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, p < 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.
Keywords: clinical trial; depression; intervention; mhealth; moderation; rural; treatment; urban.