Introduction. Teenage pregnancy is a national health priority. Having to deal with pregnancy during adolescence can cause the mother, at an already vulnerable age, to doubt her maternal capacity to cope with a challenge of this magnitude. The teenage mother's assessment of her maternal self-efficacy is associated with her performance, in other words, the way she relates and responds to the needs of her infant, which has major implications for the latter's development. Objective. To study the association between personal (depressive symptoms, self-esteem) and environmental characteristics (social support, partner satisfaction) and those of the infant (problems with infant care, the infants's temperament) and the perception of maternal self-efficacy (PME) in adolescent mothers. Method. Cross-sectional study. The following instruments were applied: Center for Epidemiologic Studies Depression Scale (CES-D), Post-partum Depression Predictors Inventory-Revised (PDPI-R), and Maternal Efficacy Questionnaire to 120 mothers under 20 during the first six months postpartum. Bivariate lineal regression and hierarchical linear regression analyses were used for the data analysis. Results. When adjusting for other variables, symptoms of depression and difficult infant temperament were associated with lower PME. Social support was only associated with increased PME in the bivariate analysis. Discussion and conclusion. These findings contribute to the limited literature on the subject and provide elements for designing strategies to improve adolescent mothers' PME to encourage behaviors that are more relevant and sensitive to infants' physical and emotional needs.

The COVID-19 pandemic affected the mental health of pregnant and postpartum women in unique, unprecedented ways. Given the impossibility of delivering face-to-face care, digital platforms emerged as a first-line solution to provide emotional support. This qualitative study sought to examine the role that a closed Facebook group (CFG) played in providing social support for Mexican perinatal women and to explore the concerns they shared during the COVID-19 pandemic. A thematic analysis of all the posts in the CFG yielded nine main categories: (1) COVID-19 infections in participants and their families; (2) fear of infection; (3) infection prevention; (4) health services; (5) vaccines; (6) concerns about non-COVID-19-related health care; (7) effects of social isolation; (8) probable mental health cases; and (9) work outside the home. Participants faced stressful situations and demands that caused intense fear and worry. In addition to household tasks and perinatal care, they were responsible for adopting COVID-19 preventive measures and caring for infected family members. The main coping mechanism was their religious faith. The CFG was found to be a useful forum for supporting perinatal women, where they could share concerns, resolve doubts, and obtain information in a warm, compassionate, and empathetic atmosphere. Health providers would be advised to seek new social media to improve the quality of their services.

Background Web-based interventions are at an early stage in non–English-speaking low- and middle-income countries, where they remain scarce. Help for Depression (HDep) is one of the few unguided web-based interventions available in Latin America. The results of a use/usability analysis of the original version served as the basis for generating a more user-friendly second version. Objective The aim of this study is to explore participants’ satisfaction and acceptability for the second version of HDep. Methods A retrospective cross-sectional design was used. An email invitation to complete a web-based survey was sent to all people who accessed HDep in 2018. The questionnaire included satisfaction and acceptability scales and open-ended questions. Complete questionnaires were retrieved from 191 participants: 35.1% (67/191) from those who visited only the home page (home page users [HPUs]) and 6.47% (124/1916) from those who registered to use the program (program users [PUs]). Results In all groups, users experienced high levels of depressive symptoms (189/191, 98.9%; Center for Epidemiological Studies Scale-Depression >16). Moderate levels of satisfaction (HPUs: mean 21.9, SD 6.7; PUs: mean 21.1, SD 5.8; range: 8-32) and acceptability (HPUs: mean 13.8, SD 3.9; PUs: mean 13.9, SD 3.2; range: 5-20) were found in both groups. Logistic regression analyses showed that among HPUs, women were more satisfied with HDep (odds ratio [OR] 3.4, 95% CI 1.1-10.0), whereas among PUs, older respondents (OR 1.04, 95% CI 1.01-1.08), those with paid work (OR 3.1, 95% CI 2.4-7.6), those who had not been in therapy (OR 2.42, 95% CI 1.09-5.98), and those who had not attempted suicide (OR 3.4, 95% CI 1.1-11.1) showed higher satisfaction. None of the sociodemographic/mental health variables distinguished the acceptability ratings among HPUs. Among PUs, those with paid work (OR 2.5, 95% CI 1.1-5.5), those who had not been in therapy (OR 3.1, 95% CI 1.3-7.3), those without disability (OR 2.9, 95% CI 1.3-6.6), and those who had not attempted suicide (OR 2.6, 95% CI 1.0-6.6) showed higher acceptability. Conclusions HDep has good levels of satisfaction and acceptability for approximately half of its users, and the information provided by respondents suggested feasible ways to remedy some of the deficiencies. This qualitative–quantitative study from a low- to middle-income, non–English-speaking country adds to existing knowledge regarding acceptance and satisfaction with web-based interventions for depression in resource-limited countries. This information is important for the creation and adaptation of web-based interventions in low- and middle-income countries, where access to treatment is a major concern, and web-based prevention and treatment programs can help deliver evidence-based alternatives. It is necessary to document the pitfalls, strengths, and challenges of such interventions in this context. Understanding how users perceive an intervention might suggest modifications to increase adherence.

ImportanceGuided internet-delivered cognitive behavioral therapy (i-CBT) is a low-cost way to address high unmet need for anxiety and depression treatment. Scalability could be increased if some patients were helped as much by self-guided i-CBT as guided i-CBT.ObjectiveTo develop an individualized treatment rule using machine learning methods for guided i-CBT vs self-guided i-CBT based on a rich set of baseline predictors.Design, Setting, and ParticipantsThis prespecified secondary analysis of an assessor-blinded, multisite randomized clinical trial of guided i-CBT, self-guided i-CBT, and treatment as usual included students in Colombia and Mexico who were seeking treatment for anxiety (defined as a 7-item Generalized Anxiety Disorder [GAD-7] score of ≥10) and/or depression (defined as a 9-item Patient Health Questionnaire [PHQ-9] score of ≥10). Study recruitment was from March 1 to October 26, 2021. Initial data analysis was conducted from May 23 to October 26, 2022.InterventionsParticipants were randomized to a culturally adapted transdiagnostic i-CBT that was guided (n = 445), self-guided (n = 439), or treatment as usual (n = 435).Main Outcomes and MeasuresRemission of anxiety (GAD-7 scores of ≤4) and depression (PHQ-9 scores of ≤4) 3 months after baseline.ResultsThe study included 1319 participants (mean [SD] age, 21.4 [3.2] years; 1038 women [78.7%]; 725 participants [55.0%] came from Mexico). A total of 1210 participants (91.7%) had significantly higher mean (SE) probabilities of joint remission of anxiety and depression with guided i-CBT (51.8% [3.0%]) than with self-guided i-CBT (37.8% [3.0%]; P = .003) or treatment as usual (40.0% [2.7%]; P = .001). The remaining 109 participants (8.3%) had low mean (SE) probabilities of joint remission of anxiety and depression across all groups (guided i-CBT: 24.5% [9.1%]; P = .007; self-guided i-CBT: 25.4% [8.8%]; P = .004; treatment as usual: 31.0% [9.4%]; P = .001). All participants with baseline anxiety had nonsignificantly higher mean (SE) probabilities of anxiety remission with guided i-CBT (62.7% [5.9%]) than the other 2 groups (self-guided i-CBT: 50.2% [6.2%]; P = .14; treatment as usual: 53.0% [6.0%]; P = .25). A total of 841 of 1177 participants (71.5%) with baseline depression had significantly higher mean (SE) probabilities of depression remission with guided i-CBT (61.5% [3.6%]) than the other 2 groups (self-guided i-CBT: 44.3% [3.7%]; P = .001; treatment as usual: 41.8% [3.2%]; P < .001). The other 336 participants (28.5%) with baseline depression had nonsignificantly higher mean (SE) probabilities of depression remission with self-guided i-CBT (54.4% [6.0%]) than guided i-CBT (39.8% [5.4%]; P = .07).Conclusions and RelevanceGuided i-CBT yielded the highest probabilities of remission of anxiety and depression for most participants; however, these differences were nonsignificant for anxiety. Some participants had the highest probabilities of remission of depression with self-guided i-CBT. Information about this variation could be used to optimize allocation of guided and self-guided i-CBT in resource-constrained settings.Trial RegistrationClinicalTrials.gov Identifier: NCT04780542

BACKGROUND Web-based interventions can offer effective and accessible help for depression to large numbers of people at low cost. While these interventions have a long history in high-income countries, they are at an early stage in non-English-speaking low- and middle- income countries, where they remain relatively new and scarce. Help for Depression (HDep) is one of the few unguided web-based interventions available in Latin America. It is multimodal and based on the cognitive behavioral therapy (CBT) approach. The results of a usage/usability analysis of the original version of HDep served as the basis for generating a more user-friendly second version, freely available since 2014. OBJECTIVE The aim of this study was to explore participants’ satisfaction and acceptability ratings for the HDep, second version. METHODS A retrospective, cross-sectional design was used. An email invitation to complete an online survey was sent to all the people who accessed HDep in 2018. The questionnaire included satisfaction and acceptability scales and open-ended questions. Complete questionnaires were retrieved from 191 participants: 67 from those who visited only the home page (HPUs) and 124 from those who registered to use the program (PUs). RESULTS In all groups, users experienced high levels of depressive symptoms (98.9% CES-D > 16). Moderate levels of satisfaction (HPUs M = 21.90, SD = 6.7; PUs M = 21.10, SD = 5.8; range: 8-32) and acceptability (HPUs M = 13.84, SD = 3.97; PUs M = 13.97, SD = 3.29; range: 5-20) were found in both groups. Logistic regression analyses showed that among HPUs, women were more satisfied with HDep (OR = 3.44; 95% CI: 1.16-10.0), while among PUs, older respondents (OR = 1.04; 95% CI: 1.01-1.08), those with paid work (OR = 3.12; 95% CI: 2.40-7.69) those who had not been in therapy (OR = 2.42; 95% CI: 1.09-5.98), and those who had not attempted suicide (OR = 3.44; 95% CI: 1.08-11.11) showed higher satisfaction. None of the sociodemographic/mental health variables distinguished acceptability ratings among HPUs. Among PUs, those with paid work (OR = 2.50; 95% CI: 1.16-5.55), those who had not been in therapy (OR = 3.17; 95% CI: 1.38-7.30), those without disability (OR = 2.94; 95% CI: 1.35-6.66), and those who had not attempted suicide (OR = 2.63; 95% CI: 1.03-6.66) showed higher acceptability. CONCLUSIONS HDep has good levels of satisfaction and acceptability for just over half of its users, and the information provided by respondents suggested feasible ways to remedy some of the deficiencies. This qualitative-quantitative study from a low/middle-income non-English speaking country adds to existing knowledge regarding acceptance and satisfaction with CBT-based programs for depression in high-income countries. This information is important for the creation and adaptation of web-based interventions in low- and middle-income countries, where access to treatment is a major concern, and online prevention and treatment programs can help to deliver evidence-based alternatives. It is necessary to document the pitfalls, strengths, and challenges of such interventions in this context. Understanding how users perceive the intervention might suggest modifications to increase adherence.