TY  - JOUR
AU  - Benjet, Corina
AU  - Zainal, Nur Hani
AU  - Albor, Yesica
AU  - Alvis-Barranco, Libia
AU  - Carrasco Tapia, Nayib
AU  - Contreras-Ibáñez, Carlos C
AU  - Cortés-Morelos, Jacqueline
AU  - Cudris-Torres, Lorena
AU  - de la Peña, Francisco R
AU  - González, Noé
AU  - Gutierrez-Garcia, Raúl A
AU  - Vargas-Contreras, Eunice
AU  - Medina-Mora, Maria Elena
AU  - Patiño, Pamela
AU  - Gildea, Sarah M
AU  - Kennedy, Chris J
AU  - Luedtke, Alex
AU  - Sampson, Nancy A
AU  - Petukhova, Maria V
AU  - Zubizarreta, Jose R
AU  - Cuijpers, Pim
AU  - Kazdin, Alan E
AU  - Kessler, Ronald C
PY  - 2025
DA  - 2025/2/28
TI  - The Effect of Predicted Compliance With a Web-Based Intervention for Anxiety and Depression Among Latin American University Students: Randomized Controlled Trial
JO  - JMIR Ment Health
SP  - e64251
VL  - 12
KW  - anxiety
KW  - depression
KW  - web-based cognitive behavioral therapy
KW  - compliance
KW  - randomized controlled trial
AB  - Background: Web-based cognitive behavioral therapy (wb-CBT) is a scalable way to reach distressed university students. Guided wb-CBT is typically superior to self-guided wb-CBT over short follow-up periods, but evidence is less clear over longer periods. Objective: This study aimed to compare short-term (3 months) and longer-term (12 months) aggregate effects of guided and self-guided wb-CBT versus treatment as usual (TAU) in a randomized controlled trial of Colombian and Mexican university students and carry out an initially unplanned secondary analysis of the role of differential predicted compliance in explaining these differences. Methods: The 1319 participants, recruited either through email and social media outreach invitations or from waiting lists of campus mental health clinics, were undergraduates (1038/1319, 78.7% female) with clinically significant baseline anxiety (Generalized Anxiety Disorder–7 score≥10) or depression (Patient Health Questionnaire–9 score≥10). The intervention arms comprised guided wb-CBT with weekly asynchronous written human feedback, self-guided wb-CBT with the same content as the guided modality, and TAU as provided at each university. The prespecified primary outcome was joint remission (Generalized Anxiety Disorder–7 score=0-4 and Patient Health Questionnaire–9 score=0-4). The secondary outcome was joint symptom reduction (mean scores on the Patient Health Questionnaire Anxiety and Depression Scale) at 3 and 12 months after randomization. Results: As reported previously, 3-month outcomes were significantly better with guided wb-CBT than self-guided wb-CBT (P=.02) or TAU (P=.02). However, subsequent follow-up showed that 12-month joint remission (adjusted risk differences=6.0-6.5, SE 0.4-0.5, and P<.001 to P=.007; adjusted mean differences=2.70-2.69, SE 0.7-0.8, and P<.001 to P=.001) was significantly better with self-guided wb-CBT than with the other interventions. Participants randomly assigned to the guided wb-CBT arm spent twice as many minutes logged on as those in the self-guided wb-CBT arm in the first 12 weeks (mean 12.5, SD 36.9 vs 5.9, SD 27.7; χ21=107.1, P<.001), whereas participants in the self-guided wb-CBT arm spent twice as many minutes logged on as those in the guided wb-CBT arm in weeks 13 to 52 (mean 0.4, SD 7.5 vs 0.2, SD 4.4; χ21=10.5, P=.001). Subgroup analysis showed that this longer-term superiority of self-guided wb-CBT was confined to the 40% (528/1319) of participants with high predicted self-guided wb-CBT compliance beyond 3 months based on a counterfactual nested cross-validated machine learning model. The 12-month outcome differences were nonsignificant across arms among other participants (all P>.05). Conclusions: The results have important practical implications for precision intervention targeting to maximize longer-term wb-CBT benefits. Future research needs to investigate strategies to increase sustained guided wb-CBT use once guidance ends. Trial Registration: ClinicalTrials.gov NCT04780542; https://www.clinicaltrials.gov/study/NCT04780542 International Registered Report Identifier (IRRID): RR2-10.1186/s13063-022-06255-3  
SN  - 2368-7959
UR  - https://mental.jmir.org/2025/1/e64251
UR  - https://doi.org/10.2196/64251
DO  - 10.2196/64251
ID  - info:doi/10.2196/64251
ER  -