Abstract

Schure

There is a critical need to bridge the gap between mental health care needs and mental health care availability and accessibility in Montana’s rural communities. In 2015, Montana had a higher prevalence of depression compared to the entire nation (1) and had the third highest suicide rate in the nation (2). Yet, rural Montana communities face a severe scarcity of mental health care providers (3), longer distances to care, and lasting stigma to seeking mental health care (4). Thus, new acceptable modalities of evidence-based care are needed to address mental health care needs, improve the quality of life, and reduce suicidal risk for rural Montanans.

This study seeks to evaluate the efficacy of a culturally-adapted version of Thrive, a computerized cognitive behavior therapy (cCBT) program, to reduce the frequency and severity of depressive symptoms among rural Montanans. Cognitive Behavior Therapy (CBT) is the most studied and proven psychotherapy for common mental disorders such as depression, anxiety, and post-traumatic stress disorder (5, 6). Computerized versions of CBT (cCBT) have shown similar positive effects in treating multiple mental disorders when compared to clinician-provided CBT (7), with a recent review showing comparable results among rural and urban communities (8). The acceptance of cCBT has also been established among rural communities in other countries (9, 10). Thrive-Montana is an internet-based program consisting of three interactive learning modules: Assertive Communication, Constructive Thinking, and Rewarding Activities. Each module consists of instructional videos, example vignette stories, individualized assessments, and tailored practice sessions to guide the user to improve her/his skills in each of the content areas.

In 2016, we partnered with our university Extension program and One Montana to identify key community informants and facilitate community focus groups. We conducted 18 key informant interviews and 19 focus groups (n = 101) in 15 rural Montana communities. Information from the interviews and focus groups was used to guide the program adaptation, study promotion and recruitment. In September of 2017, we began recruitment for a randomized waitlist controlled trial (RCT) of Thrive-Montana, the culturally-adapted cCBT program. By January 1, 2018, nearly 300 people have been enrolled in the RCT, approximately two-thirds of the overall recruitment goal (n=459). The primary outcome assessment is depression symptom severity, with secondary outcome assessments of anxiety, work and social adjustment, and resilience. Informed by the stages of behavioral therapies research framework (11), our goal is to successfully complete the implementation and evaluation of the Thrive-Montana RCT.

Specific Aims

Aim 1: Complete data collection and evaluation of subjects.

With enrollment rates to date, we expect recruitment to be completed by early March with 8-week follow-up assessments collected for all by early May of 2018, allowing for the evaluation of short-term efficacy of the Thrive-Montana program.

Aim 2: Assess the short-term efficacy of Thrive-Montana by comparing outcomes between randomized groups over 8 weeks of treatment.

Primary hypothesis: Compared to the wait-list controlled group, persons receiving the intervention program will have significantly reduced depression symptoms.

Secondary hypothesis: Compared to the wait-list controlled group, persons receiving the intervention program will have significantly reduced anxiety, improved work and social adjustment, and greater resilience.

Aim 3: Assess the long-term impact of Thrive-Montana over a 1-year follow-up period.

Primary hypothesis: Thrive-Montana users will have overall sustained reductions in depression symptoms at 1-year follow-up.

Secondary hypothesis: Thrive-Montana users will have overall sustained reductions in anxiety symptoms, improved work and social adjustment, and greater resilience at 1-year follow-up.

Primary Contact

Mark Schure mark.schure@montana.edu