Twelve-Month Follow-Up to a Fully Automated Internet-Based Cognitive Behavior Therapy Intervention for Rural Adults With Depression Symptoms: Single-Arm Longitudinal Study

• Published in: Journal of medical Internet research 2020-10, Vol.22 (10), p.e21336-e21336
• Main Authors: Schure, Mark, McCrory, Bernadette, Tuchscherer Franklin, Kathryn, Greist, John, Weissman, Ruth Striegel
• Format: Article
• Language: English
• Subjects: Adherence; Adjustment; Adults; Algorithms; Anxiety; Anxiety disorders; Automation; Behavior; Behavior modification; Cognition & reasoning; Cognitive aspects; Cognitive behavioral therapy; Cognitive-behavioral factors; Curricula; Evaluation; Feedback; Generalized anxiety disorder; Internet; Intervention; Longitudinal studies; Mental depression; Mental disorders; Mental health care; Original Paper; Resilience; Rural areas; Rural communities; Social functioning; Social networks; Suicidal ideation; Suicide; Symptoms; Websites
• ISSN: 1438-8871; 1439-4456; 1438-8871
• DOI: 10.2196/21336

Internet-based cognitive behavior therapy (iCBT) interventions have the potential to help individuals with depression, regardless of time and location. Yet, limited information exists on the longer-term (>6 months) effects of iCBT and adherence to these interventions. The primary aim of this study was to evaluate the longitudinal (12 months) effectiveness of a fully automated, self-guided iCBT intervention called Thrive, designed to enhance engagement with a rural population of adults with depression symptoms. The secondary aim was to determine whether the program adherence enhanced the effectiveness of the Thrive intervention. We analyzed data from 181 adults who used the Thrive intervention. Using self-reports, participants were evaluated at baseline, 8 weeks, 6 months, and 12 months for the primary outcome of depression symptom severity using the Patient Health Questionnaire-9 (PHQ-9) scale and secondary outcome measures, namely, the Generalized Anxiety Disorder Scale-7 (GAD-7) scores, Work and Social Adjustment Scale (WSAS) scores, Conner-Davidson Resilience Scale-10 (CD-RISC-10) scores, and suicidal ideation (ninth item of the PHQ-9 scale) scores. The Thrive program adherence was measured using the numbers of program logins, page views, and lessons completed. The assessment response rates for 8-week, 6-month, and 12-month outcomes were 58.6% (106/181), 50.3% (91/181), and 51.4% (93/181), respectively. By 8 weeks, significant improvements were observed for all outcome measures. These improvements were maintained at 12 months with mean reductions in severities of depression (mean -6.5; P