Mennis Jeremy, Coatsworth J Douglas, Russell Michael, Zaharakis Nikola, Brown Aaron R, Mason Michael J
Department of Geography, Environment and Urban Studies, Temple University, Philadelphia, PA 19122, USA.
College of Social Work, University of Tennessee, Knoxville, TN 37996, USA.
Int J Environ Res Public Health. 2024 Nov 26;21(12):1572. doi: 10.3390/ijerph21121572.
Depression among young adults represents a growing health problem in the U.S., but access to effective treatment remains a challenge. Mobile health (mHealth) approaches promise to deliver accessible and effective depression treatment; however, questions remain regarding how mHealth depression treatment efficacy may vary geographically based on urban and rural environmental contexts. The present study addresses this knowledge gap by leveraging data from a randomized clinical trial of an mHealth depression treatment called Cognitive Behavioral Therapy-text (CBT-txt) as applied to a sample of 103 U.S. young adults (ages 18-25). Prior research has demonstrated the efficacy of CBT-txt to reduce depressive symptoms. In the present study, we conduct an exploratory, post hoc analysis employing moderated growth curve modeling to investigate whether observed treatment efficacy differed between study participants residing in rural versus urban areas. The findings indicate that CBT-txt treatment effects in terms of reducing depression symptoms were significantly stronger for young adults residing in rural, as compared to urban, regions (β = 13.759, 95% CI = 0.796, 26.723, < 0.038). We speculate that this is because of the lack of mental healthcare resources in rural, as compared to urban areas, as well as the greater level of environmental stressors, such as artificial light and noise, found in cities, which may mitigate treatment effects.
在美国，年轻人中的抑郁症是一个日益严重的健康问题，但获得有效治疗仍然是一项挑战。移动健康（mHealth）方法有望提供可及且有效的抑郁症治疗；然而，关于mHealth抑郁症治疗效果如何因城乡环境背景而在地理上有所不同，仍存在疑问。本研究通过利用一项名为认知行为疗法-文本（CBT-txt）的mHealth抑郁症治疗随机临床试验的数据，来填补这一知识空白，该试验应用于103名美国年轻人（年龄在18至25岁之间）的样本。先前的研究已经证明了CBT-txt在减轻抑郁症状方面的疗效。在本研究中，我们进行了一项探索性的事后分析，采用调节增长曲线模型来调查居住在农村地区与城市地区的研究参与者之间观察到的治疗效果是否存在差异。研究结果表明，与城市地区的年轻人相比，居住在农村地区的年轻人在减轻抑郁症状方面，CBT-txt治疗效果显著更强（β = 13.759，95% CI = 0.796，26.723，P < 0.038）。我们推测，这是因为与城市地区相比，农村地区缺乏心理保健资源，以及城市中存在更多的环境压力源，如人造光和噪音，这可能会减轻治疗效果。
