title: A four-year experience with a Web-based self-help intervention for depressive symptoms in Mexico.
abstract: OBJECTIVE
  To describe a four-year descriptive, naturalistic study monitoring the use of HDep (Help for Depression or Ayuda para depression (ADep)in Spanish), an open-access/free Web-based, psycho-education, cognitive-behavioral intervention program produced in Mexico consisting of seven self-help modules that include feedback-generating assessments of depressive symptoms, vignettes, recorded messages, a relaxation exercise, a personal workbook, blogs, and user discussion forums.
  
  
  METHODS
  Data were collected on all individuals who entered the HDep site since the program's launching in 2009. Those who entered the site two or more times and also registered as "users" or "participants." The user data consisted of 1) user profiles; 2) scores for the CES-D (Center for Epidemiological Studies Depression Scale), for users who completed the feedback-generating assessments of depressive symptoms; 3) user evaluations of the usefulness of HDep; and 4) transcripts of HDep discussion forum posts. The raw user data were obtained through Moodle (Modular Object-Oriented Dynamic Learning Environment, a free software e-learning platform) and analyzed quantitatively (using SPSS) and qualitatively (using ATLAS.ti).
  
  
  RESULTS
  A total of 28 078 individuals accessed HDep and 17 318 of those (61.6%) qualified as users. Of all users, 84.4% were women, 64.6% used the workbook, and 60.9% entered the discussion forums (of whom 16.3% added a post). Depressive symptoms (CES-D score ≥ 16) were observed in 97.1% of the users who completed the feedback-generating assessment (n = 16 564). User retention dropped across the seven modules (from 12 366 users for Module 1 to 626 for Module 7). However, all seven modules were rated very high for "helpfulness/usefulness," with mean scores all above 4 on a 1 - 5 scale. The HDep discussion forums showed a rich social interaction. Predictors of entering at least one module (based on stepwise logistic regression analysis) included being a woman, being ≥ 30 years old, reporting disability, and having attempted suicide. Of the 72 participants who completed the final user evaluation of HDep, 97.5% said it had an enormous influence on helping them to identify and transform negative thoughts.
  
  
  CONCLUSIONS
  Despite the high attrition among users, and the need for further structure adaptation, HDep can be considered a potentially useful mental health tool in Mexico for 1) detecting depression (via the CES-D assessments) and 2) providing a means of social support to those with depression. The high levels of depressive symptoms detected among users suggest that the role of free-access, self-help, Web-based interventions in public mental health programs should be further investigated. The effectiveness of HDep in reducing depressive symptoms and providing a support system has yet to be assessed and should be examined in future research.
authors.affiliation: Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico City, Mexico, laracan@imp.edu.mx.
authors.forename: María Asunción
authors.initials: MA
authors.lastname: Lara
authors.affiliation: Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico City, Mexico, laracan@imp.edu.mx.
authors.forename: Marcela
authors.initials: M
authors.lastname: Tiburcio
authors.affiliation: Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico City, Mexico, laracan@imp.edu.mx.
authors.forename: Araceli
authors.initials: A
authors.lastname: Aguilar Abrego
authors.affiliation: Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico City, Mexico, laracan@imp.edu.mx.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Sánchez-Solís
mesh_terms: D000293:Adolescent; D000328:Adult; D003863:Depression / Q000628:therapy*; D005260:Female; D006801:Humans; D020407:Internet; D008297:Male; D008800:Mexico; D008875:Middle Aged; D012657:Self-Help Groups; D013997:Time Factors; D055815:Young Adult