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

Abstract

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

Impact of an Automated Internet-Based Cognitive Behavioral Therapy Program on Suicide Thinking and Risk Among US Rural Adults

“…In the rst Thrive trial [22], the number of lessons completed predicted reduced depression and anxiety symptom severity and improved social functioning. Yet, in this second trial, our program adherence analyses produced less consistent ndings of lessons completed with each outcome measure.…”

“…Analyses of Thrive program adherence (Thrive group only) were completed by assessing the longitudinal change over time in the outcomes to assess the relationship with lessons completed in the program. Using separate logistic regression models for the primary outcome and linear mixed models with repeated measures for secondary outcomes, the adherence measure (lessons completed) was assessed at baseline, 4 weeks and 8 weeks for each outcome [22]. All models contained xed-effects terms for the lessons completed, time (baseline, week 4, week 8), and respective baseline outcome measure as a covariate.…”

Impact of an automated Internet-based cognitive behavioral therapy program on suicide thinking and risk among United States rural adults

“…Analyses of Thrive program adherence (INT group only) were completed by assessing the longitudinal change over time in the outcomes to assess the relationship with lessons completed in the program. Using separate logistic regression models for the primary outcome and linear mixed models with repeated measures for secondary outcomes, the adherence measure (lessons completed) was assessed at baseline, 4 weeks, and 8 weeks for each outcome [22]. All models contained fixed-effects terms for the lessons completed, time (baseline, week 4, week 8), and respective baseline outcome measure as a covariate.…”

Italia Ti Ascolto [Italy, I am listening]: an app-based group psychological intervention during the COVID-19 pandemic

“…More specifically, considering online interventions for depressive features, a systematic review by Burger, Neerincx, and Brinkman (2020) highlighted that 76% of the digital interventions are delivered via Web, and 85% of the studies investigated the efficacy of internet-based cognitive behavioral therapy (iCBT) highlighting successful treatments on depressive symptoms' reduction (e.g. Forsell et al, 2017;Hallgren et al, 2015;Schure et al, 2020;Miller et al, 2021). For example, Bakker and colleagues (2018) conducted a randomized controlled trial on three mental health apps efficacy: MoodPrism, MoodKit and MoodMission.…”