A Culturally Adapted Cognitive Behavioral Internet-Delivered Intervention for Depressive Symptoms: Randomized Controlled Trial

Alicia Salamanca-Sanabria, Derek Richards, Ladislav Timulak, Sarah Connell, Monica Mojica Perilla, Yamilena Parra-Villa, Leonidas Castro-Camacho, Alicia Salamanca-Sanabria, Derek Richards, Ladislav Timulak, Sarah Connell, Monica Mojica Perilla, Yamilena Parra-Villa, Leonidas Castro-Camacho

Abstract

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

Objective: The objective of this study was to assess the efficacy of a culturally adapted cognitive behavioral internet-delivered treatment for college students with depressive symptoms in Colombia.

Methods: This was a randomized controlled trial with a 3-month follow-up. The program comprised seven modules. A total of 214 Colombian college students were recruited. They were assessed and randomly assigned to either the treatment group (n=107) or a waiting list (WL) control group (n=107). Participants received weekly support from a trained supporter. The primary outcome was symptoms of depression, as measured by the Patient Health Questionnaire - 9, and the secondary outcomes were anxiety symptoms assessed by the Generalized Anxiety Disorder questionnaire - 7. Other measures, including satisfaction with treatment, were evaluated after 7 weeks.

Results: Research attrition and treatment dropouts were high in this study. On average, 7.6 sessions were completed per user. The mean time spent on the program was 3 hours and 18 min. The linear mixed model (LMM) showed significant effects after treatment (t197.54=-5.189; P<.001) for the treatment group, and these effects were maintained at the 3-month follow-up (t39.62=4.668; P<.001). Within-group results for the treatment group yielded a large effect size post treatment (d=1.44; P<.001), and this was maintained at the 3-month follow-up (d=1.81; P<.001). In addition, the LMM showed significant differences between the groups (t197.54=-5.189; P<.001). The results showed a large effect size between the groups (d=0.91; P<.001). In the treatment group, 76.0% (16/107) achieved a reliable change, compared with 32.0% (17/107) in the WL control group. The difference between groups was statistically significant (X22=10.5; P=.001).

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

Trial registration: ClinicalTrials.gov NCT03062215; https://ichgcp.net/clinical-trials-registry/NCT03062215.

Keywords: South America; cognitive behavioral therapy; culture; depressive symptoms; internet; students.

Conflict of interest statement

Conflicts of Interest: AS was the recipient of an IRC scholarship award [EPSPG/2014/98] under the Enterprise/Academia collaboration scheme with SilverCloud Health. From March 2018 to March 2019, AS was a part-time employee in SilverCloud Health. DR is the Chief Science Officer at SilverCloud Health. LT provides a research consultancy for SilverCloud Health. SC worked as a data analyst at SilverCloud Health.

©Alicia Salamanca-Sanabria, Derek Richards, Ladislav Timulak, Sarah Connell, Monica Mojica Perilla, Yamilena Parra-Villa, Leonidas Castro-Camacho. Originally published in JMIR Mental Health (http://mental.jmir.org), 31.01.2020.

Figures

Figure 1
Figure 1
Study participants flowchart—Consolidated Standards of Reporting Trials diagram. PHQ-9: Patient Health Questionnaire - 9.
Figure 2
Figure 2
Percentage of users accessing modules over time.
Figure 3
Figure 3
Changes in depression symptoms pre- to postintervention. PHQ-9: Patient Health Questionnaire - 9.
Figure 4
Figure 4
Changes in anxiety symptoms pre- to postintervention. GAD-7: Generalized Anxiety Disorder - 7.

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Source: PubMed

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