Mindful Walking for Depression Relief in Rural Communities
Role: Principal Investigator
Status: In development
Funding Sources: N/A
THE BIG PICTURE:
Depression is undertreated in the US at great cost.
Rural communities experience disparities in mental health treatment and experience substantial stress.
Mindfulness and physical activity are proven stress-busters that when combined (i.e., Mindful Walking), may synergize to bring depression relief.
We will be developing a tailored Mindful Walking program for rural-dwelling adults experiencing depression in the near future.
Depression is a common, public health threat, yet remains undertreated in the U.S. Depression represents a significant public health concern, contributing to increased morbidity and mortality, worse overall health outcomes and quality of life, and increased healthcare utilization. Only about one-third of those with depression receive treatment at great cost to individuals, their families, and the society.
Disparities in depression care disproportionately affect rural Americans. Although rural Americans experience depression at rates similar to their urban peers, they are less likely to receive any mental health care, including evidence-supported, guideline-concordant depression treatment. Rural residents encounter substantial barriers to conventional depression care. For instance, the vast majority of masters-level social workers (MSW), psychologists and psychiatrists practice exclusively in urban settings. The provider shortage is exacerbated by care access-related challenges, including high poverty and unemployment rates, high proportions of uninsured or underinsured persons, distance to care, travel burden, and transportation issues. Further propagating treatment disparities, many rural residents forgo available care due to cultural values (e.g., self-reliance and independence), shame and stigma surrounding MH and its treatment. These structural and cultural barriers suggest that traditional approaches to depression care may not be available, accessible, or acceptable to this population, compromising health outcomes.
Mindfulness and physical activity offer promise to overcome the shortcomings of existing approaches and address depression burden among rural residents. Stress is a critical construct thought to underlie the development and maintenance of depression and thus, represents an ideal mechanistic target of change among affected rural adults. To this end, two broad intervention approaches have firmly established efficacy in the amelioration of stress: physical activity and mindfulness-meditation practice. Intriguingly, integrated physical activity-mindfulness programs may offer synergistic potential to improve stress and depression beyond what either therapeutic modality can provide alone; such programs also address the concern of conventional mindfulness meditation practices being largely sedentary.
Mindful Walking (MW) programs, which combine light physical activity and mindfulness practice, have recently emerged as a promising integrated approach to stress reduction, as well as mood and wellness improvement in adults. An inexpensive, independent, self-guided, audio-recorded MW program conducted in private may also address several of the documented barriers to mental health care among rural adults (e.g., cost, preferences for self-reliance, independence, privacy and informal systems of care). Despite significant promise (e.g., Yang & Conroy, 2018), existing MW programs have not been tailored to, nor tested among, rural adults with depression.
Objective: The objective of this project is to translate an existing Mindful Walking (MW) protocol into a manualized, stakeholder- and expert-informed, scalable 8-week self-guided program, tailored to the needs of rural adults with depression.
Aim 1: Translate a Mindful Walking (MW) program for the needs of rural adults experiencing depression. Following the Participatory Action Research (PAR) methodology, we will rigorously, in a step-wise manner, adapt MW for distressed rural adults. Deliverables: MW manual, tailored to rural settings.
Aim 2: Using mixed-methods, assess MW feasibility, acceptability, usability, and explore the potential impact of MW on stress coping, a hypothesized mechanism of change, and depression and its stress-responsive common comorbidities (e.g., pain) among 20 rural adults with active depression. Deliverables: Feasibility/acceptability assessment, preliminary data for future studies; fine-tuned MW manual.
Next Steps: Our team will aim to begin data collection in Summer 2022.