Abstract 4369887: Online Cognitive Behavioral Therapy for Depressed Rural Cardiac Patients: Effective Regardless of Health Literacy Level.

Introduction: Rural-dwelling adults with cardiovascular disease and failure have high rates of depression. However, delivering interventions that are both effective and accessible remains a challenge. Given the lower health literacy levels in rural areas, like Appalachia, existing interventions should be tested. In the COMBAT-DS study, we compared two online methods of delivering cognitive behavioral therapy (CBT) to lower depressive symptoms in areas where providers are scarce, like rural Appalachia. Purpose: To determine whether health literacy moderates the impact of the COMBAT intervention on depressive symptoms. Methods: In a secondary data analysis for a large comparative effectiveness randomized controlled trial comparing cognitive behavioral therapy (CBT) via video-conferencing with a therapist vs. self- directed CBT online program. We used OLS regression with the PROCESS macro in SPSS to determine whether health literacy moderated the effect of the intervention on depressive symptoms. Depressive symptoms were measured using the Patient Health Questionnaire – 9 (PHQ-9). Health literacy was measured using the Newest Vital Sign (NVS) and converted into two groups (limited health literacy and adequate health literacy) based on the published cutpoint (0-3 inadequate health literacy, 4-6 adequate health literacy). Results: In our sample of 303 individuals (age 58 ± 12; 49% were women), both interventions resulted in statistically and clinically significant reductions in depressive symptoms scores, and level of health literacy did not moderate the effect of the interventions on depressive symptoms over time (p = 0.642; Figure). Conclusions: Health literacy levels did not moderate the relationship of the COMBAT interventions with depressive symptoms in rural participants with cardiac diseases. Online CBT with or without a therapist is equally effective in reducing depressive symptoms regardless of health literacy level. This makes both types excellent interventions to use in rural areas.