@Article{info:doi/10.2196/21336,
author="Schure, Mark
and McCrory, Bernadette
and Tuchscherer Franklin, Kathryn
and Greist, John
and Weissman, Ruth Striegel",
title="Twelve-Month Follow-Up to a Fully Automated Internet-Based Cognitive Behavior Therapy Intervention for Rural Adults With Depression Symptoms: Single-Arm Longitudinal Study",
journal="J Med Internet Res",
year="2020",
month="Oct",
day="2",
volume="22",
number="10",
pages="e21336",
keywords="internet-based cognitive behavior therapy; depression; anxiety; long-term outcomes; iCBT; CBT; therapy; mental health; outcome",
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 ",
issn="1438-8871",
doi="10.2196/21336",
url="https://www.jmir.org/2020/10/e21336",
url="https://doi.org/10.2196/21336",
url="http://www.ncbi.nlm.nih.gov/pubmed/33006561"
}