Background 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. Objective 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. Methods 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. Results 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<.001) and anxiety symptoms (mean –4.3; P<.001). Improvements were also observed in work and social functioning (mean –6.9; P<.001) and resilience (mean 4.3; P<.001). Marked decreases were observed in suicidal ideation (PHQ-9 ninth item score >1) at 6 months (16.5%) and 12 months (17.2%) compared to baseline (39.8%) (P<.001). In regard to the program adherence, cumulative counts of page views and lessons completed were significantly related to lower PHQ-9, GAD-7, and WSAS scores and higher CD-RISC-10 scores (all P values <.001 with an exception of page views with WSAS for which P value was .02). Conclusions The Thrive intervention was effective at reducing depression and anxiety symptom severity and improving functioning and resilience among a population of adults from mostly rural communities in the United States. These gains were maintained at 1 year. Program adherence, measured by the number of logins and lessons completed, indicates that users who engage more with the program benefit more from the intervention. Trial Registration ClinicalTrials.gov NCT03244878; https://clinicaltrials.gov/ct2/show/NCT03244878
BACKGROUND Internet-based cognitive behavior therapy (iCBT) interventions have the potential to help individuals suffering from depression, regardless of time and location. Yet, limited information exists on the longer-term effects of iCBT and adherence to these interventions. OBJECTIVE The primary aim of this study was to evaluate the longitudinal (one year) effectiveness of a fully automated, self-guided iCBT intervention called Thrive, designed to enhance engagement for a rural community population of adults with depression symptoms. The secondary aim was to determine whether program adherence enhanced effectiveness of the Thrive intervention. METHODS We analyzed data from 181 adults who were randomized to the Thrive intervention group. Using self-reports, intervention group participants were evaluated at baseline, 8 weeks, 6 months, and 12 months for the primary outcome of depression symptom severity (Patient Health Questionnaire [PHQ-9]) and secondary outcome measures including the Generalized Anxiety Disorder Scale (GADS-7), Work and Social Adjustment Scale (WSAS), Conner-Davidson Resilience Scale (CD-RISC-10), and suicidal ideation (PHQ-9 ninth item). Thrive program adherence was measured using number of program logins, pages views and lessons completed. RESULTS By 8 weeks, significant improvements were observed for all outcome measures. These improvements were maintained at 12 months with mean reductions in depression and anxiety symptom severity (M = -6.5, P<.001 and M = -4.3, P<.001, respectively). Improvements were also observed in work and social functioning (M = -6.9, P<.001) and resilience (M = 4.3, P<.001). Twenty-two percent fewer participants endorsed suicidal ideation (PHQ-9 ninth item score >1) at 12 months (17.2%) compared to baseline (39.8%; P<.001) In regard to program adherence, the cumulative count of page views and lessons completed were significantly related to lower PHQ-9, GAD-7, WSAS scores, and higher CD-RISC-10 scores. CONCLUSIONS The Thrive intervention was effective at reducing depression and anxiety symptom severity and improving functioning and resilience among a mostly rural community population of US adults. These gains were maintained at one year. Program adherence measured by number of logins and lessons completed indicate that users who engage more with the program benefit more. CLINICALTRIAL NIHTrials.gov: NCT03244878
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