Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Jun 11, 2020
Open Peer Review Period: Jun 11, 2020 - Jun 19, 2020
Date Accepted: Sep 2, 2020
Date Submitted to PubMed: Oct 23, 2020
(closed for review but you can still tweet)
Twelve-month follow-up to a fully automated internet-based cognitive behavior therapy intervention for community-dwelling adults with depression symptoms
ABSTRACT
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. Clinical Trial: NIHTrials.gov: NCT03244878
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