Limitations
depressive
The study results should be considered in light of the following limitations. First, although this study was structured as a follow-up pilot study, having a larger sample size and longer follow-up periods may strengthen confidence in the findings. Second, the sample was 84% female, limiting the generalization across biological sexes. Although the rates of major depressive episodes are double for female young adults compared with male young adults (22.9% vs 11.1%) [The results of this trial provide further support for CBT-txt as an efficacious, efficient, and reliable form of treatment to address depressive symptomatology among young adults. To the best of our knowledge, CBT-txt is unique in its SMS text message–delivered modality and in its strong clinical evidence supporting efficacy. While acknowledging the study limitations and the potential treatment effect fluctuations due to the sample size, these results build upon our first trial’s promising findings and provide more empirical evidence for the treatment format, delivery modality, and clinical possibilities of using CBT-txt at scale.This research was funded by the Betsey R Bush endowment for Children and Families at Risk and Behavioral Health Research, Center for Behavioral Health Research, College of Social Work, University of Tennessee.Conflicts of Interest: None declared.Full model results for latent change score mediations.CONSORT eHEALTH checklist (V 1.6.2).