Multimedia Internet-Based Program for Workers with Subthreshold Depression

DESCRIPTION (provided by applicant): Depression is one of the most prevalent mental disorders to afflict adults. It seriously impacts role functioning and often takes a recurrent or chronic course. Given the high prevalence and associated impairments, depression has become a major public health concern. Because most adults who suffer from depression never receive treatment, there is a critical need to develop interventions that can be easily implemented and widely disseminated. This project will develop and test an interactive multimedia program to teach cognitive-behavioral and interpersonal skills to workers with subthreshold depression in order to reduce symptoms, improve functioning at the workplace, and potentially reduce the risk for escalation to full-syndrome depression. The intervention will consist of knowledge- and skills-based modules including: understanding depression, work stress management, mood monitoring, pleasant activity scheduling, increasing positive thinking, decreasing negative thinking, skill integration, and planning for the future. The competency-based instructional design will be structured for multiple sessions using video-based tutorials, testimonials, and behavior modeling vignettes. Additional browser modules will include depression self-screening, getting support, learning to relax, problem solving and communication, and additional resources. The online support system will include an electronic bulletin board, personal weekly conferences with an intervention coach, and an ask-an-expert forum. The intervention will include six target populations: men and women in early, mid and late life. The basic structure of the program will be the same for each target population, but specific content will be customized to each user group. The Phase I prototype, targeted to 18-39 year-old women, provided training on understanding depression, mood monitoring, and scheduling pleasant activities. Results from a small randomized trial (n = 42) showed moderate to large effect sizes for pre to post change in depressive symptomatology, knowledge, use of the skills taught, and self-efficacy. Participants found the program easy to use and gave it high satisfaction and usability ratings. The fully developed Phase II product will be evaluated in a large randomized trial (N = 300) with an eight- week intervention and 1-month follow-up period. The Phase II trial is expected to show reductions in depressive symptoms and increases in occupational functioning, and these changes in the outcome measures are expected to be mediated by changes in the specific skills acquired through the intervention. The potential commercial applications of the Phase II product are to employee assistance programs, behavioral health organizations, health insurance companies, and mental health clinics/practices. PUBLIC HEALTH RELEVANCE: Depression has become a major public health concern given its high prevalence and associated impairments. Although there have been significant advances in the diagnosis and treatment of depression, the design and evaluation of interventions for subthreshold depression have received little attention to date. Because most adults who suffer from depression never receive treatment, there is a critical need to develop interventions that can be easily implemented and widely disseminated.