There is evidence to suggest that self-help programs on the Internet may be of value for people with major depressive disorder. However, effect sizes in previous research have usually been modest. Limitations of earlier work include the general nature of the interventions and emphasis on written materials. It is conceivable that computerized self-help programs employing interactive videos aimed at a homogeneous user population could be especially valuable for individuals with major depressive disorder. The proposed Intervention Development / Exploratory Research (R34) project is designed to address this issue by tailoring for spouses of combat veterans a previously developed Internet intervention aimed at people with major depressive disorder. The proposed project is timely because many if not most combatants return from Iraq or Afghanistan to live with their families. Therefore, spouses not infrequently find themselves dealing with consequences of the family members'exposure to combat. Spouses with major depressive disorder constitute a relatively homogeneous group whose emotional distress is complicated by (if not precipitated by) the combatant's war zone experiences. Moreover, distance, lack of time, inadequate resources, limited awareness, and unclear eligibility for services may make it difficult for spouses to participate in face to face treatment programs. Technologies such as the World Wide Web and-or CD-ROMs could help address these needs. The proposed project will adapt and augment an existing cognitive-behavioral Internet computer program shown in randomized trials to be efficacious for adult health maintenance organization members with major depressive disorder. The program will be adapted to focus on issues that are of key importance to depressed spouses of combatants who have served in Iraq or Afghanistan. The current, chiefly textual, system will be augmented with pertinent videos. The updated program will be reviewed by spouses in treatment for major depressive disorder and then modified based on their suggestions. The modified program will be tested against the existing system in a randomized design. Outcome measures will include user satisfaction, knowledge about major depressive disorder, symptoms of major depressive disorder, and attitudes toward treatment. The proposed project will generate data needed to plan a large-scale randomized clinical trial. The project unites academic, military, Veterans Affairs, and health care system researchers who have expertise in major depressive disorder, inter-active computer technology development, and family studies. The relevance of the research to public health is several-fold. First, the proposed project will refine technology that may especially benefit military service members'families. Second, data from the study will provide important information about the value of tailoring Internet behavioral health interventions to meet the needs of homogeneous user groups. Third, the research will examine ways to increase the assistance provided to people with major depressive disorder via computerized self-help systems.
| Lewy, Colleen S; Oliver, Celina M; McFarland, Bentson H (2014) Barriers to mental health treatment for military wives. Psychiatr Serv 65:1170-3 |
