Urban-Rural Variation in the Efficacy of a Mobile Health Anxiety Treatment for Young Adults: Secondary Analysis of a Randomized Clinical Trial.

PURPOSE: This health brief reports how the efficacy of a mobile health generalized anxiety disorder (GAD) treatment for young adults differed across the urban-rural gradient.

METHODS

Data from a randomized clinical trial (n = 102) of the GAD treatment CBT-txt-A was used to test for urban-rural moderation of the treatment effect.

RESULTS

The effect of CBT-txt-A on reducing GAD symptoms was significantly stronger for residents of more rural, than urban, regions (β = -1.949, p = .023, 95% confidence interval = -3.627, -0.271), with the treatment effect size approximately three times larger in more rural, than more urban, regions.

DISCUSSION: Though findings are considered preliminary, results may reflect the increased stigma and lack of in-person access to mental health treatment in rural areas, as well as the negative impact of urban conditions on mental health. Consideration of geographic factors may enhance treatment efficacy through population targeting and treatment personalization.