后处理评估（T1）上分析了此可行性研究的主要结果。计算CSQ-8和SUS的平均值和标准差以检验可行性。检查组内次要结局（抑郁，焦虑和生活质量）的异常值和正态分布。配对样本t检验用于研究次要结局时间点之间的差异。采用了定量和定性分析的混合方法。主要的和次要的结局都通过单独的半结构化访谈进行了探索，并进行了描述性的综合。结果：共有50名参与者完成了干预。我们发现，满意度和接受度为中到高水平，理想可用性（≥70）略低于平均水平，坚持率达到52％，高于干预措施的新颖性。次要结果的结果表明抑郁和焦虑有所减轻。对于抑郁症，抑郁症两个时间点之间的总体平均差异为3.92（95％CI 2.75-5.1； Hedges g 1.15；P <.001）。对于焦虑症，两个时间点之间的总体平均差异为3.34（95％CI 2.06-4.61； Hedges g 1.02；P <.001）。此外，发现在改善生活质量方面有适度的效果（g= 0.50）。总体而言，参与者对在线干预和ECoaches（在线指导）持积极态度，他们认为干预在文化上是适当的。结论：针对印度尼西亚大学生而言，一种文化适应性强，经过诊断，基于互联网的干预措施似乎可以接受并且可行，可以减轻抑郁症，焦虑症或两者的症状，并提高生活质量。未来的研究应包括一项随机对照试验，以评估此类干预措施的有效性，因为它们可以补充大学现有的咨询服务，降低治疗费用并在资源贫乏的地区最大程度地提高治疗的可及性。