The Challenges of a Cognitive-Behavior Workbook to Improve Depression in Rural Women: A Case Study

Abstract

Depression is a challenge for the rurally based primary care nurse practitioner. Within all primary care settings, women seek assistance for depression more often than men. In addition, the rural woman faces challenges in her management related to lack of specialty providers, lack of insurance and lack of health resources. Evidence-based guidelines recommend a stepped approach to care which includes pharmaceuticals such as selective serotonin reuptake inhibitors (SSRIs) and cognitive behavior therapy (CBT). One approach to meet the needs of the rural woman is guided self-help CBT (GSH-CBT). The aim of the review was to discover different methods of CBT and the feasibility of methods within the rural health setting. Formats reviewed include telephone supported CBT, internet based CBT, and written material CBT. Each method was utilized in conjunction with traditional care by primary care providers; however, only one study demonstrates the nurse practitioner as the guide of CBT within the primary care setting. The evidence indicates that GSH-CBT does improve depression symptoms; however, most of the studies were performed in homogeneous groups within the National Health Service of the United Kingdom. More pilot studies need to be carried out within rural communities of different population groups, to include African-American, Hispanic, Asians, and Native American. The goal of this paper is to discuss a case study of a rural woman, utilizing Understanding Depression, which improved depression in a primary care setting. The case study also revealed various challenges which include primary care management of depression in a rural setting and lack of personal self-reflective perspective.