Computerized cognitive behavioral therapy for anxiety and depression in farming communities: mixed methods feasibility study of participant use and acceptability
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Abstract
BACKGROUND: Farmers have higher rates of depression than nonfarmers and higher rates of suicide than the general population. Several barriers to help seeking have been identified in farmers, which may be overcome by offering web-based mental health support. Computerized cognitive behavioral therapy (cCBT) is an effective intervention used to prevent and treat mild to moderate depression but has not been evaluated in the farming community. OBJECTIVE: This study explored the feasibility of delivering a cCBT course tailored to farmers using a mixed methods approach. METHODS: Farmers (aged ≥18 years) with no, minimal, or moderately severe depressive symptoms (Patient Health Questionnaire-9 [PHQ-9] score <20) were recruited using web-based and offline advertisements and given access to a cCBT course consisting of 5 core modules and automated and personalized email support. Depression (PHQ-9), anxiety (General Anxiety Disorder-7), and social functioning (Work and Social Adjustment Scale) were measured at baseline and the 8-week follow-up. Wilcoxon signed rank tests assessed changes in scores for all outcome measures over time. Telephone interviews focusing on participant use and satisfaction with the course were analyzed using thematic analysis. RESULTS: Overall, 56 participants were recruited; 27 (48%) through social media. Overall, 62% (35/56) of participants logged into the course. At baseline, almost half of the participants reported experiencing minimal depressive symptoms (25/56, 45%) and mild anxiety (25/56, 45%), and just over half (30/56, 54%) reported mild to moderate functional impairment. Posttreatment data were available for 27% (15/56) of participants (41/56, 73% attrition rate). On average, participants experienced fewer depressive symptoms (P=.38) and less functional impairment (P=.26) at the 8-week follow-up; these results were not statistically significant. Participants experienced significantly fewer symptoms of anxiety at the 8-week follow-up (P=.02). Most participants (13/14, 93%) found the course helpful and easy to access (10/13, 77%) and the email support helpful (12/14, 86%). Qualitative interviews identified heavy workloads and mental health stigma within the farming community as barriers to help seeking. Participants thought that web-based support would be helpful, being convenient and anonymous. There were concerns that older farmers and those with limited internet connections may have difficulty accessing the course. Improvements regarding the layout and content of the course were suggested. Dedicated support from someone with farming knowledge was recommended to improve retention. CONCLUSIONS: cCBT may be a convenient way of supporting mental health within farming communities. However, challenges in recruiting and retaining farmers may indicate that cCBT supported only by email may not be an acceptable mode of mental health care delivery for many; however, it was valued by respondents. Involving farming organizations in planning, recruitment, and support may address these issues. Mental health awareness campaigns targeting farming communities may also help reduce stigma and improve recruitment and retention.
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Given time restrictions by often long and unpredictable working hours in farming, individual time composition appears especially important for adherence and might help dissolve the conflict of prioritizing work over help-seeking.
“Given time restrictions by often long and unpredictable working hours in this occupational group (Bowyer et al., 2023; Braun et al., 2022; Daghagh Yazd et al., 2019; Vayro et al., 2020), individual time composition appears to be especially important for adherence and might help to dissolve the conflict of prioritizing work over help-seeking reported in other studies (Vayro et al., 2020).”
The involvement of experts with farming knowledge was previously recommended by Bowyer et al. (2023) to improve retention in online CBT intervention for farmer's mental health.
“The involvement of experts with farming knowledge was previously recommended by Bowyer et al. (2023) to improve retention in online CBT intervention for farmer's mental health as a conclusion of their acceptability study.”
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- Authors
- Bowyer, H. L., Pegler, R., & Williams, C.
- Affiliations
- Glasgow Caledonian University (GB)
- National Health Service Scotland (GB)
- University of Glasgow (GB)
- Corresponding author
- Bowyer, Harriet L
- Venue
- JMIR Formative Research
- Publisher
- JMIR Publications Inc.
- Published
- 2023-06-19
- Volume
- 7
- Pages
- e42573
- ISSN
- 2561-326X (ISSN-L)
- PMC
- PMC10337352
- OpenAlex
- W4381190562
- Cited by
- 6
- References
- 39
- Citations by year
- 2024: 4 · 2023: 2
- FWCI
- 1.55
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- JMIR Formative Research (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- ENLIGHTEN (Jurnal Bimbingan dan Konseling Islam) (submittedVersion, cc-by)
- ResearchOnline (submittedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- ResearchOnline (Glasgow Caledonian University) (submittedVersion, cc-by)
- Topics
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- computerized cognitive behavioral therapy, farmers, depression, anxiety, help-seeking barriers, mental health stigma, occupational stress, attrition, participant satisfaction, email support, social functioning, suicide prevention, rural mental health, feasibility, elderly farmers, social media recruitment
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