Self-guided Depression Treatment on Long-duration Space Flights: A Continuation Study

The depression treatment program developed through this project has the potential to help individuals receive an evidence-based treatment for depression who would otherwise not have access to it. Worldwide, depression is now the leading cause of disability, and in wealthier nations such as the United States, mental health disorders account for 4 of the 10 leading causes of lost productivity. A recent study of over 60,000 employees of large American companies found that 4.5% have high levels of psychological distress but that only 22% of them are receiving treatment. The annual cost to the United States in unearned income due to mental health disorders is $193 billion. Nonetheless, successful treatment of mental disorders generally returns individuals to functioning comparable to those who have no history of mental health problems. Effective, evidence-based treatments for depression do exist; however, there are major barriers to their widespread dissemination in the United States, including cost, transportation, availability, logistics, stigma, and training. The cost of behavioral health and psychiatric care is often borne directly by consumers and prohibitive for those with limited income. Moreover, the availability of services is limited, and many Americans lack adequate access to behavioral health professionals. Logistics of travel and scheduling pose barriers to receiving behavioral health care on Earth as well as in space. Taking the time off from work, arranging childcare, and potentially traveling a great distance to appointments all conspire against individuals receiving a sufficient dose of behavioral intervention. Additionally, the stigma of asking for mental health care -- in self-perception and in social and employment consequences -- can prevent individuals from asking for help when it is needed on Earth, just as in space. Finally, many Master's and Doctoral-level behavioral health professionals lack training in evidence-based treatment for depression. Practicing clinicians typically fail to adopt such treatments. Moreover, even when they are aware of the evidence-based guidelines and do attempt to provide them, the treatments are often not delivered effectively. If ultimately found to be effective, the problem-solving treatment program developed through this project could help overcome the barriers of cost, availability, logistics, stigma, and training, while potentially facilitating major improvements in public mental health. It could be rolled out in a mass scale, making an evidence-based treatment for depression available at any location, at any time. This computer-based depression treatment, with simple modifications and revisions, could be adapted for use in other isolated operational environments, such as polar research stations, submarines, commercial ships, oil rigs, and underwater research bases. Furthermore, even greater value could be derived by making similar psychosocial support systems available to the public in settings such as primary care practices, public and mental health centers, schools, social services offices, places of worship, military bases, prisons, and eventually at home or in any location, through broadband Internet. More »

During 2008-2009, we completed development and alpha-testing (debugging) of a depression treatment computer program. The program uses video, audio, graphics, and text to guide users through the steps of problem-solving treatment, and evidence-based treatment for depression. Users are guided through the treatment by Dr. Mark Hegel, a national expert in the intervention, who is presented via video and audio. The user's experience is tailored to his or her responses to questions, progress in the treatment, and depression level. Dr. Hegel asks questions and users respond via free text and menus. Each of the program's six sessions involves six steps. The efficacy of problem-solving treatment has been well-established in clinical settings, so our research questions were whether a computer program could be developed to deliver the intervention, and how efficacious it would be. If such a program could be built and is effective, it would be possible to provide a validated intervention to astronauts on long-duration missions who require treatment for depression. After completing development and alpha-testing, we conducted a pilot study to obtain an initial estimate of the program's efficacy. A randomized clinical trial was conducted with a small number of participants (N=14), of which 10 were female, 2 were Latino/Hispanic, and 1 was African American. The mean age was 50.5 years and all had completed at least 4 years of college, making them somewhat analogous to the astronaut population. Half of the participants were assigned to use the depression treatment program for 6 sessions, with a 1-week and 1-month follow-up. The other half were assigned to a wait-list control condition and re-evaluated after 7 weeks. (Note that not receiving a behavioral intervention is likely to be typical for astronauts with depression on long-duration missions, making the wait list a "treatment as usual" condition.) One of the control group participants dropped out of the study and 2 of the experimental group participants' data were omitted due to excessive lapses of time between sessions 3 and 4. The primary outcome was the Hamilton Depression Inventory, a standard measure of depression. No differences were found between groups at pre-test, and the mean for both groups was in the mild range of depression. A comparison of percent change from pre-test to post-test was made for the experimental (treatment) group and the control group. A significant difference (p<.045) was found between groups, with the experimental group improving more. The effect size was large (Cohen's d = 1.73). These results suggest that the depression treatment program may be efficacious for treating minor depression; however, a larger-sample clinical trial is required to confirm them. More »