This 3-year, exploratory, Stage I behavioral treatment research study responding to NIH PAR-09-173 (replacing PAR-06-248), will establish digital story as a means of promoting therapeutic change among low- income rural women with major depressive disorder (MDD). Digital story is an autobiographical narrative that has been digitally audio recorded, augmented with still pictures, video, music, and other digitized media and converted to a movie that can be played on most computer platforms. When the autobiographical digital story is produced within the context of a therapeutic relationship and used to evoke adaptive change in the depression illness narrative, it can serve as a mechanism for improving women's view of themselves, for increasing their effectiveness in interpersonal interaction, and for promoting social engagement, ultimately reducing depressive symptoms. Narrative change occurs in interaction with the psychiatric nurse specialist, through the differential and additive effects of speech, audio, visual, and cognitive processes on narrative processing and memory in diverse areas of the brain, by women's experience of success in learning and applying new skills, and through supported engagement in new social interactions. As Stage I research, a theoretical framework is presented informed by a diverse and extensive social and behavioral science literature that links MDD with narrative disruption, interactional distress, and social withdrawal. A multi-method case study research design establishing those linkages is proposed. Using within and across case analyses that integrate qualitative and quantitative research approaches the investigative team will 1) Establish instructional, therapeutic, and technological procedures that foster adaptive change in illness narratives of rural, low-income women with MDD, 2) Determine a) how autobiographical illness narratives change during the process of creation and production of a digital story, b) what therapeutic and technological processes effect narrative change, and c) outcomes associated with completing digital story, and 3) Identify personal, intrapersonal, interpersonal, narrative and other characteristics associated with response and non-response to the creation and production of digital story. Outcomes of this intensive research study include a treatment procedure manual for digital story, methods for evaluating narrative change and its effect on outcomes, and hypotheses about potential change mechanisms associated with digital story that can be tested in a future, R01 level randomized clinical trial.
Depression affects as many as 40% of low-income rural women, yet they are less likely than urban women to obtain treatment. This unmet need, apparently due to limited rural health care resources, and reject of formal mental health treatments by rural populations, has led to excessive co-morbidity, frequent hospitalizations, and higher rates of suicide among rural populations. The proposed research tests a gender and culturally sensitive alternative treatment for depression that has the potential to be acceptable, affordable, and sustainable in resource poor rural health and community settings.