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Kaminer D, Booysen D, Ellis K, Kristensen CH, Patel AR, Robjant K, Sardana S. Improving access to evidence-based interventions for trauma-exposed adults in low- and middle-income countries. J Trauma Stress 2024; 37:563-573. [PMID: 38459223 DOI: 10.1002/jts.23031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 02/11/2024] [Accepted: 02/11/2024] [Indexed: 03/10/2024]
Abstract
In low- and middle-income countries (LMICs), the mental health consequences of trauma exposure pose a substantial personal, societal, and economic burden. Yet, the significant need for evidence-based mental health treatment remains largely unmet. To unlock the potential for mental health care for trauma survivors in lower-resource contexts, it is critical to map treatment barriers and identify strategies to improve access to evidence-based, culturally appropriate, and scalable interventions. This review, based on an International Society for Traumatic Stress (ISTSS) briefing paper, describes the treatment gap facing adults with traumatic stress in LMICs and identifies the barriers that contribute to this gap. We then highlight strategies for enhancing access to effective treatments for these populations, including task-sharing, the use of culturally adapted and multiproblem interventions, and digital tools to scale access to appropriate care. Finally, we offer recommendations for policymakers, researchers, and service providers to guide an agenda for action to close the treatment gap for trauma survivors in LMICs.
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Affiliation(s)
- Debra Kaminer
- Department of Psychology, University of Cape Town, Cape Town, South Africa
| | - Duane Booysen
- Department of Psychology, Rhodes University, Grahamstown, South Africa
| | - Kate Ellis
- Department of Psychology, American University in Cairo, New Cairo, Egypt
| | - Christian Haag Kristensen
- School of Health and Life Sciences, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Anushka R Patel
- Department of Epidemiology, Harvard Chan School of Public Health, Boston, Massachusetts, USA
| | - Katy Robjant
- Department of Psychology, University of Konstanz, Konstanz, Germany
| | - Srishti Sardana
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
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Higashi RT, Etingen B, Richardson E, Palmer J, Zocchi MS, Bixler FR, Smith B, McMahon N, Frisbee KL, Fortney JC, Turvey C, Evans J, Hogan TP. Veteran Experiences With an mHealth App to Support Measurement-Based Mental Health Care: Results From a Mixed Methods Evaluation. JMIR Ment Health 2024; 11:e54007. [PMID: 38728684 PMCID: PMC11127133 DOI: 10.2196/54007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 02/28/2024] [Accepted: 03/15/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Mental health conditions are highly prevalent among US veterans. The Veterans Health Administration (VHA) is committed to enhancing mental health care through the integration of measurement-based care (MBC) practices, guided by its Collect-Share-Act model. Incorporating the use of remote mobile apps may further support the implementation of MBC for mental health care. OBJECTIVE This study aims to evaluate veteran experiences with Mental Health Checkup (MHC), a VHA mobile app to support remote MBC for mental health. METHODS Our mixed methods sequential explanatory evaluation encompassed mailed surveys with veterans who used MHC and follow-up semistructured interviews with a subset of survey respondents. We analyzed survey data using descriptive statistics. We then compared responses between veterans who indicated having used MHC for ≥3 versus <3 months using χ2 tests. We analyzed interview data using thematic analysis. RESULTS We received 533 surveys (533/2631, for a 20% response rate) and completed 20 interviews. Findings from these data supported one another and highlighted 4 key themes. (1) The MHC app had positive impacts on care processes for veterans: a majority of MHC users overall, and a greater proportion who had used MHC for ≥3 months (versus <3 months), agreed or strongly agreed that using MHC helped them be more engaged in their health and health care (169/262, 65%), make decisions about their treatment (157/262, 60%), and set goals related to their health and health care (156/262, 60%). Similarly, interviewees described that visualizing progress through graphs of their assessment data over time motivated them to continue therapy and increased self-awareness. (2) A majority of respondents overall, and a greater proportion who had used MHC for ≥3 months (versus <3 months), agreed/strongly agreed that using MHC enhanced their communication (112/164, 68% versus 51/98, 52%; P=.009) and rapport (95/164, 58% versus 42/98, 43%; P=.02) with their VHA providers. Likewise, interviewees described how MHC helped focus therapy time and facilitated trust. (3) However, veterans also endorsed some challenges using MHC. Among respondents overall, these included difficulty understanding graphs of their assessment data (102/245, 42%), not receiving enough training on the app (73/259, 28%), and not being able to change responses to assessment questions (72/256, 28%). (4) Interviewees offered suggestions for improving the app (eg, facilitating ease of log-in, offering additional reminder features) and for increasing adoption (eg, marketing the app and its potential advantages for veterans receiving mental health care). CONCLUSIONS Although experiences with the MHC app varied, veterans were positive overall about its use. Veterans described associations between the use of MHC and engagement in their own care, self-management, and interactions with their VHA mental health providers. Findings support the potential of MHC as a technology capable of supporting the VHA's Collect-Share-Act model of MBC.
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Affiliation(s)
- Robin T Higashi
- Peter O'Donnell Jr School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX, United States
- eHealth Partnered Evaluation Initiative, Veterans Affairs Bedford Healthcare System, Bedford, MA, United States
| | - Bella Etingen
- Peter O'Donnell Jr School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX, United States
- eHealth Partnered Evaluation Initiative, Veterans Affairs Bedford Healthcare System, Bedford, MA, United States
- Research and Development Service, Dallas Veterans Affairs Medical Center, Dallas, TX, United States
| | - Eric Richardson
- eHealth Partnered Evaluation Initiative, Veterans Affairs Bedford Healthcare System, Bedford, MA, United States
- Center for Healthcare Organization and Implementation Research (CHOIR), Veterans Affairs Boston Healthcare System, Boston, MA, United States
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Jennifer Palmer
- eHealth Partnered Evaluation Initiative, Veterans Affairs Bedford Healthcare System, Bedford, MA, United States
- Center for Healthcare Organization and Implementation Research (CHOIR), Veterans Affairs Boston Healthcare System, Boston, MA, United States
- Section of General Internal Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States
| | - Mark S Zocchi
- eHealth Partnered Evaluation Initiative, Veterans Affairs Bedford Healthcare System, Bedford, MA, United States
- Center for Healthcare Organization and Implementation Research (CHOIR), Veterans Affairs Bedford Healthcare System, Bedford, MA, United States
| | - Felicia R Bixler
- eHealth Partnered Evaluation Initiative, Veterans Affairs Bedford Healthcare System, Bedford, MA, United States
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Hines Veterans Affairs Hospital, Hines, IL, United States
| | - Bridget Smith
- eHealth Partnered Evaluation Initiative, Veterans Affairs Bedford Healthcare System, Bedford, MA, United States
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Hines Veterans Affairs Hospital, Hines, IL, United States
- Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Nicholas McMahon
- eHealth Partnered Evaluation Initiative, Veterans Affairs Bedford Healthcare System, Bedford, MA, United States
- Center for Healthcare Organization and Implementation Research (CHOIR), Veterans Affairs Bedford Healthcare System, Bedford, MA, United States
| | - Kathleen L Frisbee
- eHealth Partnered Evaluation Initiative, Veterans Affairs Bedford Healthcare System, Bedford, MA, United States
- Office of Connected Care, Veterans Health Administration, US Department of Veterans Affairs, Washington, DC, United States
| | - John C Fortney
- Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, WA, United States
- Division of Population Health, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - Carolyn Turvey
- Center for Access & Delivery Research and Evaluation, Iowa City Veterans Affairs Health Care System, Iowa City, IA, United States
- Office of Rural Health, Veterans Rural Health Resource Center - Iowa City, Iowa City Veterans Affairs Health Care System, Iowa City, IA, United States
- Department of Psychiatry, University of Iowa, Iowa City, IA, United States
| | - Jennifer Evans
- Office of Mental Health and Suicide Prevention, US Department of Veterans Affairs, Washington, DC, United States
| | - Timothy P Hogan
- Peter O'Donnell Jr School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX, United States
- eHealth Partnered Evaluation Initiative, Veterans Affairs Bedford Healthcare System, Bedford, MA, United States
- Center for Healthcare Organization and Implementation Research (CHOIR), Veterans Affairs Bedford Healthcare System, Bedford, MA, United States
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Alfaro AJ, Sakai E, Carlson C, Mehta PS, Anderson J, Wynn M, Gould CE. Geri-Mobile Health: Feasibility of a VA Mental Health Mobile Apps Coaching Program for Older Veterans. Clin Gerontol 2024; 47:110-121. [PMID: 35998237 DOI: 10.1080/07317115.2022.2115433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES This program evaluation examined the feasibility, acceptability, and preliminary effects of an individualized coaching program to help older Veterans use VA mental health mobile apps to address mental health and well-being goals. METHODS The program delivers individual technical and clinical support to facilitate the use of mobile devices and VA apps. Participants completed assessments of mobile device proficiency, app use frequency, app comfort, quality of life, and mental health symptoms (completed by a subset, n = 11) pre- and post-participation. RESULTS Of 24 enrollees, 17 completed the program and received an average of 7.58 (SD = 2.87) sessions including the initial assessment. Mobile device proficiency (t (16) = -3.80, p = .002) and number of days/week apps were used (t (16) = -2.34, p = .032) increased significantly from pre- to post-participation. Depressive and anxiety scores decreased significantly (t (10) = 3.16, p = .010; t (10) = 3.29, p = .008) among the subset completing those measures. Overall satisfaction was high; 100% reported they would recommend the program. CONCLUSIONS Findings suggest the program is feasible, highly acceptable, and increases mobile device proficiency and use of apps. CLINICAL IMPLICATIONS Coaching programs can equip older adults with the skills to use mental health apps.
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Affiliation(s)
- Ana J Alfaro
- VA Palo Alto Health Care System, Geriatric Research, Education and Clinical Center (GRECC), Palo Alto, California, USA
- Department of Psychiatry and Behavioral Services, Stanford University School of Medicine, Palo Alto, California, USA
| | - Erin Sakai
- VA Palo Alto Health Care System, Geriatric Research, Education and Clinical Center (GRECC), Palo Alto, California, USA
- Department of Psychiatry and Behavioral Services, Stanford University School of Medicine, Palo Alto, California, USA
- Psychology Service, VA Palo Alto Health Care System, Palo Alto, California, USA
| | - Chalise Carlson
- VA Palo Alto Health Care System, Geriatric Research, Education and Clinical Center (GRECC), Palo Alto, California, USA
| | - Priyanka S Mehta
- VA Palo Alto Health Care System, Geriatric Research, Education and Clinical Center (GRECC), Palo Alto, California, USA
| | - Jason Anderson
- Psychology Service, VA Palo Alto Health Care System, Palo Alto, California, USA
| | - Matthew Wynn
- Psychology Service, VA Palo Alto Health Care System, Palo Alto, California, USA
| | - Christine E Gould
- VA Palo Alto Health Care System, Geriatric Research, Education and Clinical Center (GRECC), Palo Alto, California, USA
- Department of Psychiatry and Behavioral Services, Stanford University School of Medicine, Palo Alto, California, USA
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Roddy MK, Chen PV, Fletcher TL, Wassef M, Lindsay JA, Cloitre M, Hogan JB. Coaching with Internet-Based Mental Health Program: Patient and Coach Experiences. Telemed J E Health 2023; 29:1853-1861. [PMID: 37219868 DOI: 10.1089/tmj.2023.0116] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2023] Open
Abstract
Introduction: The COVID-19 pandemic has laid bare the need for mental health treatment and the shortage of available providers. Internet-based, asynchronous mental health programs that incorporate coaching with a licensed provider address this widespread challenge. This study provides an in-depth exploration of both the patient and provider experience in webSTAIR, a coached, internet-based psychoeducational program, where coaching took place over video-telehealth. We focus on how patients and licensed mental health providers understood their coaching relationship in an internet-based mental health program. Materials and Methods: We interviewed a purposive sample of 60 patients who completed the coached, internet-based program and all 9 providers who provided coaching from 2017 to 2020. The project team and interviewers took notes during interviews. Patient interviews were studied using content and matrix analysis. Coach interviews were studied using thematic analysis. Results: Interviews across patients and coaches reveal the continued importance of relationship building and rapport and emphasized the central role of the coach in providing content clarification and application of skills. Discussion: For patients, coaches were critical for understanding and completing the internet-based program. As well, positive relationship with their coach further enhanced their experience in the program. Providers echoed the importance of relationship building and rapport for program success and saw their main role as helping patients to understand content and apply skills.
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Affiliation(s)
- McKenzie K Roddy
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Patricia V Chen
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas, USA
| | - Terri L Fletcher
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas, USA
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA
- VA South Central Mental Illness Research, Education and Clinical Center, Houston, Texas, USA
| | - Miryam Wassef
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas, USA
| | - Jan A Lindsay
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas, USA
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA
- VA South Central Mental Illness Research, Education and Clinical Center, Houston, Texas, USA
| | | | - Julianna B Hogan
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas, USA
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Stephenson KR, Latimer SRE, Zippan NL, Brotto LA. History of Sexual Assault as a Predictor of Response to a Self-Guided Online Program for Sexual Desire and Arousal Difficulties in Women. ARCHIVES OF SEXUAL BEHAVIOR 2023; 52:3379-3391. [PMID: 37697093 DOI: 10.1007/s10508-023-02685-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 07/29/2023] [Accepted: 08/02/2023] [Indexed: 09/13/2023]
Abstract
Sexual Interest/Arousal Disorder (distressing, long-lasting impairments in sexual desire and/or arousal) is common in women, but few have access to efficacious psychotherapies, including cognitive-behavioral therapy (CBT) and mindfulness-based therapy (MBT). eSense, an online program meant to maximize treatment access, has been shown to be a feasible, satisfactory, and potentially efficacious intervention. However, subpopulations such as sexual assault survivors may find the program less usable or efficacious. The current study compared women with and without a history of sexual assault (SA) regarding their ability to use and benefit from eSense. Forty-four women (22 with a history of SA; M age = 34.20 years) used eSense (CBT or MBT) and completed validated self-report scales of sexual function, sexual distress, treatment satisfaction, and homework compliance. A history of SA did not predict differences in attrition or changes in clinical outcomes. Exploratory analyses suggested that women with a history of SA reported slightly higher difficulty completing homework assignments, but also slightly higher treatment satisfaction. These preliminary results suggest that eSense may be usable and helpful for women with a history of SA. We discuss ways to maximize the acceptability and efficacy of online programs for women with a history of SA.
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Affiliation(s)
- Kyle R Stephenson
- School of Psychology, Xavier University, 3800 Victory Parkway, Cincinnati, OH, 45207, USA.
| | | | - Natasha L Zippan
- Department of Psychology, Queen's University, Kingston, ON, Canada
| | - Lori A Brotto
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada
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Han HJ, Mendu S, Jaworski BK, Owen JE, Abdullah S. Preliminary Evaluation of a Conversational Agent to Support Self-management of Individuals Living With Posttraumatic Stress Disorder: Interview Study With Clinical Experts. JMIR Form Res 2023; 7:e45894. [PMID: 37247220 DOI: 10.2196/45894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 04/26/2023] [Accepted: 04/27/2023] [Indexed: 05/30/2023] Open
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) is a serious public health concern. However, individuals with PTSD often do not have access to adequate treatment. A conversational agent (CA) can help to bridge the treatment gap by providing interactive and timely interventions at scale. Toward this goal, we have developed PTSDialogue-a CA to support the self-management of individuals living with PTSD. PTSDialogue is designed to be highly interactive (eg, brief questions, ability to specify preferences, and quick turn-taking) and supports social presence to promote user engagement and sustain adherence. It includes a range of support features, including psychoeducation, assessment tools, and several symptom management tools. OBJECTIVE This paper focuses on the preliminary evaluation of PTSDialogue from clinical experts. Given that PTSDialogue focuses on a vulnerable population, it is critical to establish its usability and acceptance with clinical experts before deployment. Expert feedback is also important to ensure user safety and effective risk management in CAs aiming to support individuals living with PTSD. METHODS We conducted remote, one-on-one, semistructured interviews with clinical experts (N=10) to gather insight into the use of CAs. All participants have completed their doctoral degrees and have prior experience in PTSD care. The web-based PTSDialogue prototype was then shared with the participant so that they could interact with different functionalities and features. We encouraged them to "think aloud" as they interacted with the prototype. Participants also shared their screens throughout the interaction session. A semistructured interview script was also used to gather insights and feedback from the participants. The sample size is consistent with that of prior works. We analyzed interview data using a qualitative interpretivist approach resulting in a bottom-up thematic analysis. RESULTS Our data establish the feasibility and acceptance of PTSDialogue, a supportive tool for individuals with PTSD. Most participants agreed that PTSDialogue could be useful for supporting self-management of individuals with PTSD. We have also assessed how features, functionalities, and interactions in PTSDialogue can support different self-management needs and strategies for this population. These data were then used to identify design requirements and guidelines for a CA aiming to support individuals with PTSD. Experts specifically noted the importance of empathetic and tailored CA interactions for effective PTSD self-management. They also suggested steps to ensure safe and engaging interactions with PTSDialogue. CONCLUSIONS Based on interviews with experts, we have provided design recommendations for future CAs aiming to support vulnerable populations. The study suggests that well-designed CAs have the potential to reshape effective intervention delivery and help address the treatment gap in mental health.
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Affiliation(s)
- Hee Jeong Han
- College of Information Sciences and Technology, Pennsylvania State University, University Park, PA, United States
| | - Sanjana Mendu
- College of Information Sciences and Technology, Pennsylvania State University, University Park, PA, United States
| | - Beth K Jaworski
- National Center for PTSD, VA Palo Alto Health Care System, US Department of Veterans Affairs, Menlo Park, CA, United States
| | - Jason E Owen
- National Center for PTSD, VA Palo Alto Health Care System, US Department of Veterans Affairs, Menlo Park, CA, United States
| | - Saeed Abdullah
- College of Information Sciences and Technology, Pennsylvania State University, University Park, PA, United States
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Sasseville M, LeBlanc A, Tchuente J, Boucher M, Dugas M, Gisèle M, Barony R, Chouinard MC, Beaulieu M, Beaudet N, Skidmore B, Cholette P, Aspiros C, Larouche A, Chabot G, Gagnon MP. The impact of technology systems and level of support in digital mental health interventions: a secondary meta-analysis. Syst Rev 2023; 12:78. [PMID: 37143171 PMCID: PMC10157597 DOI: 10.1186/s13643-023-02241-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 04/20/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND The majority of people with a chronic disease (e.g., diabetes, hypertension, COPD) have more than one concurrent condition and are also at higher risk for developing comorbidities in mental health, including anxiety and depression. There is an urgent need for more relevant and accurate data on digital interventions in this area to prepare for an increase demand for mental health services. The aim of this study was to conduct a meta-analysis of the digital mental health interventions for people with comorbid physical and mental chronic diseases to compare the effect of technology systems and level of support. METHODS This secondary meta-analysis follows a rapid review of systematic reviews, a virtual workshop with knowledge users to identify research questions and a modified Delphi study to guide research methods: What types of digital health interventions (according to a recognized categorization) are the most effective for the management of concomitant mental health and chronic disease conditions in adults? We conducted a secondary analysis of the primary studies identified in the rapid review. Two reviewers independently screened the titles and abstracts and applied inclusion criteria: RCT design using a digital mental health intervention in a population of adults with another chronic condition, published after 2010 in French or English, and including an outcome measurement of anxiety or depression. RESULTS Seven hundred eight primary studies were extracted from the systematic reviews and 84 primary studies met the inclusion criteria Digital mental health interventions were significantly more effective than in-person care for both anxiety and depression outcomes. Online messaging was the most effective technology to improve anxiety and depression scores; however, all technology types were effective. Interventions partially supported by healthcare professionals were more effective than self-administered. CONCLUSIONS While our meta-analysis identifies digital intervention's characteristics are associated with better effectiveness, all technologies and levels of support could be used considering implementation context and population. TRIAL REGISTRATION The protocol for this review is registered in the National Collaborating Centre for Methods and Tools (NCCMT) COVID-19 Rapid Evidence Service (ID 75).
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Affiliation(s)
- Maxime Sasseville
- Université Laval-VITAM Research Center on Sustainable Health, Quebec City, Canada.
| | - Annie LeBlanc
- Université Laval-VITAM Research Center on Sustainable Health, Quebec City, Canada
| | - Jack Tchuente
- VITAM Research Center on Sustainable Health, Quebec City, Canada
| | | | - Michèle Dugas
- VITAM Research Center on Sustainable Health, Quebec City, Canada
| | | | | | | | | | - Nicolas Beaudet
- Université de Sherbrooke, Omnimed, Sherbrooke, Quebec, Canada
| | - Becky Skidmore
- Université Laval-VITAM Research Center on Sustainable Health, Quebec City, Canada
| | - Pascale Cholette
- Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale Nationale, Quebec City, Canada
| | - Christine Aspiros
- Université Laval-VITAM Research Center on Sustainable Health, Quebec City, Canada
| | - Alain Larouche
- Université Laval-VITAM Research Center on Sustainable Health, Quebec City, Canada
| | - Guylaine Chabot
- Université Laval-VITAM Research Center on Sustainable Health, Quebec City, Canada
| | - Marie-Pierre Gagnon
- Université Laval-VITAM Research Center on Sustainable Health, Quebec City, Canada
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Liu JJ, Ein N, Forchuk C, Wanklyn SG, Ragu S, Saroya S, Nazarov A, Richardson JD. A meta-analysis of internet-based cognitive behavioral therapy for military and veteran populations. BMC Psychiatry 2023; 23:223. [PMID: 37013501 PMCID: PMC10068715 DOI: 10.1186/s12888-023-04668-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 03/09/2023] [Indexed: 04/05/2023] Open
Abstract
BACKGROUND Military and veteran populations are unique in their trauma exposures, rates of mental illness and comorbidities, and response to treatments. While reviews have suggested that internet-based Cognitive Behavioral Therapy (iCBT) can be useful for treating mental health conditions, the extent to which they may be appropriate for military and veteran populations remain unclear. The goals of the current meta-analysis are to: (1) substantiate the effects of iCBT for military and veteran populations, (2) evaluate its effectiveness compared to control conditions, and (3) examine potential factors that may influence their effectiveness. METHODS This review was completed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting and Cochrane review guidelines. The literature search was conducted using PsycInfo, Medline, Embase, and Proquest Dissertation & Theses on June 4, 2021 with no date restriction. Inclusion criteria included studies that: (1) were restricted to adult military or veteran populations, (2) incorporated iCBT as the primary treatment, and (3) evaluated mental health outcomes. Exclusion criteria included: (1) literature reviews, (2) qualitative studies, (3) study protocols, (4) studies that did not include a clinical/analogue population, and (5) studies with no measure of change on outcome variables. Two independent screeners reviewed studies for eligibility. Data was pooled and analyzed using random-effects and mixed-effects models. Study data information were extracted as the main outcomes, including study condition, sample size, and pre- and post-treatment means, standard deviations for all assessed outcomes, and target outcome. Predictor information were also extracted, and included demographics information, the types of outcomes measured, concurrent treatment, dropout rate, format, length, and delivery of intervention. RESULTS A total of 20 studies and 91 samples of data were included in the meta-analysis. The pooled effect size showed a small but meaningful effect for iCBT, g = 0.54, SE = 0.04, 95% CI (0.45, 0.62), Z = 12.32, p < .001. These effects were heterogenous across samples, (I2 = 87.96), Q(90) = 747.62, p < .001. Predictor analyses found length of intervention and concurrent treatment to influence study variance within sampled studies, p < .05. Evaluation of iCBT on primary outcomes indicated a small but meaningful effect for PTSD and depression, while effects of iCBT on secondary outcomes found similar results with depression, p < .001. CONCLUSIONS Findings from the meta-analysis lend support for the use of iCBT with military and veteran populations. Conditions under which iCBT may be optimized are discussed.
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Affiliation(s)
- Jenny Jw Liu
- The MacDonald Franklin OSI Research Centre, Parkwood Institute Research, Lawson Health Research Institute, Mental Health Building, 550 Wellington Road, RM F4-367, London, ON, N6C 0A7, Canada.
- Schulich School of Medicine, University of Western Ontario, London, ON, Canada.
| | - Natalie Ein
- The MacDonald Franklin OSI Research Centre, Parkwood Institute Research, Lawson Health Research Institute, Mental Health Building, 550 Wellington Road, RM F4-367, London, ON, N6C 0A7, Canada
| | - Callista Forchuk
- The MacDonald Franklin OSI Research Centre, Parkwood Institute Research, Lawson Health Research Institute, Mental Health Building, 550 Wellington Road, RM F4-367, London, ON, N6C 0A7, Canada
| | - Sonya G Wanklyn
- Operational Stress Injury Clinic, Parkwood lnstitute, Greater Toronto Area (GTA), ON, Canada
| | - Suriya Ragu
- The MacDonald Franklin OSI Research Centre, Parkwood Institute Research, Lawson Health Research Institute, Mental Health Building, 550 Wellington Road, RM F4-367, London, ON, N6C 0A7, Canada
| | - Samdarsh Saroya
- The MacDonald Franklin OSI Research Centre, Parkwood Institute Research, Lawson Health Research Institute, Mental Health Building, 550 Wellington Road, RM F4-367, London, ON, N6C 0A7, Canada
| | - Anthony Nazarov
- The MacDonald Franklin OSI Research Centre, Parkwood Institute Research, Lawson Health Research Institute, Mental Health Building, 550 Wellington Road, RM F4-367, London, ON, N6C 0A7, Canada
- Schulich School of Medicine, University of Western Ontario, London, ON, Canada
| | - J Don Richardson
- The MacDonald Franklin OSI Research Centre, Parkwood Institute Research, Lawson Health Research Institute, Mental Health Building, 550 Wellington Road, RM F4-367, London, ON, N6C 0A7, Canada
- Schulich School of Medicine, University of Western Ontario, London, ON, Canada
- Operational Stress Injury Clinic, Parkwood lnstitute, Greater Toronto Area (GTA), ON, Canada
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Reger GM, Smolenski D, Williams R, Norr AM, Foa E, Kuhn E, Schnurr PP, Weathers F, Zoellner L. Design and methods of a randomized controlled trial evaluating the effects of the PE Coach mobile application on prolonged exposure among veterans with PTSD. Contemp Clin Trials 2023; 127:107115. [PMID: 36758935 DOI: 10.1016/j.cct.2023.107115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 02/02/2023] [Accepted: 02/05/2023] [Indexed: 02/10/2023]
Abstract
BACKGROUND Little is known about the impact of mobile applications (apps) designed to support patients progressing through an evidence-based psychotherapy. Prolonged exposure (PE) is an efficacious treatment for posttraumatic stress disorder (PTSD) and PE Coach is a treatment companion app that may increase patient engagement with the active components of PE, thereby supporting recovery. METHODS This paper describes a randomized clinical trial that will evaluate PE delivered with and without PE Coach at post-treatment, and 1-month and 4-months post-treatment. Veterans with PTSD (N = 124) will be randomized (1:1) to conditions and complete up to 15 treatment sessions based on a priori defined termination criteria. We hypothesize that compared to PE without PE Coach, PE with the app will result in greater improvements in PTSD-related social and occupational functioning (primary outcome is the PTSD-Related Functioning Inventory), quality of life, and greater reductions in functional impairment, neurobehavioral symptoms, depression, and suicidal ideation (Aim 1). We also hypothesize that including PE Coach will reduce assessor-masked PTSD symptom severity, relative to PE without the app, as assessed by the revised Clinician-Administered PTSD Scale for DSM-5 (Aim 2). We hypothesize that PE Coach will facilitate increased treatment adherence, as measured by completion of PE homework (Aim 3). We will explore the impact of PE Coach on treatment engagement, as measured by reduced treatment dropout. CONCLUSION Data on the outcomes of PE Coach can inform dissemination efforts and help evaluate the return on investment to guide future mental health app development. CLINICAL TRIAL REGISTRATION NUMBER ClinicalTrials.govNCT04959695.
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Affiliation(s)
- Greg M Reger
- VA Puget Sound Health Care System, Seattle, WA, United States of America; University of Washington School of Medicine, Department of Psychiatry and Behavioral Sciences, Seattle, WA, United States of America.
| | - Derek Smolenski
- Psychological Health Center of Excellence, Defense Health Agency, Silver Spring, MD, United States of America
| | - Rhonda Williams
- VA Puget Sound Health Care System, Seattle, WA, United States of America; University of Washington School of Medicine, Department of Rehabilitation Medicine, Seattle, WA, United States of America
| | - Aaron M Norr
- University of Washington School of Medicine, Department of Psychiatry and Behavioral Sciences, Seattle, WA, United States of America; VISN 20 Mental Illness Research Evaluation and Clinical Center, Seattle, WA, United States of America
| | - Edna Foa
- University of Pennsylvania Perelman School of Medicine, Department of Psychiatry, PA, United States of America
| | - Eric Kuhn
- Dissemination and Training Division, National Center for PTSD, Palo Alto VA Medical Center, Palo Alto, CA, United States of America; Stanford University School of Medicine, Stanford, CA, United States of America
| | - Paula P Schnurr
- Executive Division, National Center for PTSD, White River Junction, VT, United States of America; Geisel School of Medicine at Dartmouth, Hanover, NH, United States of America
| | - Frank Weathers
- National Center for PTSD, VA Boston Health Care System, MA, United States of America
| | - Lori Zoellner
- University of Washington, Department of Psychology, Seattle, WA, United States of America
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10
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Hensler I, Sveen J, Cernvall M, Arnberg FK. Longitudinal follow-up of the randomized controlled trial of access to the trauma-focused self-management app PTSD coach. Internet Interv 2023. [DOI: 10.1016/j.invent.2023.100618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
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11
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Possemato K, Johnson E, Barrie K, Ghaus S, Noronha D, Wade M, Greenbaum MA, Rosen C, Cloitre M, Owen J, Jain S, Beehler G, Prins A, Seal K, Kuhn E. A Randomized Clinical Trial of Clinician-Supported PTSD Coach in VA Primary Care Patients. J Gen Intern Med 2023:10.1007/s11606-023-08130-6. [PMID: 36932268 PMCID: PMC10022983 DOI: 10.1007/s11606-023-08130-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 03/01/2023] [Indexed: 03/19/2023]
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) is common in primary care patients; however, evidence-based treatments are typically only available in specialty mental healthcare settings and often not accessed. OBJECTIVE To test the effectiveness of a brief primary care-based treatment, Clinician-Supported PTSD Coach (CS PTSD Coach) was compared with Primary Care Mental Health Integration-Treatment as Usual (PCMHI-TAU) in (1) reducing PTSD severity, (2) engaging veterans in specialty mental health care, and (3) patient satisfaction with care. DESIGN Multi-site randomized pragmatic clinical trial. PARTICIPANTS A total of 234 veterans with PTSD symptoms who were not currently accessing PTSD treatment. INTERVENTION CS PTSD Coach was designed to be implemented in Veterans Affairs PCMHI and combines mental health clinician support with the "PTSD Coach" mobile app. Four 30-min sessions encourage daily use of symptom management strategies. MAIN MEASURES PTSD severity was measured by clinician-rated interviews pre- and post-treatment (8 weeks). Self-report measures assessed PTSD, depression, and quality of life at pretreatment, posttreatment, and 16- and 24-week follow-ups, and patient satisfaction at post-treatment. Mental healthcare utilization was extracted from medical records. KEY RESULTS Clinician-rated PTSD severity did not differ by condition at post-treatment. CS PTSD Coach participants improved more on patient-reported PTSD severity at post-treatment than TAU participants (D = .28, p = .021). Coach participants who continued to have problematic PTSD symptoms at post-treatment were not more likely to engage in 2 sessions of specialty mental health treatment than TAU participants. Coach participants engaged in 74% more sessions in the intervention and reported higher treatment satisfaction than TAU participants (p < .001). CONCLUSIONS A structured 4-session intervention designed to align with patient preferences for care resulted in more patient-reported PTSD symptom relief, greater utilization of mental health treatment, and overall treatment satisfaction than TAU, but not more clinician-rated PTSD symptom relief or engagement in specialty mental health.
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Affiliation(s)
- Kyle Possemato
- VA Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, NY, USA.
| | - Emily Johnson
- VA Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, NY, USA
| | - Kimberly Barrie
- VA Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, NY, USA
| | | | | | - Michael Wade
- VA Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, NY, USA
| | - Mark A Greenbaum
- National Center for PTSD, Palo Alto, CA, USA
- Mental Illness Research Education and Clinical Center, VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Craig Rosen
- National Center for PTSD, Palo Alto, CA, USA
- Stanford University School of Medicine, Stanford, CA, USA
| | - Marylene Cloitre
- National Center for PTSD, Palo Alto, CA, USA
- Stanford University School of Medicine, Stanford, CA, USA
| | - Jason Owen
- National Center for PTSD, Palo Alto, CA, USA
| | - Shaili Jain
- National Center for PTSD, Palo Alto, CA, USA
- Stanford University School of Medicine, Stanford, CA, USA
| | - Gregory Beehler
- VA Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, NY, USA
| | | | - Karen Seal
- San Francisco VA Health Care System, San Francisco, USA
- University of California San Francisco, San Francisco, CA, USA
| | - Eric Kuhn
- National Center for PTSD, Palo Alto, CA, USA
- Stanford University School of Medicine, Stanford, CA, USA
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12
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Harned M, Dhami M, Reger GM. Evaluation of a Psychoeducational Group to Expand Mobile Application Knowledge and Use in a Veteran Residential Treatment Program. JOURNAL OF TECHNOLOGY IN BEHAVIORAL SCIENCE 2023; 8:118-127. [PMID: 36817623 PMCID: PMC9930040 DOI: 10.1007/s41347-023-00299-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 11/28/2022] [Accepted: 01/17/2023] [Indexed: 02/17/2023]
Abstract
Despite the availability of free, evidence-informed mental health mobile applications (apps) to support Veterans and Service Members, interventions are needed to ensure patients are aware of the developed resources. A psychoeducational group was developed and evaluated by a quality improvement project in the context of a Department of Veterans Affairs residential treatment program. Four weekly group sessions introduced 82 Veterans to two similarly themed apps at each group and supported Veteran installation, introduction to the clinical subject matter, app orientation and demonstration, and device/app troubleshooting. Although 94% owned a smartphone, prior to the group, seven of eight apps introduced during the group had been used by fewer than 10% of participants. Following group participation, the proportion of participants agreeing that they were comfortable using mental health apps increased from 33% at baseline to 75%. Similarly, relative to 54% of participants at baseline who agreed that they were aware of available mental health mobile applications, the proportion rose to 89% after the group. Most participants rated three apps as "helpful" or "very helpful" (Breath2Relax, Mindfulness Coach, and PTSD Coach) and most participants reported they were likely to use these apps in the future. Results and qualitative feedback identified needed improvements to the group, including the replacement of some featured apps and the inclusion of automated app usage metrics. Well-designed implementation studies of dissemination strategies are needed to inform best practices for the adoption of these promising interventions.
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Affiliation(s)
- Megan Harned
- grid.413919.70000 0004 0420 6540VA Puget Sound Healthcare System, 9600 Veterans Drive, Seattle/Tacoma, 98493 WA USA
| | - Mani Dhami
- grid.413919.70000 0004 0420 6540VA Puget Sound Healthcare System, 9600 Veterans Drive, Seattle/Tacoma, 98493 WA USA
| | - Greg M. Reger
- grid.413919.70000 0004 0420 6540VA Puget Sound Healthcare System, 9600 Veterans Drive, Seattle/Tacoma, 98493 WA USA ,grid.34477.330000000122986657University of Washington School of Medicine, Seattle, WA USA
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13
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McGee-Vincent P, Mackintosh MA, Jamison AL, Juhasz K, Becket-Davenport C, Bosch J, Avery TJ, Glamb L, Hampole S. Training Staff Across the Veterans Affairs Health Care System to Use Mobile Mental Health Apps: A National Quality Improvement Project. JMIR Ment Health 2023; 10:e41773. [PMID: 36633895 PMCID: PMC9880807 DOI: 10.2196/41773] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 10/19/2022] [Accepted: 10/20/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND The National Center for PTSD, within the Department of Veterans Affairs (VA), has developed a suite of free, publicly available, evidence-informed apps that can reach an increasing number of veterans and bridge gaps in care by providing resources to those who are not engaged in mental health treatment. To expand the reach of these apps, staff across VA service lines learned about these apps, their features and limitations, and how to introduce them to veterans. OBJECTIVE This study aimed to develop, disseminate, and evaluate a training for multidisciplinary staff as part of a national quality improvement project to increase the reach of mobile mental health apps as a resource for veterans. METHODS Sites from all of VA's 18 geographic regions enrolled in this project. At each site, a minimum of 25 VA staff members who had direct contact with veterans, including staff from the mental health service line and all other service lines, were recruited to participate. Training included a 3-hour multidisciplinary core module, and a 1-hour clinical integration module designed specifically for mental health clinicians. Owing to the COVID-19 pandemic, the trainings were adapted to a live, web-based format. Pre- and posttraining surveys assessed program reach (ie, participants enrolled per site), satisfaction, and effectiveness of the training as measured by changes in knowledge, basic skills, and behavioral intentions to use apps with veterans. RESULTS A total of 1110 participants representing 34 disciplines at 19 VA sites completed the training. Overall, 67% (743/1109) of participants were mental health staff members. Sites averaged 58.4 participants (SD 36.49, median [IQR] 51). Most (961/1024, 93.85%) participants were satisfied with the training and reported that they (941/1018, 92.44%) would recommend it to others. App knowledge scores significantly increased from pretraining (mean 80.8% correct, SD 15.77%) to posttraining (mean 91.1% correct, SD 9.57%; P<.001). At posttraining, participants also reported greater confidence in their ability to show veterans how to download (z=-13.86; P<.001) and use VA mental health apps (z=-15.13; P<.001). There was near universal endorsement by staff for their intentions to recommend apps to veterans as well as their ability to think of at least one specific veteran to whom they could recommend an app. Staff also reported a strong motivation to encourage other VA staff to share apps with veterans. CONCLUSIONS The training far exceeded the initial goals for staff recruitment and training for all three metrics. Overall, 33% (366/1109) of participants came from service lines outside of mental health, indicating the feasibility of introducing these mental health resources during medical appointments and in other contexts.
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Affiliation(s)
- Pearl McGee-Vincent
- Dissemination and Training Division, National Center for PTSD, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, United States.,Office of Mental Health and Suicide Prevention, Veterans Health Administration, Menlo Park, CA, United States
| | - Margaret-Anne Mackintosh
- Dissemination and Training Division, National Center for PTSD, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, United States
| | - Andrea L Jamison
- Dissemination and Training Division, National Center for PTSD, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, United States
| | - Katherine Juhasz
- Dissemination and Training Division, National Center for PTSD, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, United States.,National Training Division, Education Service, Veterans Benefits Administration, Washington, DC, United States
| | - Colleen Becket-Davenport
- Dissemination and Training Division, National Center for PTSD, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, United States.,Department of Psychiatry, Weill Cornell Medical College, New York, NY, United States
| | - Jeane Bosch
- Dissemination and Training Division, National Center for PTSD, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, United States
| | - Timothy J Avery
- Dissemination and Training Division, National Center for PTSD, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, United States.,Peninsula Vet Center, Readjustment Counselling Services, US Department of Veterans Affairs, Menlo Park, CA, United States
| | - Lauren Glamb
- Dissemination and Training Division, National Center for PTSD, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, United States.,Veterans Affairs Pacific Islands Health Care System, Honolulu, HI, United States
| | - Shilpa Hampole
- Dissemination and Training Division, National Center for PTSD, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, United States
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14
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Buis L, Etingen B, Lipschitz JM, Shimada SL, McMahon N, Bolivar D, Bixler FR, Irvin D, Wacks R, Cutrona S, Frisbee KL, Smith BM. Factors Associated With Self-reported Use of Web and Mobile Health Apps Among US Military Veterans: Cross-sectional Survey. JMIR Mhealth Uhealth 2022; 10:e41767. [PMID: 36583935 PMCID: PMC9840102 DOI: 10.2196/41767] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 10/26/2022] [Accepted: 11/22/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Despite their prevalence and reported patient interest in their use, uptake of health-related apps is limited. The Veterans Health Administration (VHA) has developed a variety of apps to support veterans; however, uptake remains low nationally. OBJECTIVE We examined the prevalence of VHA health-related app use and how veterans learned about these apps in order to identify factors associated with their use. METHODS As part of a VHA quality improvement initiative, we recruited a national cohort of veterans to obtain feedback on their use of technology for health and collected data from them via a cross-sectional survey. The survey data were supplemented with VHA administrative data. We used descriptive statistics to examine demographic and health characteristics, health-related technology use, and how veterans learned about apps. We assessed factors associated with app use using bivariate analyses and multiple logistic regression models. RESULTS We had complete data on 1259 veterans. A majority of the sample was male (1069/1259, 84.9%), aged older than 65 years (740/1259, 58.8%), White (1086/1259, 86.3%), and non-Hispanic (1218/1259, 96.7%). Most respondents (1125/1259, 89.4%) reported being very comfortable and confident using computers, over half (675/1259, 53.6%) reported being an early adopter of technology, and almost half (595/1259, 47.3%) reported having used a VHA health-related app. Just over one-third (435/1259, 34.6%) reported that their VHA care team members encouraged them to use health-related apps. Respondents reported learning about available VHA health-related apps by reading about them on the VHA's patient portal (468/1259, 37.2%), being told about them by their VHA health care team (316/1259, 25.1%), and reading about them on the VHA's website (139/1259, 11%). Veterans who self-reported having used VHA health-related apps were more likely to receive care at the VHA (OR [odds ratio] 1.3, 95% CI 1.0-1.7), be in worse health (as assessed by Hierarchical Condition Community score; OR 1.1, 95% CI 1.0-1.2), report owning a desktop or laptop computer (OR 1.8, 95% CI 1.1-3.1), have posttraumatic stress disorder (OR 1.4, 95% CI 1.1-1.9), and report having VHA health care team members encourage them to use the apps (OR 2.7, 95% CI 2.1-3.4). CONCLUSIONS We found strong associations between self-reported use by veterans of VHA health-related apps and multiple variables in our survey. The strongest association was observed between a veteran self-reporting app use and having received encouragement from their VHA health care team to use the apps. Veterans who reported receiving encouragement from their VHA care team members had nearly 3 times higher odds of using VHA apps than veterans who did not report receiving such encouragement. Our results add to growing evidence suggesting that endorsement of apps by a health care system or health care team can positively impact patient uptake and use.
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Affiliation(s)
| | - Bella Etingen
- eHealth Partnered Evaluation Initiative, Veterans Affairs Bedford Healthcare System, Bedford, MA, United States.,Center of Innovation for Complex Chronic Healthcare, Hines Veterans Affairs Hospital, Hines, IL, United States
| | - Jessica M Lipschitz
- Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States
| | - Stephanie L Shimada
- eHealth Partnered Evaluation Initiative, Veterans Affairs Bedford Healthcare System, Bedford, MA, United States.,Center for Healthcare Organization and Implementation Research, Veterans Affairs Bedford Healthcare System, Bedford, MA, United States.,Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA, United States.,Division of Health Informatics and Implementation Science, Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Nicholas McMahon
- eHealth Partnered Evaluation Initiative, Veterans Affairs Bedford Healthcare System, Bedford, MA, United States.,Center for Healthcare Organization and Implementation Research, Veterans Affairs Bedford Healthcare System, Bedford, MA, United States
| | - Derek Bolivar
- eHealth Partnered Evaluation Initiative, Veterans Affairs Bedford Healthcare System, Bedford, MA, United States.,Center for Healthcare Organization and Implementation Research, Veterans Affairs Bedford Healthcare System, Bedford, MA, United States
| | - Felicia R Bixler
- eHealth Partnered Evaluation Initiative, Veterans Affairs Bedford Healthcare System, Bedford, MA, United States.,Center of Innovation for Complex Chronic Healthcare, Hines Veterans Affairs Hospital, Hines, IL, United States
| | - Dawn Irvin
- eHealth Partnered Evaluation Initiative, Veterans Affairs Bedford Healthcare System, Bedford, MA, United States.,Center of Innovation for Complex Chronic Healthcare, Hines Veterans Affairs Hospital, Hines, IL, United States
| | - Rachel Wacks
- eHealth Partnered Evaluation Initiative, Veterans Affairs Bedford Healthcare System, Bedford, MA, United States.,Center for Healthcare Organization and Implementation Research, Veterans Affairs Bedford Healthcare System, Bedford, MA, United States
| | - Sarah Cutrona
- eHealth Partnered Evaluation Initiative, Veterans Affairs Bedford Healthcare System, Bedford, MA, United States.,Center for Healthcare Organization and Implementation Research, Veterans Affairs Bedford Healthcare System, Bedford, MA, United States.,Division of Health Informatics and Implementation Science, Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Kathleen L Frisbee
- eHealth Partnered Evaluation Initiative, Veterans Affairs Bedford Healthcare System, Bedford, MA, United States.,Office of Connected Care, Veterans Health Administration, US Department of Veterans Affairs, Washington, DC, United States
| | - Bridget M Smith
- eHealth Partnered Evaluation Initiative, Veterans Affairs Bedford Healthcare System, Bedford, MA, United States.,Center of Innovation for Complex Chronic Healthcare, Hines Veterans Affairs Hospital, Hines, IL, United States.,Northwestern University Feinberg School of Medicine, Chicago, IL, United States
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15
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Rennick-Egglestone S, Newby C, Robinson C, Yeo C, Ng F, Elliott R, Ali Y, Llewellyn-Beardsley J, Pomberth S, Harrison J, Gavan SP, Cuijpers P, Priebe S, Hall C, Slade M. Differences between online trial participants who have used statutory mental health services and who have not: analysis of baseline data from two pragmatic trials of a digital health intervention (Preprint). J Med Internet Res 2022. [DOI: 10.2196/44687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023] Open
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16
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McLean C, Davis CA, Miller M, Ruzek J, Neri E. The Effects of an Exposure-Based Mobile App on Symptoms of Posttraumatic Stress Disorder in Veterans: Pilot Randomized Controlled Trial. JMIR Mhealth Uhealth 2022; 10:e38951. [PMID: 36331540 PMCID: PMC9675013 DOI: 10.2196/38951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 09/09/2022] [Accepted: 10/06/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Barriers to accessing in-person care can prevent veterans with posttraumatic stress disorder (PTSD) from receiving trauma-focused treatments such as exposure therapy. Mobile apps may help to address unmet need for services by offering tools for users to self-manage PTSD symptoms. Renew is a mobile mental health app that focuses on exposure therapy and incorporates a social support function designed to promote user engagement. OBJECTIVE We examined the preliminary efficacy of Renew with and without support from a research staff member compared with waitlist among 93 veterans with clinically significant PTSD symptoms. We also examined the impact of study staff support on participant engagement with the app. METHODS In a pilot randomized controlled trial, we compared Renew with and without support from a research staff member (active use condition) with waitlist (delayed use condition) over 6 weeks. Participants were recruited through online advertisements. The Posttraumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) was used to measure PTSD symptoms at pre, post, and 6-week follow-up. Usage data were collected to assess engagement with Renew. RESULTS Results indicated a small effect size (d=-0.39) favoring those in the active use conditions relative to the delayed use condition, but the between-group difference was not significant (P=.29). There were no differences on indices of app engagement between the 2 active use conditions. Exploratory analyses found that the number of support persons users added to the app, but not the number of support messages received, was positively correlated with app engagement. CONCLUSIONS Findings suggest Renew may hold promise as a self-management tool to reduce PTSD symptoms in veterans. Involving friends and family in mobile mental health apps may help bolster engagement with no additional cost to public health systems. TRIAL REGISTRATION ClinicalTrials.gov NCT04155736; https://clinicaltrials.gov/ct2/show/NCT04155736.
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Affiliation(s)
- Carmen McLean
- National Center for Posttraumatic Stress Disorder, Dissemination and Training Division, Department of Veterans Affairs, Menlo Park, CA, United States
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, United States
| | - C Adrian Davis
- National Center for Posttraumatic Stress Disorder, Dissemination and Training Division, Department of Veterans Affairs, Menlo Park, CA, United States
| | - Madeleine Miller
- National Center for Posttraumatic Stress Disorder, Dissemination and Training Division, Department of Veterans Affairs, Menlo Park, CA, United States
| | - Josef Ruzek
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, United States
- Department of Psychology, University of Colorado, Colorado Springs, CO, United States
| | - Eric Neri
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, United States
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17
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Sysko R, Michaelides A, Costello K, Herron DM, Hildebrandt T. An Initial Test of the Efficacy of a Digital Health Intervention for Bariatric Surgery Candidates. Obes Surg 2022; 32:3641-3649. [PMID: 36074201 PMCID: PMC10312669 DOI: 10.1007/s11695-022-06258-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 08/22/2022] [Accepted: 08/25/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Rigorous research on smartphone apps for individuals pursuing bariatric surgery is limited. A digital health intervention was recently developed using standard behavioral weight loss programs with specific modifications for bariatric surgery. The current study evaluated this intervention for improving diet, exercise, and psychosocial health over 8 weeks prior to surgery in an academic medical center. METHODS Fifty patients were randomized to receive either the digital intervention or treatment as usual prior to a surgical procedure. Measures of anxiety, depression, stress, quality of life, physical activity, and diet were administered at baseline and at 8-week follow-up. Statistical power of 80% estimated for N = 50 to detect ES = 0.68 with alpha = 0.05. RESULTS Results of intent-to-treat (N = 50 baseline, N = 36 follow-up) analyses indicated significant moderate differences in stress and anxiety (ES = - 0.58 to - 0.62) favoring the digital intervention. Effects of the program on total daily calories consumed, body mass index, quality of life, and eating disorder symptoms were small (ES = - 0.24 to 0.33) and not significant. Given small effects for these domains, the sample size of the study likely affected the ability to detect significant differences. CONCLUSIONS The digital health intervention appears to significantly impact several measures of physical activity and emotional functioning in candidates for bariatric surgery, which could augment surgical outcomes.
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Affiliation(s)
- Robyn Sysko
- Center of Excellence for Eating and Weight Disorders, Icahn School of Medicine at Mount Sinai, One Gustave L Levy Place, Box 1230, New York, NY, 10029, USA.
| | | | - Kayla Costello
- Center of Excellence for Eating and Weight Disorders, Icahn School of Medicine at Mount Sinai, One Gustave L Levy Place, Box 1230, New York, NY, 10029, USA
| | - Daniel M Herron
- Garlock Division of General Surgery, Icahn School of Medicine at Mount Sinai, 5 East 98th Street, 3rd Fl, New York, NY, 10029, USA
| | - Tom Hildebrandt
- Center of Excellence for Eating and Weight Disorders, Icahn School of Medicine at Mount Sinai, One Gustave L Levy Place, Box 1230, New York, NY, 10029, USA
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18
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Leach B, Parkinson S, Gkousis E, Abel G, Atherton H, Campbell J, Clark C, Cockcroft E, Marriott C, Pitchforth E, Sussex J. Digital Facilitation to Support Patient Access to Web-Based Primary Care Services: Scoping Literature Review. J Med Internet Res 2022; 24:e33911. [PMID: 35834301 PMCID: PMC9335178 DOI: 10.2196/33911] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 02/15/2022] [Accepted: 04/10/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The use of web-based services within primary care (PC) in the National Health Service in England is increasing, with medically underserved populations being less likely to engage with web-based services than other patient groups. Digital facilitation-referring to a range of processes, procedures, and personnel that seek to support patients in the uptake and use of web-based services-may be a way of addressing these challenges. However, the models and impact of digital facilitation currently in use are unclear. OBJECTIVE This study aimed to identify, characterize, and differentiate between different approaches to digital facilitation in PC; establish what is known about the effectiveness of different approaches; and understand the enablers of digital facilitation. METHODS Adopting scoping review methodology, we searched academic databases (PubMed, EMBASE, CINAHL, Web of Science, and Cochrane Library) and gray literature published between 2015 and 2020. We conducted snowball searches of reference lists of included articles and articles identified during screening as relevant to digital facilitation, but which did not meet the inclusion criteria because of article type restrictions. Titles and abstracts were independently screened by 2 reviewers. Data from eligible studies were analyzed using a narrative synthesis approach. RESULTS A total of 85 publications were included. Most (71/85, 84%) were concerned with digital facilitation approaches targeted at patients (promotion of services, training patients to improve their technical skills, or other guidance and support). Further identified approaches targeted PC staff to help patients (eg, improving staff knowledge of web-based services and enhancing their technical or communication skills). Qualitative evidence suggests that some digital facilitation may be effective in promoting the uptake and use of web-based services by patients (eg, recommendation of web-based services by practice staff and coaching). We found little evidence that providing patients with initial assistance in registering for or accessing web-based services leads to increased long-term use. Few studies have addressed the effects of digital facilitation on health care inequalities. Those that addressed this suggested that providing technical training for patients could be effective, at least in part, in reducing inequalities, although not entirely. Factors affecting the success of digital facilitation include perceptions of the usefulness of the web-based service, trust in the service, patients' trust in providers, the capacity of PC staff, guidelines or regulations supporting facilitation efforts, and staff buy-in and motivation. CONCLUSIONS Digital facilitation has the potential to increase the uptake and use of web-based services by PC patients. Understanding the approaches that are most effective and cost-effective, for whom, and under what circumstances requires further research, including rigorous evaluations of longer-term impacts. As efforts continue to increase the use of web-based services in PC in England and elsewhere, we offer an early typology to inform conceptual development and evaluations. TRIAL REGISTRATION PROSPERO International Prospective Register of Systematic Reviews CRD42020189019; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=189019.
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Affiliation(s)
| | | | | | - Gary Abel
- University of Exeter Medical School, Exeter, United Kingdom
| | | | - John Campbell
- University of Exeter Medical School, Exeter, United Kingdom
| | | | - Emma Cockcroft
- University of Exeter Medical School, Exeter, United Kingdom
| | - Christine Marriott
- National Institute of Health and Care Research Collaboration South West Peninsula Patient Engagement Group, University of Exeter Medical School, Exeter, United Kingdom
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19
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Mavragani A, Weingarden H, Wolfe EC, Hall MD, Snorrason I, Wilhelm S. Human Support in App-Based Cognitive Behavioral Therapies for Emotional Disorders: Scoping Review. J Med Internet Res 2022; 24:e33307. [PMID: 35394434 PMCID: PMC9034419 DOI: 10.2196/33307] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 01/18/2022] [Accepted: 01/31/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Smartphone app-based therapies offer clear promise for reducing the gap in available mental health care for people at risk for or people with mental illness. To this end, as smartphone ownership has become widespread, app-based therapies have become increasingly common. However, the research on app-based therapies is lagging behind. In particular, although experts suggest that human support may be critical for increasing engagement and effectiveness, we have little systematic knowledge about the role that human support plays in app-based therapy. It is critical to address these open questions to optimally design and scale these interventions. OBJECTIVE The purpose of this study is to provide a scoping review of the use of human support or coaching in app-based cognitive behavioral therapy for emotional disorders, identify critical knowledge gaps, and offer recommendations for future research. Cognitive behavioral therapy is the most well-researched treatment for a wide range of concerns and is understood to be particularly well suited to digital implementations, given its structured, skill-based approach. METHODS We conducted systematic searches of 3 databases (PubMed, PsycINFO, and Embase). Broadly, eligible articles described a cognitive behavioral intervention delivered via smartphone app whose primary target was an emotional disorder or problem and included some level of human involvement or support (coaching). All records were reviewed by 2 authors. Information regarding the qualifications and training of coaches, stated purpose and content of the coaching, method and frequency of communication with users, and relationship between coaching and outcomes was recorded. RESULTS Of the 2940 titles returned by the searches, 64 (2.18%) were eligible for inclusion. This review found significant heterogeneity across all of the dimensions of coaching considered as well as considerable missing information in the published articles. Moreover, few studies had qualitatively or quantitatively evaluated how the level of coaching impacts treatment engagement or outcomes. Although users tend to self-report that coaching improves their engagement and outcomes, there is limited and mixed supporting quantitative evidence at present. CONCLUSIONS Digital mental health is a young but rapidly expanding field with great potential to improve the reach of evidence-based care. Researchers across the reviewed articles offered numerous approaches to encouraging and guiding users. However, with the relative infancy of these treatment approaches, this review found that the field has yet to develop standards or consensus for implementing coaching protocols, let alone those for measuring and reporting on the impact. We conclude that coaching remains a significant hole in the growing digital mental health literature and lay out recommendations for future data collection, reporting, experimentation, and analysis.
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Affiliation(s)
| | - Hilary Weingarden
- Massachusetts General Hospital, Boston, MA, United States.,Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Emma C Wolfe
- Massachusetts General Hospital, Boston, MA, United States
| | | | - Ivar Snorrason
- Massachusetts General Hospital, Boston, MA, United States.,Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Sabine Wilhelm
- Massachusetts General Hospital, Boston, MA, United States.,Department of Psychiatry, Harvard Medical School, Boston, MA, United States
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20
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Mavragani A, Sveen J, Cernvall M, Arnberg FK. Efficacy, Benefits, and Harms of a Self-management App in a Swedish Trauma-Exposed Community Sample (PTSD Coach): Randomized Controlled Trial. J Med Internet Res 2022; 24:e31419. [PMID: 35353052 PMCID: PMC9008528 DOI: 10.2196/31419] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 12/19/2021] [Accepted: 01/05/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Self-guided interventions may complement and overcome obstacles to in-person treatment options. The efficacy of app interventions targeting posttraumatic stress disorder (PTSD) is unclear, and results from previous studies on PTSD Coach-an app for managing trauma-related distress-are inconsistent. OBJECTIVE This study investigates whether access to the Swedish version of the PTSD Coach affects posttraumatic stress, depressive, and somatic symptoms. In addition, we aim to assess the perceived helpfulness, satisfaction, negative effects, response, and remission related to PTSD Coach. METHODS Adults who had experienced potentially traumatic events in the past 2 years were randomized (1:1) to have access to PTSD Coach (n=89) or be on the waitlist (n=90). We assessed clinical characteristics at baseline (semistructured interviews and self-rating scales) and after 3 months (self-rating scales). We analyzed the data in R software using linear mixed effects models, chi-square tests, and Fisher exact test. RESULTS Intention-to-treat analyses indicated that access to PTSD Coach decreased posttraumatic stress and depressive symptoms but not somatic symptoms. More participants who had access to PTSD Coach responded with clinically significant improvement and fewer instances of probable PTSD after 3 months compared with waitlist controls. Overall, participants found that PTSD Coach was slightly to moderately helpful and moderately satisfactory. Half of the intervention group (36/71, 51%) reported at least one negative reaction related to using PTSD Coach (eg, disappointment with the app or its results, arousal of stress, or distressing memories). CONCLUSIONS Using PTSD Coach may trigger symptoms among a few users; however, most of them perceived PTSD Coach as helpful and satisfactory. This study showed that having access to PTSD Coach helped improve psychological trauma-related symptoms. In addition, we have discussed implications for future research and clinical practice. TRIAL REGISTRATION ClinicalTrials.gov NCT04094922; https://clinicaltrials.gov/ct2/show/NCT04094922.
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Affiliation(s)
| | - Josefin Sveen
- National Centre for Disaster Psychiatry, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Martin Cernvall
- Psychiatry, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Filip K Arnberg
- National Centre for Disaster Psychiatry, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
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21
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Hallenbeck HW, Jaworski BK, Wielgosz J, Kuhn E, Ramsey KM, Taylor K, Juhasz K, McGee-Vincent P, Mackintosh MA, Owen JE. PTSD Coach Version 3.1: A Closer Look at the Reach, Use, and Potential Impact of This Updated Mobile Health App in the General Public. JMIR Ment Health 2022; 9:e34744. [PMID: 35348458 PMCID: PMC9006138 DOI: 10.2196/34744] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 01/24/2022] [Accepted: 01/24/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND With widespread smartphone ownership, mobile health apps (mHealth) can expand access to evidence-based interventions for mental health conditions, including posttraumatic stress disorder (PTSD). Research to evaluate new features and capabilities in these apps is critical but lags behind app development. The initial release of PTSD Coach, a free self-management app developed by the US Departments of Veterans Affairs and Defense, was found to have a positive public health impact. However, major stakeholder-driven updates to the app have yet to be evaluated. OBJECTIVE We aimed to characterize the reach, use, and potential impact of PTSD Coach Version 3.1 in the general public. As part of characterizing use, we investigated the use of specific app features, which extended previous work on PTSD Coach. METHODS We examined the naturalistic use of PTSD Coach during a 1-year observation period between April 20, 2020, and April 19, 2021, using anonymous in-app event data to generate summary metrics for users. RESULTS During the observation period, PTSD Coach was broadly disseminated to the public, reaching approximately 150,000 total users and 20,000 users per month. On average, users used the app 3 times across 3 separate days for 18 minutes in total, with steep drop-offs in use over time; a subset of users, however, demonstrated high or sustained engagement. More than half of users (79,099/128,691, 61.46%) accessed one or more main content areas of the app (ie, Manage Symptoms, Track Progress, Learn, or Get Support). Among content areas, features under Manage Symptoms (including coping tools) were accessed most frequently, by over 40% of users (53,314/128,691, 41.43% to 56,971/128,691, 44.27%, depending on the feature). Users who provided initial distress ratings (56,971/128,691, 44.27%) reported relatively high momentary distress (mean 6.03, SD 2.52, on a scale of 0-10), and the use of a coping tool modestly improved momentary distress (mean -1.38, SD 1.70). Among users who completed at least one PTSD Checklist for DSM-5 (PCL-5) assessment (17,589/128,691, 13.67%), PTSD symptoms were largely above the clinical threshold (mean 49.80, SD 16.36). Among users who completed at least two PCL-5 assessments (4989/128,691, 3.88%), PTSD symptoms decreased from the first to last assessment (mean -4.35, SD 15.29), with approximately one-third (1585/4989, 31.77%) of these users experiencing clinically significant improvements. CONCLUSIONS PTSD Coach continues to fulfill its mission as a public health resource. Version 3.1 compares favorably with version 1 on most metrics related to reach, use, and potential impact. Although benefits appear modest on an individual basis, the app provides these benefits to a large population. For mHealth apps to reach their full potential in supporting trauma recovery, future research should aim to understand the utility of individual app features and identify strategies to maximize overall effectiveness and engagement.
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Affiliation(s)
- Haijing Wu Hallenbeck
- Dissemination and Training Division, National Center for Posttraumatic Stress Disorder, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, United States.,Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
| | - Beth K Jaworski
- Dissemination and Training Division, National Center for Posttraumatic Stress Disorder, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, United States
| | - Joseph Wielgosz
- Dissemination and Training Division, National Center for Posttraumatic Stress Disorder, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, United States.,Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States.,Sierra Pacific Mental Illness Research Education and Clinical Center, Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA, United States
| | - Eric Kuhn
- Dissemination and Training Division, National Center for Posttraumatic Stress Disorder, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, United States.,Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
| | - Kelly M Ramsey
- Dissemination and Training Division, National Center for Posttraumatic Stress Disorder, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, United States
| | - Katherine Taylor
- Dissemination and Training Division, National Center for Posttraumatic Stress Disorder, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, United States
| | - Katherine Juhasz
- Dissemination and Training Division, National Center for Posttraumatic Stress Disorder, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, United States
| | - Pearl McGee-Vincent
- Dissemination and Training Division, National Center for Posttraumatic Stress Disorder, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, United States
| | - Margaret-Anne Mackintosh
- Dissemination and Training Division, National Center for Posttraumatic Stress Disorder, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, United States
| | - Jason E Owen
- Dissemination and Training Division, National Center for Posttraumatic Stress Disorder, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, United States
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22
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Kirk MA, Taha B, Dang K, McCague H, Hatzinakos D, Katz J, Ritvo P. A Web-Based Cognitive Behavioral Therapy, Mindfulness Meditation, and Yoga Intervention for Posttraumatic Stress Disorder: Single-Arm Experimental Clinical Trial. JMIR Ment Health 2022; 9:e26479. [PMID: 34499613 PMCID: PMC8922150 DOI: 10.2196/26479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 06/16/2021] [Accepted: 07/07/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) is a debilitating, undertreated condition. The web-based delivery of cognitive behavioral therapy supplemented with mindfulness meditation and yoga is a viable treatment that emphasizes self-directed daily practice. OBJECTIVE This study aims to examine the effectiveness of a web-based cognitive behavioral therapy, mindfulness, and yoga (CBT-MY) program designed for daily use. METHODS We conducted an 8-week, single-arm, experimental, registered clinical trial on adults reporting PTSD symptoms (n=22; aged 18-35 years). Each participant received web-based CBT-MY content and an hour of web-based counseling each week. Pre-post outcomes included self-reported PTSD symptom severity, depression, anxiety, chronic pain, and mindfulness. Pre-post psychophysiological outcomes included peak pupil dilation (PPD) and heart rate variability (HRV). HRV and PPD were also compared with cross-sectional data from a non-PTSD comparison group without a history of clinical mental health diagnoses and CBT-MY exposure (n=46). RESULTS Pre-post intention-to-treat analyses revealed substantial improvements in PTSD severity (d=1.60), depression (d=0.83), anxiety (d=0.99), and mindfulness (d=0.88). Linear multilevel mixed models demonstrated a significant pre-post reduction in PPD (B=-0.06; SE=0.01; P<.001; d=0.90) but no significant pre-post change in HRV (P=.87). Overall, participants spent an average of 11.53 (SD 22.76) min/day on self-directed mindfulness practice. CONCLUSIONS Web-based CBT-MY was associated with clinically significant symptom reductions and significant PPD changes, suggesting healthier autonomic functioning. Future randomized controlled trials are needed to further examine the gains apparent in this single-arm study. TRIAL REGISTRATION ClinicalTrials.gov NCT03684473; https://clinicaltrials.gov/ct2/show/NCT03684473.
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Affiliation(s)
- Megan A Kirk
- School of Kinesiology and Health Sciences, York University, Toronto, ON, Canada.,Yale Center for Emotional Intelligence, Yale School of Medicine, Yale University, New Haven, CT, United States
| | - Bilal Taha
- Department of Electrical and Computer Engineering, Faculty of Applied Science and Engineering, University of Toronto, Toronto, ON, Canada
| | - Kevin Dang
- School of Kinesiology and Health Sciences, York University, Toronto, ON, Canada
| | - Hugh McCague
- Institute for Social Research, York University, Toronto, ON, Canada
| | - Dimitrios Hatzinakos
- Department of Electrical and Computer Engineering, Faculty of Applied Science and Engineering, University of Toronto, Toronto, ON, Canada
| | - Joel Katz
- Department of Psychology, York University, Toronto, ON, Canada
| | - Paul Ritvo
- School of Kinesiology and Health Sciences, York University, Toronto, ON, Canada.,Department of Psychology, York University, Toronto, ON, Canada
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23
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Voth M, Chisholm S, Sollid H, Jones C, Smith-MacDonald L, Brémault-Phillips S. Efficacy, Effectiveness, and Quality of Resilience-Building Mobile Health Apps for Military, Veteran, and Public Safety Personnel Populations: Scoping Literature Review and App Evaluation. JMIR Mhealth Uhealth 2022; 10:e26453. [PMID: 35044307 PMCID: PMC8811698 DOI: 10.2196/26453] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 10/09/2021] [Accepted: 11/19/2021] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Military members (MMs) and public safety personnel (PSP) are vulnerable to occupational stress injuries because of their job demands. When MMs and PSP transition out of these professions, they may continue to experience mental health challenges. The development and implementation of resilience-building mobile health (mHealth) apps as an emergent mental health intervention platform has allowed for targeted, cost-effective, and easily accessible treatment when in-person therapy may be limited or unavailable. However, current mHealth app development is not regulated, and often lacks both clear evidence-based research and the input of health care professionals. OBJECTIVE This study aims to evaluate the evidence-based quality, efficacy, and effectiveness of resilience-building mobile apps targeted toward the MMs, PSP, and veteran populations via a scoping literature review of the current evidence base regarding resilience apps for these populations and an evaluation of free resilience apps designed for use among these populations. METHODS The studies were selected using a comprehensive search of MEDLINE, CINAHL Plus, PsycINFO, SocINDEX, Academic Search Complete, Embase, and Google and were guided by PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews). A narrative synthesis of the resulting papers was performed. The Alberta Rating Index for Apps was used to conduct a review of each of the identified apps. The inclusion criteria consisted of apps that were free to download in either the Google Play Store or the Apple App Store; updated within the last 3 years; available in English and in Canada; and intended for use by MMs, veterans, and PSP. RESULTS In total, 22 apps met the inclusion criteria for evaluation. The resilience strategies offered by most apps included psychoeducation, mindfulness, cognitive behavioral therapy, and acceptance and commitment therapy. Overall, 50% (11/22) of apps had been tested in randomized controlled trials, 7 (32%) apps had been evaluated using other research methods, and 5 (23%) apps had not been studied. Using the Alberta Rating Index for Apps, the app scores ranged from 37 to 56 out of 72, with higher rated apps demonstrating increased usability and security features. CONCLUSIONS The mHealth apps reviewed are well-suited to providing resilience strategies for MMs, PSP, and veterans. They offer easy accessibility to evidence-based tools while working to encourage the use of emotional and professional support with safety in mind. Although not intended to function as a substitute for professional services, research has demonstrated that mHealth apps have the potential to foster a significant reduction in symptom severity for posttraumatic stress disorder, depression, anxiety, and other mental health conditions. In clinical practice, apps can be used to supplement treatment and provide clients with population-specific confidential tools to increase engagement in the treatment process.
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Affiliation(s)
- Melissa Voth
- Heroes in Mind, Advocacy and Research Consortium, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
- Department of Occupational Therapy, Faculty of Rehabilitation, University of Alberta, Edmonton, AB, Canada
| | - Shannon Chisholm
- Department of Occupational Therapy, Faculty of Rehabilitation, University of Alberta, Edmonton, AB, Canada
| | - Hannah Sollid
- Department of Occupational Therapy, Faculty of Rehabilitation, University of Alberta, Edmonton, AB, Canada
| | - Chelsea Jones
- Heroes in Mind, Advocacy and Research Consortium, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
- Leiden University Medical Centre, Leiden University, Leiden, Netherlands
- Operational Stress Injury Clinic, Alberta Health Services, Edmonton, AB, Canada
| | - Lorraine Smith-MacDonald
- Heroes in Mind, Advocacy and Research Consortium, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
- Department of Occupational Therapy, Faculty of Rehabilitation, University of Alberta, Edmonton, AB, Canada
| | - Suzette Brémault-Phillips
- Heroes in Mind, Advocacy and Research Consortium, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
- Department of Occupational Therapy, Faculty of Rehabilitation, University of Alberta, Edmonton, AB, Canada
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24
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Henderson E. Conceptualizing Suicide Prevention in Firefighters Through the lens of the Interpersonal-Psychological Theory of Suicide: A Narrative Review. Arch Suicide Res 2022; 26:28-43. [PMID: 32589858 DOI: 10.1080/13811118.2020.1779152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Suicide is the 10th leading cause of death in the United States and is a significant public health problem. Suicide has also become a major concern among career American firefighters with rates for suicidal ideation and attempts in firefighters two to three times higher than rates in the general population. Firefighter suicide and mental health are major issues facing fire service leaders, mental health professionals, and most recently suicide experts. Despite an increased focus on understanding suicide in the fire service, there is little empirical evidence on the effectiveness of prevention in this population. The juxtaposition of elevated suicide rates with a dearth of empirical prevention data specific to firefighters warrants new approaches and conceptualizations of suicide prevention in this population. Grounded in the framework of the interpersonal-psychological theory of suicide (IPTS), this narrative review integrates select relevant firefighter specific suicide risk/protective factors and multi-level intervention/prevention literature to provide a structured approach to identifying current suicide intervention/prevention efforts with promising transportability to firefighters. Several recommendations for future intervention research specific to firefighters are also proposed.
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25
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Tong F, Lederman R, D'Alfonso S, Berry K, Bucci S. Digital Therapeutic Alliance With Fully Automated Mental Health Smartphone Apps: A Narrative Review. Front Psychiatry 2022; 13:819623. [PMID: 35815030 PMCID: PMC9256980 DOI: 10.3389/fpsyt.2022.819623] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 05/30/2022] [Indexed: 11/29/2022] Open
Abstract
Fully automated mental health smartphone apps show strong promise in increasing access to psychological support. Therefore, it is crucial to understand how to make these apps effective. The therapeutic alliance (TA), or the relationship between healthcare professionals and clients, is considered fundamental to successful treatment outcomes in face-to-face therapy. Thus, understanding the TA in the context of fully automated apps would bring us insights into building effective smartphone apps which engage users. However, the concept of a digital therapeutic alliance (DTA) in the context of fully automated mental health smartphone apps is nascent and under-researched, and only a handful of studies have been published in this area. In particular, no published review paper examined the DTA in the context of fully automated apps. The objective of this review was to integrate the extant literature to identify research gaps and future directions in the investigation of DTA in relation to fully automated mental health smartphone apps. Our findings suggest that the DTA in relation to fully automated smartphone apps needs to be conceptualized differently to traditional face-to-face TA. First, the role of bond in the context of fully automated apps is unclear. Second, human components of face-to-face TA, such as empathy, are hard to achieve in the digital context. Third, some users may perceive apps as more non-judgmental and flexible, which may further influence DTA formation. Subdisciplines of computer science, such as affective computing and positive computing, and some human-computer interaction (HCI) theories, such as those of persuasive technology and human-app attachment, can potentially help to foster a sense of empathy, build tasks and goals and develop bond or an attachment between users and apps, which may further contribute to DTA formation in fully automated smartphone apps. Whilst the review produced a relatively limited quantity of literature, this reflects the novelty of the topic and the need for further research.
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Affiliation(s)
- Fangziyun Tong
- School of Computing and Information Systems, University of Melbourne, Parkville, VIC, Australia.,Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, United Kingdom
| | - Reeva Lederman
- School of Computing and Information Systems, University of Melbourne, Parkville, VIC, Australia
| | - Simon D'Alfonso
- School of Computing and Information Systems, University of Melbourne, Parkville, VIC, Australia
| | - Katherine Berry
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, United Kingdom.,Complex Trauma and Resilience Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Sandra Bucci
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, United Kingdom.,Complex Trauma and Resilience Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
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26
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Clinical wisdom in the age of computer apps: a systematic review of four functions that may complement clinical treatment. COGNITIVE BEHAVIOUR THERAPIST 2022. [DOI: 10.1017/s1754470x22000368] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
Mental health clinicians perform complex tasks with patients that potentially could be improved by the massive computing power available through mobile apps. This study aimed to analyse commercially available mobile and computer applications (apps) focused on treating psychiatric disorders. Apps were analysed by two independent raters for whether they took advantage of computer power to process data in a fashion that augments four main elements of clinical treatment including (1) assessment/diagnosis, (2) treatment planning, (3) treatment fidelity monitoring, and (4) outcome tracking. The evidence base for each of these apps was also explored via PsychINFO, Research Gate and Google Scholar. Searches of the Google Play Store, the Apple App Store, and the One Mind PsyberGuide found 722 apps labelled for mental health use, of which 163 apps were judged relevant to clinical work with patients with psychiatric disorders. Fifty-nine of these were determined to contain a computer-driven function for at least one of the four main elements of clinical treatment. The most common element was assessment/diagnosis (55/59 apps), followed by outcome tracking (34/59 apps). Six apps updated treatment plans using user input. Only one app tracked treatment fidelity. None of the apps contained computer-driven functions for all four elements. Twelve apps were supported in randomized clinical trials to show greater efficacy compared with either wait-list or other active treatments. Results showed that these four clinical elements can be meaningfully augmented, but the full potential of computer processing appears unreached in mental health-related apps.
Key learning aims
(1)
To understand what apps are currently available to treat clinical-level psychiatric problems.
(2)
To understand how many of the commercially available mental health-focused apps can be used for the treatment of clinical populations.
(3)
To understand how mental health services can be complemented by utilizing computer processing power within apps.
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27
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Bröcker E, Olff M, Suliman S, Kidd M, Mqaisi B, Greyvenstein L, Kilian S, Seedat S. A clinician-monitored 'PTSD Coach' intervention: findings from two pilot feasibility and acceptability studies in a resource-constrained setting. Eur J Psychotraumatol 2022; 13:2107359. [PMID: 36212116 PMCID: PMC9542529 DOI: 10.1080/20008066.2022.2107359] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: The high prevalence of trauma exposure and consequent post-traumatic stress disorder (PTSD) is well documented in low- and middle-income countries, and most individuals with PTSD have limited access to treatment in these settings. Freely available internet-based interventions, such as PTSD Coach (web-based and mobile application), can help to address this gap and improve access to and efficiency of care. Objective: We conducted two pilot studies to evaluate the feasibility, acceptability, and preliminary effectiveness of PTSD Coach in a South African resource-constrained context. Method: Pilot 1: Participants with PTSD (n = 10) were randomized to counsellor-supported PTSD Coach Online (PCO) or enhanced treatment as usual. Pilot 2: Participants (n = 10) were randomized to counsellor-supported PTSD Coach Mobile App or self-managed PTSD Coach Mobile App. Feasibility and acceptability were assessed by comparing attrition rates (loss to follow-up), reviewing participant and counsellor feedback contained in fieldnotes, and analysing data on the 'Perceived helpfulness of the PTSD Coach App' (Pilot 2). PTSD symptom severity was assessed with the Clinician Administered PTSD Scale for DSM-5 (CAPS-5), changes between treatment and control groups were compared, the reliable change index (RCI) was calculated, and clinically significant changes were determined. Results: Three participants in Pilot 1 and two participants in Pilot 2 were lost to follow-up. Fieldnotes indicated that PTSD Coach Mobile App addressed identified computer literacy challenges in Pilot 1 (PCO); and a shorter duration of intervention (from 8 to 4 weeks) was associated with less attrition. The RCI indicated that four participants in Pilot 1 and eight participants in Pilot 2 experienced significant improvement in PTSD symptom severity. Conclusions: The preliminary results suggest that both platforms can alleviate PTSD symptoms, and that the involvement of volunteer counsellors is beneficial. The use of PTSD Coach Mobile App may be more feasible than the online version (PCO) in our setting. HIGHLIGHTS Research on supported PTSD Coach interventions is limited in resource-constrained settings.Both volunteer counsellor-supported PTSD Coach Online and the PTSD Coach Mobile App showed preliminary reliable and clinically significant changes.The use of PTSD Coach Mobile App seems more feasible than the volunteer counsellor-supported PTSD Coach Online.
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Affiliation(s)
- Erine Bröcker
- Department of Psychiatry and MRC Genomics of Brain Disorders Unit, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Miranda Olff
- Department of Psychiatry, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Sharain Suliman
- Department of Psychiatry and MRC Genomics of Brain Disorders Unit, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Martin Kidd
- Department of Psychiatry and MRC Genomics of Brain Disorders Unit, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Busisiwe Mqaisi
- Department of Psychiatry and MRC Genomics of Brain Disorders Unit, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - L Greyvenstein
- Department of Psychiatry and MRC Genomics of Brain Disorders Unit, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Sanja Kilian
- Department of Psychiatry and MRC Genomics of Brain Disorders Unit, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Soraya Seedat
- Department of Psychiatry and MRC Genomics of Brain Disorders Unit, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Smith SK, Somers TJ, Kuhn E, Laber E, Sung AD, Syrjala KL, Feger B, Kelleher SA, Majestic C, Gebert R, LeBlanc M, Owen JE, Applebaum AJ. A SMART approach to optimizing delivery of an mHealth intervention among cancer survivors with posttraumatic stress symptoms. Contemp Clin Trials 2021; 110:106569. [PMID: 34536584 PMCID: PMC8595815 DOI: 10.1016/j.cct.2021.106569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 09/01/2021] [Accepted: 09/13/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND/AIMS Many cancer survivors who received intensive treatment such as hematopoietic stem cell transplantation (HCT) experience posttraumatic stress disorder (PTSD) symptoms. PTSD is associated with lower quality of life and other symptoms that require clinical treatment. The iterative treatment decisions that happen in clinical practice are not adequately represented in traditional randomized controlled trials (RCT) of PTSD treatments. The proposed stepped-care SMART design allows for evaluation of initial response to the Cancer Distress Coach mobile app; adaptive stepped-care interventions; and precision treatment strategies that tailor treatment selection to patient characteristics. METHODS/DESIGN HCT survivors (N = 400) reporting PTSD symptoms are being recruited at two cancer centers and randomly assigned to: 1) Cancer Distress Coach app or 2) Usual Care. The app includes educational and cognitive behavioral therapy (CBT)-based activities. Four weeks post-randomization, participants re-rate their PTSD symptoms and, based on intervention response, non-responders are re-randomized to receive video-conferenced sessions with a therapist: 3) coaching sessions in using the mobile app; or 4) CBT specific to HCT survivors. Participants complete outcome measures of PTSD, depression, and anxiety after Months 1, 3, and 6. Participant characteristics moderating intervention responses will be examined. CONCLUSIONS This novel adaptive trial design will afford evidence that furthers knowledge about optimizing PTSD interventions for HCT survivors. To our knowledge, this study is the first SMART design evaluating PTSD symptom management in cancer survivors. If successful, it could be used to optimize treatment among a range of cancer and other trauma survivors.
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Affiliation(s)
- Sophia K Smith
- School of Nursing, Duke University, Durham, NC, United States of America; Duke Cancer Institute, Duke University Medical Center, Durham, NC, United States of America.
| | - Tamara J Somers
- Duke Cancer Institute, Duke University Medical Center, Durham, NC, United States of America; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, United States of America
| | - Eric Kuhn
- Dissemination and Training Division, National Center for PTSD, Palo Alto, CA, United States of America; Department of Psychiatry and Behavioral Sciences, School of Medicine, Stanford University, Stanford, CA, United States of America
| | - Eric Laber
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, United States of America
| | - Anthony D Sung
- Duke Cancer Institute, Duke University Medical Center, Durham, NC, United States of America; Department of Medicine, Division of Hematologic Malignancies and Cellular Therapy, Duke University, Durham, NC, United States of America
| | - Karen L Syrjala
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States of America
| | - Bryan Feger
- Duke Clinical Research Institute, Durham, NC, United States of America
| | - Sarah A Kelleher
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, United States of America
| | - Catherine Majestic
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, United States of America
| | - Rebecca Gebert
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America
| | - Matthew LeBlanc
- School of Nursing, Duke University, Durham, NC, United States of America
| | - Jason E Owen
- Dissemination and Training Division, National Center for PTSD, Palo Alto, CA, United States of America
| | - Allison J Applebaum
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America; Department of Psychology in Psychiatry, Weill Cornell Medicine, New York, NY, United States of America
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Ménard F, Ouellet-Morin I, Guay S. Efficacité des applications mobiles et des messages textes comme intervention en cybersanté mentale pour les 3 blessures de stress opérationnel les plus fréquentes chez le personnel de la sécurité publique : une recension-cadre. SANTE MENTALE AU QUEBEC 2021. [DOI: 10.7202/1081518ar] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Contexte La fréquence de diagnostic probable de trouble de santé mentale est beaucoup plus haute chez le personnel de la sécurité publique (PSP) que dans la population générale, ce qui s’explique entre autres par l’exercice des fonctions opérationnelles. Les blessures de stress opérationnelles (BSO) les plus fréquentes chez les PSP au Canada sont la dépression, le trouble de stress posttraumatique et le trouble d’anxiété généralisée. Par leur caractère confidentiel et accessible, les interventions en cybersanté mentale délivrées par des téléphones intelligents (interventions mobiles) offrent un fort potentiel chez les PSP. La Commission de la santé mentale du Canada a proposé des critères évaluatifs afin de faire un examen complet des interventions mobiles, qui dépasse l’examen scientifique de l’efficacité de l’outil.
Objectifs Cette recension-cadre vise d’abord à recenser les résultats des recensions systématiques et des méta-analyses qui portent sur l’évaluation des interventions mobiles visant à diminuer les symptômes reliés à au moins une BSO chez les PSP. Ensuite, nous évaluerons les interventions mobiles ayant été étudiées auprès de PSP à l’aide des critères évaluatifs proposés par la Commission de la santé mentale du Canada, afin d’établir si leur usage peut être recommandé.
Méthode Des termes en lien avec les BSO, les technologies mobiles et les interventions ont été utilisées dans les bases de données PubMed, PsycInfo et Embase. Les articles évaluant l’efficacité des interventions mobiles en lien avec au moins une BSO et desquels il était possible d’extraire les informations nécessaires à cette recension ont été retenus. Un examen des articles inclus dans les recensions retenues a été fait afin de repérer les études réalisées auprès d’un échantillon de PSP.
Résultats La recherche de la littérature n’a relevé aucune recension qui s’intéressait particulièrement aux PSP, ce pour quoi nous avons dû élargir notre recherche à la population générale. Neuf articles correspondent aux critères d’inclusion, lesquels ont été publiés entre 2016 et 2019. De manière générale, les interventions mobiles semblent réduire de manière significative les symptômes d’anxiété, de dépression et de stress posttraumatique. Deux interventions mobiles étudiées auprès de PSP ont été identifiées, et ces dernières remplissent la majorité des critères évaluatifs.
Conclusion Les interventions mobiles recensées dans la littérature offrent un fort potentiel auprès de la population générale et auprès des PSP. Toutefois, les méta-analyses et les recensions systématiques rapportent certaines limites importantes telles qu’une hétérogénéité entre les études et un taux d’abandon élevé. Les recherches futures sur les interventions mobiles destinées aux PSP gagneraient à investiguer davantage les aspects liés à l’ergonomie, la désirabilité pour l’utilisateur et la sécurité des renseignements personnels. Les échantillons devraient également inclure une plus grande variété de professions liées à la sécurité publique.
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Affiliation(s)
- Florence Ménard
- Département de psychologie, Université de Montréal – Centre de recherche, Institut universitaire en santé mentale de Montréal (CR-IUSMM)
| | - Isabelle Ouellet-Morin
- Chaire de recherche du Canada sur les origines développementales de la vulnérabilité et de la résilience – Professeure agrégée, École de criminologie, Université de Montréal
- Chercheure affiliée à l’Institut universitaire en santé mentale de Montréal et au GRIP – Codirectrice d’AXEL : Accélérateur d’intelligence technologique en santé mentale – Centre de recherche, Institut universitaire en santé mentale de Montréal (CR-IUSMM)
| | - Stéphane Guay
- Professeur titulaire à l’École de criminologie et au Département de psychiatrie et d’addictologie – Université de Montréal – Directeur du Centre de recherche de l’Institut universitaire en santé mentale de Montréal (CR-IUSMM)
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Davison KM, Thakkar V, Lin S(L, Stabler L, MacPhee M, Carroll S, Collins B, Rezler Z, Colautti J, Xu C(C, Fuller-Thomson E, Hey B, Kelly K, Mullaly L, Remick R, Ravindran A, Paric A, D’Andreamatteo C, Smye V. Interventions to Support Mental Health among Those with Health Conditions That Present Risk for Severe Infection from Coronavirus Disease 2019 (COVID-19): A Scoping Review of English and Chinese-Language Literature. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:7265. [PMID: 34299716 PMCID: PMC8303838 DOI: 10.3390/ijerph18147265] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 06/24/2021] [Accepted: 06/24/2021] [Indexed: 12/02/2022]
Abstract
This study aimed to address knowledge gaps related to the prevention and management of mental health responses among those with a condition that presents risk of severe COVID-19 infection. A scoping review that mapped English and Chinese-language studies (2019-2020) located in MEDLINE (Ovid), Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycInfo, Sociological Abstracts, Embase, China National Knowledge Infrastructure (CNKI), Wanfang Data, and Airiti Library was undertaken. Search terms related to COVID-19, mental health, and physical health were used and articles that included all three of these factors were extracted (n = 77). With the exception of one hospital-based pilot study, there were no intervention studies targeting mental health in those at risk of severe COVID-19 infection. Promising practices such as integrated care models that appropriately screen for mental health issues, address health determinants, and include use of digital resources were highlighted. Patient navigator programs, group online medical visits, peer support, and social prescribing may also support those with complex needs. Future policies need to address digital health access inequities and the implementation of multi-integrated health and social care. Furthermore, research is needed to comprehensively assess multi-integrated interventions that are resilient to public health crises.
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Affiliation(s)
- Karen M. Davison
- Health Science Program, Kwantlen Polytechnic University, 12666 72 Ave, Surrey, BC V3W 2M8, Canada;
| | - Vidhi Thakkar
- Health Science Program, Kwantlen Polytechnic University, 12666 72 Ave, Surrey, BC V3W 2M8, Canada;
| | - Shen (Lamson) Lin
- Factor-Inwentash Faculty of Social Work, University of Toronto, 46 Bloor St W, Toronto, ON M5S 1V4, Canada; (S.L.); (E.F.-T.)
| | - Lorna Stabler
- CASCADE Children’s Social Care Research and Development Centre, School of Social Sciences, Cardiff University, 1-3 Museum Place, Cardiff CF10 3BD, UK;
| | - Maura MacPhee
- School of Nursing, University of British Columbia, T201-2211 Wesbrook Mall, Vancouver, BC V6T 2B5, Canada;
| | - Simon Carroll
- Department of Sociology, Cornett Building, University of Victoria, A333, Victoria, BC V8W 3P5, Canada;
| | - Benjamin Collins
- Department of Anthropology, University of Manitoba, 432 Fletcher Argue Building, 15 Chancellor Circle, Winnipeg, MB R3T 2N2, Canada;
| | - Zachary Rezler
- Health Sciences Program, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4K1, Canada; (Z.R.); (J.C.); (C.X.)
| | - Jake Colautti
- Health Sciences Program, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4K1, Canada; (Z.R.); (J.C.); (C.X.)
| | - Chaoqun (Cherry) Xu
- Health Sciences Program, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4K1, Canada; (Z.R.); (J.C.); (C.X.)
| | - Esme Fuller-Thomson
- Factor-Inwentash Faculty of Social Work, University of Toronto, 46 Bloor St W, Toronto, ON M5S 1V4, Canada; (S.L.); (E.F.-T.)
| | - Brandon Hey
- COVID 19 Policy, Programs and Priorities, Mental Health Commission of Canada, 350 Albert Street, Suite 1210, Ottawa, ON K1R 1A4, Canada;
| | - Krystal Kelly
- Mental Health Advancement, Mental Health Commission of Canada, 350 Albert Street, Suite 1210, Ottawa, ON K1R 1A4, Canada; (L.M.); (K.K.)
| | - Laura Mullaly
- Mental Health Advancement, Mental Health Commission of Canada, 350 Albert Street, Suite 1210, Ottawa, ON K1R 1A4, Canada; (L.M.); (K.K.)
| | - Ron Remick
- Lookout Housing and Health Society, 544 Columbia St, New Westminster, BC V3L 1B1, Canada;
| | - Arun Ravindran
- Campbell Family Mental Health Research Institute, The Centre for Addiction and Mental Health, 1001 Queen St W, Toronto, ON M6J 1H4, Canada; (A.R.); (A.P.)
| | - Angela Paric
- Campbell Family Mental Health Research Institute, The Centre for Addiction and Mental Health, 1001 Queen St W, Toronto, ON M6J 1H4, Canada; (A.R.); (A.P.)
| | - Carla D’Andreamatteo
- Department of Food and Human Nutritional Sciences, University of Manitoba, 209 Human Ecology Building, Winnipeg, MB R3T 2N2, Canada;
| | - Victoria Smye
- Arthur Labatt School of Nursing, Western University, 1151 Richmond Street, London, ON N6A 3K7, Canada;
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McGee-Vincent P, Juhasz K, Jamison AL, Avery TJ, Owen JE, Jaworski BK, Blonigen DM. Mobile Mental Health Apps from the National Center for PTSD: Digital Self-Management Tools for Co-Occurring Disorders. J Dual Diagn 2021; 17:181-192. [PMID: 34152258 DOI: 10.1080/15504263.2021.1939919] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Mobile mental health apps can help bridge gaps in access to care for those with substance use disorders and dual diagnoses. The authors describe a portfolio of free, publicly available mobile mental health apps developed by the National Center for PTSD. The authors also demonstrate how this suite of primarily non-substance use disorder-specific mobile mental health apps may support the active ingredients of substance use disorder treatment or be used for self-management of substance use disorder and related issues. The potential advantages of these apps, as well as limitations and considerations for future app development, are discussed.
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Affiliation(s)
- Pearl McGee-Vincent
- National Center for PTSD, Dissemination and Training Division, VA Palo Alto Health Care System, Menlo Park, California, USA
| | - Katherine Juhasz
- National Center for PTSD, Dissemination and Training Division, VA Palo Alto Health Care System, Menlo Park, California, USA
| | - Andrea L Jamison
- National Center for PTSD, Dissemination and Training Division, VA Palo Alto Health Care System, Menlo Park, California, USA
| | - Timothy J Avery
- National Center for PTSD, Dissemination and Training Division, VA Palo Alto Health Care System, Menlo Park, California, USA
| | - Jason E Owen
- National Center for PTSD, Dissemination and Training Division, VA Palo Alto Health Care System, Menlo Park, California, USA
| | - Beth K Jaworski
- National Center for PTSD, Dissemination and Training Division, VA Palo Alto Health Care System, Menlo Park, California, USA
| | - Daniel M Blonigen
- HSR&D Center for Innovation to Implementation, VA Palo Alto Health Care System; Menlo Park, California, USA.,Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA
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Hensler I, Sveen J, Cernvall M, Arnberg FK. Ecological momentary assessment of self-rated health, daily strategies and self-management app use among trauma-exposed adults. Eur J Psychotraumatol 2021; 12:1920204. [PMID: 34104354 PMCID: PMC8168782 DOI: 10.1080/20008198.2021.1920204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Background: The process whereby trauma-exposed people benefit from self-management apps to increase health is poorly understood. Objective: We investigated whether access to a self-management smartphone app for posttraumatic stress (PTSD Coach) improved momentary self-rated health (SRH) and if use of a self-management app or specific strategies related to SRH. Method: Participants were 179 adults in Sweden with trauma exposure in the past 2 years who were enrolled in a randomized trial of PTSD Coach versus waitlist. Ecological momentary assessments (EMA) were collected twice daily during 21 consecutive days from participants in both groups, with questions about momentary SRH as well as self-management app use and use of strategies (social support, distress management, monitoring of discomfort and seeking information) in the preceding 12 hours. Results: Overall, neither access to PTSD Coach nor reported use of an app in the preceding hours was related to SRH. Even so, people with access to PTSD Coach reported using more social support over time. Socializing and use of social support predicted greater SRH. Use of other strategies was associated with worse short-term SRH. Conclusions: Momentarily improved health relates to utilization of social support. However, the directionality of the day-to-day associations is unclear; uncertainty remains around the timing for assessing these relationships.
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Affiliation(s)
- Ida Hensler
- National Centre for Disaster Psychiatry, Department of Neuroscience, Uppsala University, Uppsala, Sweden
| | - Josefin Sveen
- National Centre for Disaster Psychiatry, Department of Neuroscience, Uppsala University, Uppsala, Sweden
| | - Martin Cernvall
- Psychiatry, Department of Neuroscience, Uppsala University, Uppsala, Sweden
| | - Filip K Arnberg
- National Centre for Disaster Psychiatry, Department of Neuroscience, Uppsala University, Uppsala, Sweden
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Connolly SL, Kuhn E, Possemato K, Torous J. Digital Clinics and Mobile Technology Implementation for Mental Health Care. Curr Psychiatry Rep 2021; 23:38. [PMID: 33961135 PMCID: PMC8103883 DOI: 10.1007/s11920-021-01254-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/26/2021] [Indexed: 12/25/2022]
Abstract
PURPOSE OF REVIEW Interest in digital mental health, especially smartphone apps, has expanded in light of limited access to mental health services and the need for remote care during COVID-19. Digital clinics, in which apps are blended into routine care, offer a potential solution to common implementation challenges including low user engagement and lack of clinical integration of apps. RECENT FINDINGS While the number of mental health apps available in commercial marketplaces continues to rise, there are few examples of successful implementation of these apps into care settings. We review one example of a digital clinic created within an academic medical center and another within the Department of Veterans Affairs. We then discuss how implementation science can inform new efforts to effectively integrate mental health technologies across diverse use cases. Integrating mental health apps into care settings is feasible but requires careful attention to multiple domains that will influence implementation success, including characteristics of the innovation (e.g., utility and complexity of the app), the recipients of the technology (e.g., patients and clinicians), and context (e.g., healthcare system buy-in, reimbursement, and regulatory policies). Examples of effective facilitation strategies that can be utilized to improve implementation efforts include co-production of technology involving all end users, specialized trainings for staff and patients, creation of new team members to aid in app usage (e.g., digital navigators), and re-design of clinical workflows.
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Affiliation(s)
- Samantha L Connolly
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Eric Kuhn
- National Center for PTSD, Dissemination and Training Division, VA Palo Alto Health Care System, Palo Alto, CA, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Kyle Possemato
- VA Center for Integrated Healthcare, Syracuse Veterans Affairs Medical Center, Syracuse, NY, USA
| | - John Torous
- Division of Digital Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02446, USA.
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Wang Y, Yang X, Chen H, Xu Y. Effect of smartphone app on post-traumatic stress disorder in COVID-19 convalescent patients: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e25479. [PMID: 33832166 PMCID: PMC8036085 DOI: 10.1097/md.0000000000025479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 03/18/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND The outbreak of Coronavirus Disease 2019 (COVID-19) seriously affects humans' health worldwide physically and mentally. Studies revealed that the prevalence of post-traumatic stress disorder (PTSD) increased under this condition. PTSD can change the structure of patients' central nervous system, and increase the risk of anxiety or depression, thus greatly affecting the quality of patients' life and their families. PTSD is preventable, and the effects of early prevention are better. Non-drug intervention can prevent or reduce the psychological sequelae after hospitalization, help patients understand the experience during hospitalization, and be beneficial to their psychological rehabilitation. Whether smartphone app based intervention can be an alternative therapy for PTSD in terms of COVID-19 convalescent patients is still controversial. Therefore, we conducted a meta-analysis and systematic review to evaluate the effects of smartphone app based intervention on PTSD in COVID-19 convalescent patients, so as to provide some guidance for clinical application. METHODS The literatures that are related to the smartphone app based intervention and PTSD in COVID-19 convalescent patients from inception to February 2021 will be searched. The following databases are our focused areas: ClinicalTrials.gov, Cochrane Central Register of Controlled Trials repositories, PubMed, EmBase, and Web of Science databases. According to the inclusion and exclusion criteria, 2 investigators would independently screen the literature extract data and evaluate the risk of bias in the included studies. Meta-analysis was performed with RevMan5.3 software. RESULTS The results of this meta-analysis will be submitted to a peer-reviewed journal for publication. CONCLUSION The conclusion of our study could provide evidence for the judgment of whether smartphone app based intervention is an effective intervention on PTSD in COVID-19 convalescent patients. PROSPERO REGISTRATION NUMBER CRD42021240340.
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Affiliation(s)
| | | | | | - Yanfang Xu
- Department of Pneumology, The Sixth People's Hospital of KunShan, KunShan 215321, Jiangsu Province, China
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Meyer A, Wisniewski H, Torous J. Coaching to Support Mental Health Apps: An Exploratory Narrative Review (Preprint). JMIR Hum Factors 2021; 9:e28301. [PMID: 35258468 PMCID: PMC8941429 DOI: 10.2196/28301] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 09/08/2021] [Accepted: 01/03/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ashley Meyer
- Division of Digital Psychiatry, Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Hannah Wisniewski
- Division of Digital Psychiatry, Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - John Torous
- Division of Digital Psychiatry, Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, United States
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Steubl L, Sachser C, Baumeister H, Domhardt M. Mechanisms of change in Internet- and mobile-based interventions for PTSD: a systematic review and meta-analysis. Eur J Psychotraumatol 2021; 12:1879551. [PMID: 34025920 PMCID: PMC8128120 DOI: 10.1080/20008198.2021.1879551] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background: While Internet- and mobile-based interventions (IMIs) are potential options to increase the access to evidence-based therapies for post-traumatic stress disorder (PTSD), comprehensive knowledge on their working mechanisms is still scarce. Objective: We aimed to evaluate studies investigating the efficacy and mechanisms of change in IMIs for adults with PTSD. Method: In this systematic review and meta-analysis (PROSPERO CRD42019130314), five databases were consulted to identify relevant studies, complemented by forward (i.e. citation search) and backward (i.e. review of reference lists from included studies) searches. Randomized controlled trials (RCTs) investigating the efficacy of IMIs compared to active controls, as well as component and mediation studies were included. Two independent reviewers extracted the data and assessed the risk of bias and requirements for process research. Random-effects meta-analyses on PTSD symptom severity as primary outcome were conducted and further information was synthesized qualitatively. Results: In total, 33 RCTs were included (N = 5421). The meta-analysis comparing IMIs to non-bonafide active controls yielded a significant standardized mean difference (SMD) of -0.36 (95%CI -0.53 to -0.19) favouring IMIs. Although meta-analytic pooling was not possible for the component and mediation studies, evidence suggests no differential effects regarding PTSD symptom reduction between different levels of support and personalization and between different types of exposure. Moreover, mediation studies revealed significant intervening variable effects for self-efficacy beliefs, perceived physical impairment, social acknowledgement, and trauma disclosure. Conclusions: Results indicate that IMIs for PTSD are superior to active controls. Furthermore, findings may contribute to the development of new interventions by outlining important directions for future research (e.g. regarding requirements for process research) and highlighting potential mechanisms of change (i.e. self-efficacy, perceived physical impairment, social acknowledgement, and trauma disclosure).
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Affiliation(s)
- Lena Steubl
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Cedric Sachser
- Clinic for Child and Adolescent Psychiatry/Psychotherapy, Ulm University, Ulm, Germany
| | - Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Matthias Domhardt
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Ulm, Germany
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Muñoz AO, Camacho E, Torous J. Marketplace and Literature Review of Spanish Language Mental Health Apps. Front Digit Health 2021; 3:615366. [PMID: 34713093 PMCID: PMC8521936 DOI: 10.3389/fdgth.2021.615366] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 01/15/2021] [Indexed: 12/12/2022] Open
Abstract
Language differences between patients and providers remains a barrier to accessing health care, especially mental health services. One potential solution to reduce inequities for patients that speak different languages and improve their access to care is through the delivery of healthcare through mobile technology. Given that the Latinx community serves as the largest ethnic minority in the United States, this two-phased review examines Spanish app development, feasibility and efficacy. Phase 1 explored the commercial marketplace for apps available in Spanish, while phase 2 involved a literature review of published research centered around the creation, functions, and usability of these apps using the PubMed and Google Scholar electronic databases. Of the apps available on the database, only 14.5% of them had Spanish operability. The literature search uncovered 629 results, of which 12 research articles that tested or described 10 apps met the inclusion criteria. Of the 10 apps studied in this literature review, only four apps were translated to Spanish. Our study reveals that despite increasing interest in Spanish-language apps to address mental health, the commercial marketplace is not currently meeting the demand.
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Affiliation(s)
| | - Erica Camacho
- Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - John Torous
- Harvard Medical School, Boston, MA, United States
- Beth Israel Deaconess Medical Center, Boston, MA, United States
- *Correspondence: John Torous
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Miller-Graff L, Ellis K, Hosny N. PTSD Coach Online-Arabic: A Randomized Controlled Pilot Trial to Examine Feasibility, Acceptability, and Preliminary Effectiveness. J Trauma Stress 2021; 34:23-34. [PMID: 33159373 DOI: 10.1002/jts.22621] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 10/01/2020] [Accepted: 10/02/2020] [Indexed: 12/20/2022]
Abstract
The Egyptian Revolution of 2011 resulted in high-level exposure to sociopolitical violence, placing a large burden on the mental health care system that cannot be effectively met given the small number of available providers in Egypt. We conducted a nonblinded, randomized controlled pilot trial of an online, self-directed tool for managing posttraumatic stress symptoms (PTSS). The study aimed to evaluate the feasibility, acceptability, and preliminary effectiveness of the PTSD Coach Online-Arabic. Trauma-exposed Egyptian adults with clinically significant PTSS (N = 87; intervention group: n = 41) completed assessments at baseline, weekly over the treatment period, posttest, and 3-month follow-up. Of participants who completed weekly surveys, 88.9% used the program; 22.0% of participants reported regular, weekly use. Most tools received good likeability and perceived benefit scores, but lower perceived benefit scores on three tools suggest that some content may require additional adaptation. Intent-to-treat analyses using multilevel modeling with multiple imputation to account for missing data were conducted. Effect sizes for PTSS were below the cutoff for small effects at posttest, d = -0.14, but demonstrated a small positive effect at 3-months, d = -0.25. There was a small positive effect of treatment on anxiety at posttest, d = -0.37, and a medium effect at 3-month follow-up, d = -0.49. Treatment effects for depressed mood were below the cutoff for small effects at posttest and 3-months, ds = -0.14 and -0.18. These findings suggest that the PTSD Coach Online-Arabic may be a promising supplemental resource for support in this setting.
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Affiliation(s)
- Laura Miller-Graff
- Department of Psychology, Kroc Institute for International Peace Studies, University of Notre Dame, Notre Dame, Indiana, USA
| | - Kate Ellis
- Department of Psychology, The American University in Cairo, New Cairo, Egypt
| | - Nadine Hosny
- Department of Psychology, The American University in Cairo, New Cairo, Egypt
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Hadler NL, Bu P, Winkler A, Alexander AW. College Student Perspectives of Telemental Health: a Review of the Recent Literature. Curr Psychiatry Rep 2021; 23:6. [PMID: 33404975 PMCID: PMC7785477 DOI: 10.1007/s11920-020-01215-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/09/2020] [Indexed: 12/16/2022]
Abstract
PURPOSE OF REVIEW We review the recent literature regarding college student experiences with and attitudes toward telemental health (TMH). We examine their perspectives of the advantages and drawbacks to this form of mental healthcare and their willingness to engage in TMH. RECENT FINDINGS College students view TMH as convenient, accessible, easy to use, and helpful. TMH helps to overcome the barrier of stigma associated with seeking mental health treatment. Despite positive reviews, many students find a lack of customization or connection to the provider to be drawbacks to some forms of TMH. Willingness to engage in TMH varies based on prior experience with mental health treatment, ethnicity, and severity of symptoms. The recent literature highlights the potential for TMH to play a key role in mental health services for college students. It also highlights some of its shortcomings, which are indicative of the continued need for in-person services. Future studies should continue to track college student perspectives toward and utilization of TMH.
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Affiliation(s)
- Nicole L Hadler
- University of Michigan Medical School, 1301 Catherine Street, Ann Arbor, MI, 48109, USA.
| | - Paula Bu
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Aaron Winkler
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Amy W Alexander
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
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An Introduction to Core Competencies for the Use of Mobile Apps in Cognitive and Behavioral Practice. COGNITIVE AND BEHAVIORAL PRACTICE 2021. [DOI: 10.1016/j.cbpra.2020.11.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Kozlov E, Bantum E, Pagano I, Walser R, Ramsey K, Taylor K, Jaworski B, Owen J. The Reach, Use, and Impact of a Free mHealth Mindfulness App in the General Population: Mobile Data Analysis. JMIR Ment Health 2020; 7:e23377. [PMID: 33245289 PMCID: PMC7732704 DOI: 10.2196/23377] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 10/16/2020] [Accepted: 10/27/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND As smartphones are now used by most Americans, it is increasingly possible for mental health mobile apps to be disseminated to the general public. However, little is known about how mobile mental health apps are used by the general population outside of a controlled research design. OBJECTIVE Our objective is to describe how the general population engages with Mindfulness Coach, an iOS- and Android-based app designed to deliver a mindfulness training course. METHODS Using anonymous download and analytics data, we characterized the reach, usage, retention, and impact of Mindfulness Coach. We included mobile analytics data from all unique downloads of Mindfulness Coach between August 1, 2018, and April 8, 2019 (N=104,067) as well as starred reviews from all Mindfulness Coach users who provided reviews of the app as of March 1, 2020. Mindfulness characteristics were measured by an in-app assessment using the Five-Facet Mindfulness Questionnaire-Short Form (FFMQ-SF). RESULTS Users engaged, on average, in 4.3 visits to the app (SD 8.8; median 2; 90th percentile 8) and associated with an average total of 49.2 interactions with the app (ie, clicks within the app) (SD 113.8; median 19; 90th percentile 105). Users spent an average of 16.2 minutes (SD 63.1) engaged with the app over the full study time period. There were strong linear effects of app engagement on total FFMQ-SF scores. For example, FFMQ-SF scores were associated with more time spent engaged with the app (R2=.23; P<.001). Mindfulness Coach has been reviewed in the Google Play Store 3415 times, with an average rating of 4.7 out of 5 stars, and over 2000 times in the Apple App Store, with an average rating of 4.8 out of 5 stars. CONCLUSIONS These findings suggest that Mindfulness Coach has achieved substantial and sustained reach in the general population; however, it was used less frequently by many downloaders than researchers and designers intended. There was a subpopulation of users who engaged in the app regularly over an extended period of time, and there was a clear relationship between app use and improvements in mindfulness. To strengthen Mindfulness Coach's public health impact, more research is needed to understand who is using the app and how, and to design strategies to increase user engagement in order for users to receive a larger dose of mindfulness treatment.
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Affiliation(s)
- Elissa Kozlov
- Institute for Health, Health Policy and Aging Research, Rutgers University, New Brunswick, NJ, United States.,School of Public Health, Rutgers University, New Brunswick, NJ, United States
| | - Erin Bantum
- Cancer Prevention in the Pacific, University of Hawaii Cancer Center, Honolulu, HI, United States
| | - Ian Pagano
- Cancer Prevention in the Pacific, University of Hawaii Cancer Center, Honolulu, HI, United States
| | - Robyn Walser
- National Center for PTSD Research, VA Palo Alto Healthcare System, Menlo Park, CA, United States
| | - Kelly Ramsey
- National Center for PTSD Research, VA Palo Alto Healthcare System, Menlo Park, CA, United States
| | - Katherine Taylor
- National Center for PTSD Research, VA Palo Alto Healthcare System, Menlo Park, CA, United States
| | - Beth Jaworski
- National Center for PTSD Research, VA Palo Alto Healthcare System, Menlo Park, CA, United States
| | - Jason Owen
- National Center for PTSD Research, VA Palo Alto Healthcare System, Menlo Park, CA, United States
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Pacella‐LaBarbara ML, Suffoletto BP, Kuhn E, Germain A, Jaramillo S, Repine M, Callaway CW. A Pilot Randomized Controlled Trial of the PTSD Coach App Following Motor Vehicle Crash-related Injury. Acad Emerg Med 2020; 27:1126-1139. [PMID: 32339359 DOI: 10.1111/acem.14000] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 03/27/2020] [Accepted: 04/22/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Posttraumatic stress disorder (PTSD) symptoms (PTSS) are common after minor injuries and can impair recovery. We sought to understand whether an evidence-based mobile phone application with self-help tools (PTSD Coach) could be useful to improve recovery after acute trauma among injured emergency department (ED) patients. This pilot study examined the feasibility, acceptability, and potential benefit of using PTSD Coach among acutely injured motor vehicle crash (MVC) patients. METHODS From September 2017 to September 2018, we recruited adult patients within 24 hours post-MVC from the EDs of two Level I trauma centers in the United States. We randomly assigned 64 injured adults to either the PTSD Coach (n = 33) or treatment as usual (TAU; n = 31) condition. We assessed PTSS and associated symptoms at 1 month (83% retained) and 3 months (73% retained) postenrollment. RESULTS Enrollment was feasible (74% of eligible subjects participated) but usability and engagement were low (67% used PTSD Coach at least once, primarily in week 1); 76% of those who used it rated the app as moderately to extremely helpful. No differences emerged between groups in PTSS outcomes. Exploratory analyses among black subjects (n = 21) indicated that those in the PTSD Coach condition (vs. TAU) reported marginally lower PTSS (95% CI = -0.30 to 37.77) and higher PTSS coping self-efficacy (95% CI = -58.20 to -3.61) at 3 months. CONCLUSIONS We demonstrated feasibility to recruit acutely injured ED patients into an app-based intervention study, yet mixed evidence emerged for the usability and benefit of PTSD Coach. Most patients used the app once and rated it favorably in regard to satisfaction with and helpfulness, but longitudinal engagement was low. This latter finding may explain the lack of overall effects on PTSS. Additional research is warranted regarding whether targeting more symptomatic patients and the addition of engagement and support features can improve efficacy.
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Affiliation(s)
| | - Brian P. Suffoletto
- From the Department of Emergency Medicine School of Medicine University of Pittsburgh Pittsburgh PA
| | - Eric Kuhn
- the Dissemination and Training Division National Center for PTSD Palo Alto CA
- the Department of Psychiatry and Behavioral Sciences School of Medicine Stanford University Stanford CA
| | - Anne Germain
- and the Department of Psychiatry School of Medicine University of Pittsburgh Pittsburgh PA
| | - Stephany Jaramillo
- From the Department of Emergency Medicine School of Medicine University of Pittsburgh Pittsburgh PA
| | - Melissa Repine
- From the Department of Emergency Medicine School of Medicine University of Pittsburgh Pittsburgh PA
| | - Clifton W. Callaway
- From the Department of Emergency Medicine School of Medicine University of Pittsburgh Pittsburgh PA
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Wang L, Miller LC. Just-in-the-Moment Adaptive Interventions (JITAI): A Meta-Analytical Review. HEALTH COMMUNICATION 2020; 35:1531-1544. [PMID: 31488002 DOI: 10.1080/10410236.2019.1652388] [Citation(s) in RCA: 82] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
A just-in-time, adaptive intervention (JITAI) is an emerging type of intervention that provides tailored support at the exact time of need. It does so using enabling new technologies (e.g., mobile phones, sensors) that capture the changing states of individuals. Extracting effect sizes of primary outcomes produced by 33 empirical studies that used JITAIs, we found moderate to large effect sizes of JITAI treatments compared to (1) waitlist-control conditions (k = 9), Hedges's g = 1.65 and (2) non-JITAI treatments (k = 21), g = 0.89. Also, participants of JITAI interventions showed significant changes (k = 13) in the positive direction (g = 0.79). A series of sensitivity tests suggested that those effects persist. Those effects also persist despite differences in the behaviors of interests (e.g., blood glucose control, recovering alcoholics), duration of the treatments, and participants' age. Two aspects of tailoring, namely: (1) tailoring to what (i.e., both people's previous behavioral patterns and their current need states; with these effects additive) and (2) approach to tailoring (i.e., both using a human agent and an algorithm to decide tailored feedback; with these effects additive), are significantly associated with greater JITAI efficacy.
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Affiliation(s)
- Liyuan Wang
- Annenberg School for Communication and Journalism, University of Southern California
| | - Lynn Carol Miller
- Annenberg School for Communication and Journalism, University of Southern California
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What to Do When Evidence-Based Treatment Manuals Are Not Enough? Adapting Evidence-Based Psychological Interventions for Primary Care. COGNITIVE AND BEHAVIORAL PRACTICE 2020. [DOI: 10.1016/j.cbpra.2020.05.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Shakespeare-Finch J, Alichniewicz KK, Strodl E, Brown K, Quinn C, Hides L, White A, Gossage G, Poerio L, Batras D, Jackson S, Styles J, Kavanagh D. Experiences of Serving and Ex-Serving Members With the PTSD Coach Australia App: Mixed Methods Study. J Med Internet Res 2020; 22:e18447. [PMID: 33030438 PMCID: PMC7582151 DOI: 10.2196/18447] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 05/25/2020] [Accepted: 07/26/2020] [Indexed: 01/30/2023] Open
Abstract
Background PTSD Coach Australia is an app for serving and ex-serving defense members and was adapted for the Australian context in 2013 from PTSD Coach, which was created in the United States. Objective This study aimed to provide a user-centered evaluation of the app from the perspective of serving and ex-serving members of the Australian Defence Force. Methods Qualitative data were collected in response to questions to participants in 1 of 5 workshops (n=29) or in telephone interviews (n=24). Quantitative data were collected using the user version of Mobile Apps Rating Scale (uMARS). Results Analysis of the qualitative data demonstrated mixed support for the app. While some people found it extremely useful, especially as an adjunct to therapy, others pointed out limitations and cautioned against the app potentially triggering symptoms in people with PTSD. This perceived risk was usually found to stem from frustration with the app’s functionality rather than its content. Participants spoke about the helpful and unhelpful aspects of the app and barriers to its use and made suggestions for improvement. Many participants encouraged its continued use and highlighted the need for it to be promoted more broadly, as many were not aware of it until they were invited to participate in this research. Conclusions PTSD Coach Australia was seen in a positive light by some participants, but others thought it had too much text and the potential to trigger a traumatic response in users with PTSD. A need to update the app was also a common comment as was the need to increase awareness of the app’s existence.
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Affiliation(s)
| | | | - Esben Strodl
- Queensland University of Technology, Brisbane, Australia
| | - Kelly Brown
- Queensland University of Technology, Brisbane, Australia.,Gallipoli Medical Research Foundation, Greenslopes Private Hospital, Brisbane, Australia
| | | | | | - Angela White
- Royal Brisbane and Womens Hospital, Brisbane, Australia
| | | | | | | | - Samantha Jackson
- Mental Health Strategy & Research, Joint Health Command, Canberra, Australia
| | - Jess Styles
- Mental Health Strategy & Research, Joint Health Command, Canberra, Australia
| | - David Kavanagh
- Queensland University of Technology, Brisbane, Australia
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Zehetmair C, Nagy E, Leetz C, Cranz A, Kindermann D, Reddemann L, Nikendei C. Self-Practice of Stabilizing and Guided Imagery Techniques for Traumatized Refugees via Digital Audio Files: Qualitative Study. J Med Internet Res 2020; 22:e17906. [PMID: 32965229 PMCID: PMC7542415 DOI: 10.2196/17906] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 04/20/2020] [Accepted: 04/30/2020] [Indexed: 01/17/2023] Open
Abstract
Background Refugees have an increased risk of developing mental health problems. There are insufficient psychosocial care structures to meet the resulting need for support. Stabilizing and guided imagery techniques have shown promising results in increasing traumatized refugees’ emotional stabilization. If delivered via audio files, the techniques can be practiced autonomously and independent of time, space, and human resources or stable treatment settings. Objective This study aimed to evaluate the self-practice of stabilizing and guided imagery techniques via digital audio files for traumatized refugees living in a reception and registration center in Germany. Methods From May 2018 to February 2019, 42 traumatized refugees participated in our study. At T1, patients received digital audio files in English, French, Arabic, Farsi, Turkish, or Serbian for self-practice. Nine days later, at T2, a face-to-face interview was conducted. Two months after T2, a follow-up interview took place via telephone. Results At T2, about half of the patients reported the daily practice of stabilizing and guided imagery techniques. At follow-up, the average frequency of practice was once weekly or more for those experiencing worse symptoms. No technical difficulties were reported. According to T2 and follow-up statements, the techniques helped the patients dealing with arousal, concentration, sleep, mood, thoughts, empowerment, and tension. The guided imagery technique “The Inner Safe Place” was the most popular. Self-practice was impeded by postmigratory distress factors, like overcrowded accommodations. Conclusions The results show that self-practice of stabilizing and guided imagery techniques via digital audio files was helpful to and well accepted by the assessed refugees. Even though postmigratory distress factors hampered self-practice, “The Inner Safe Place” technique was particularly well received. Overall, the self-practiced audio-based stabilizing and guided imagery techniques showed promising results among the highly vulnerable group of newly arrived traumatized refugees.
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Affiliation(s)
- Catharina Zehetmair
- Department of General Internal Medicine and Psychosomatics, Center for Psychosocial Medicine, University Hospital of Heidelberg, Heidelberg, Germany
| | - Ede Nagy
- Department of General Internal Medicine and Psychosomatics, Center for Psychosocial Medicine, University Hospital of Heidelberg, Heidelberg, Germany
| | - Carla Leetz
- Department of General Internal Medicine and Psychosomatics, Center for Psychosocial Medicine, University Hospital of Heidelberg, Heidelberg, Germany
| | - Anna Cranz
- Department of General Internal Medicine and Psychosomatics, Center for Psychosocial Medicine, University Hospital of Heidelberg, Heidelberg, Germany
| | - David Kindermann
- Department of General Internal Medicine and Psychosomatics, Center for Psychosocial Medicine, University Hospital of Heidelberg, Heidelberg, Germany
| | - Luise Reddemann
- Department of Clinical Psychology, Psychotherapy and Psychoanalysis, University of Klagenfurt, Klagenfurt, Austria
| | - Christoph Nikendei
- Department of General Internal Medicine and Psychosomatics, Center for Psychosocial Medicine, University Hospital of Heidelberg, Heidelberg, Germany
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Melton H, Meader N, Dale H, Wright K, Jones-Diette J, Temple M, Shah I, Lovell K, McMillan D, Churchill R, Barbui C, Gilbody S, Coventry P. Interventions for adults with a history of complex traumatic events: the INCiTE mixed-methods systematic review. Health Technol Assess 2020; 24:1-312. [PMID: 32924926 DOI: 10.3310/hta24430] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND People with a history of complex traumatic events typically experience trauma and stressor disorders and additional mental comorbidities. It is not known if existing evidence-based treatments are effective and acceptable for this group of people. OBJECTIVE To identify candidate psychological and non-pharmacological treatments for future research. DESIGN Mixed-methods systematic review. PARTICIPANTS Adults aged ≥ 18 years with a history of complex traumatic events. INTERVENTIONS Psychological interventions versus control or active control; pharmacological interventions versus placebo. MAIN OUTCOME MEASURES Post-traumatic stress disorder symptoms, common mental health problems and attrition. DATA SOURCES Cumulative Index to Nursing and Allied Health Literature (CINAHL) (1937 onwards); Cochrane Central Register of Controlled Trials (CENTRAL) (from inception); EMBASE (1974 to 2017 week 16); International Pharmaceutical Abstracts (1970 onwards); MEDLINE and MEDLINE Epub Ahead of Print and In-Process & Other Non-Indexed Citations (1946 to present); Published International Literature on Traumatic Stress (PILOTS) (1987 onwards); PsycINFO (1806 to April week 2 2017); and Science Citation Index (1900 onwards). Searches were conducted between April and August 2017. REVIEW METHODS Eligible studies were singly screened and disagreements were resolved at consensus meetings. The risk of bias was assessed using the Cochrane risk-of-bias tool and a bespoke version of a quality appraisal checklist used by the National Institute for Health and Care Excellence. A meta-analysis was conducted across all populations for each intervention category and for population subgroups. Moderators of effectiveness were assessed using metaregression and a component network meta-analysis. A qualitative synthesis was undertaken to summarise the acceptability of interventions with the relevance of findings assessed by the GRADE-CERQual checklist. RESULTS One hundred and four randomised controlled trials and nine non-randomised controlled trials were included. For the qualitative acceptability review, 4324 records were identified and nine studies were included. The population subgroups were veterans, childhood sexual abuse victims, war affected, refugees and domestic violence victims. Psychological interventions were superior to the control post treatment for reducing post-traumatic stress disorder symptoms (standardised mean difference -0.90, 95% confidence interval -1.14 to -0.66; number of trials = 39) and also for associated symptoms of depression, but not anxiety. Trauma-focused therapies were the most effective interventions across all populations for post-traumatic stress disorder and depression. Multicomponent and trauma-focused interventions were effective for negative self-concept. Phase-based approaches were also superior to the control for post-traumatic stress disorder and depression and showed the most benefit for managing emotional dysregulation and interpersonal problems. Only antipsychotic medication was effective for reducing post-traumatic stress disorder symptoms; medications were not effective for mental comorbidities. Eight qualitative studies were included. Interventions were more acceptable if service users could identify benefits and if they were delivered in ways that accommodated their personal and social needs. LIMITATIONS Assessments about long-term effectiveness of interventions were not possible. Studies that included outcomes related to comorbid psychiatric states, such as borderline personality disorder, and populations from prisons and humanitarian crises were under-represented. CONCLUSIONS Evidence-based psychological interventions are effective and acceptable post treatment for reducing post-traumatic stress disorder symptoms and depression and anxiety in people with complex trauma. These interventions were less effective in veterans and had less of an impact on symptoms associated with complex post-traumatic stress disorder. FUTURE WORK Definitive trials of phase-based versus non-phase-based interventions with long-term follow-up for post-traumatic stress disorder and associated mental comorbidities. STUDY REGISTRATION This study is registered as PROSPERO CRD42017055523. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 43. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Hollie Melton
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Nick Meader
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Holly Dale
- School of Health Sciences, University of Manchester, Manchester, UK
| | - Kath Wright
- Centre for Reviews and Dissemination, University of York, York, UK
| | | | | | | | - Karina Lovell
- Division of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - Dean McMillan
- Department of Health Sciences, University of York, York, UK.,Hull York Medical School, University of York, York, UK
| | - Rachel Churchill
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Corrado Barbui
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Simon Gilbody
- Department of Health Sciences, University of York, York, UK.,Hull York Medical School, University of York, York, UK
| | - Peter Coventry
- Centre for Reviews and Dissemination, University of York, York, UK.,Department of Health Sciences, University of York, York, UK
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Strodl E, Shakespeare-Finch J, Alichniewicz KK, Brown K, Quinn C, Hides L, White A, Gossage G, Poerio L, Batras D, Jackson S, Styles J, Kavanagh DJ. Clinicians' perceptions of PTSD Coach Australia. Internet Interv 2020; 21:100333. [PMID: 32939341 PMCID: PMC7476854 DOI: 10.1016/j.invent.2020.100333] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 06/19/2020] [Accepted: 06/24/2020] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Applications or "mobile apps" are a potentially important source of assistance for serving and ex-serving Defence members with mental health problems. PTSD Coach Australia is a modified version of an application developed by the US Department of Veteran Affairs. Clinician perceptions of mobile apps are important as they influence the dissemination and adoption of apps. This study aimed to explore the perceptions of PTSD Coach Australia by clinicians with experience in assisting Defence members with mental health problems. METHOD The study involved two samples of participants who were asked about their perceptions of PTSD Coach Australia. The first involved 33 clinicians who participated in one of five focus groups. The second comprised 30 clinicians who were individually interviewed by telephone. Qualitative responses to questions regarding PTSD Coach Australia were analysed to identify representative themes. Participants in the focus group sample also rated the app on the user version of the Mobile Apps Rating Scale (uMARS). RESULTS On the uMARS, clinicians rated the mobile app's subjective quality as 'average' to 'good'. Participants generally saw the app as a useful to help track symptoms, improve engagement and help implement strategies between sessions. However, they also expressed concerns with the app not being user-friendly (e.g. too wordy, poor layout/navigation) and having technical issues (freezing or crashing on Android devices). DISCUSSION PTSD Coach Australia is generally seen as being acceptable and useful by mental health clinicians. However, it is important to include their concerns in future developments of PTSD Coach Australia and similar mobile apps in order to maximize their utilisation in Defence members.
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Affiliation(s)
- Esben Strodl
- Institute of Health & Biomedical Innovation, School of Psychology & Counselling, Queensland University of Technology, GPO Box 2434, Brisbane, Qld 4001, Australia
| | - Jane Shakespeare-Finch
- Institute of Health & Biomedical Innovation, School of Psychology & Counselling, Queensland University of Technology, GPO Box 2434, Brisbane, Qld 4001, Australia
| | - Karolina K. Alichniewicz
- Centre for Children's Health Research, Queensland University of Technology, 62 Raymond Terrace, South Brisbane, Qld 4101, Australia
| | - Kelly Brown
- Centre for Children's Health Research, Queensland University of Technology, 62 Raymond Terrace, South Brisbane, Qld 4101, Australia
| | - Catherine Quinn
- Lives Lived Well Research Group, School of Psychology, University of Queensland, St Lucia, Qld 4072, Australia
| | - Leanne Hides
- Lives Lived Well Research Group, School of Psychology, University of Queensland, St Lucia, Qld 4072, Australia
| | - Angela White
- Royal Brisbane & Women's Hospital, Butterfield Street, Herston, Qld 4029, Australia
| | - Gabrial Gossage
- Department of Veterans' Affairs, GPO Box 9998, Brisbane, QLD 4001, Australia
| | - Loretta Poerio
- Department of Veterans' Affairs, GPO Box 9998, Brisbane, QLD 4001, Australia
| | - Dimitri Batras
- Department of Veterans' Affairs, GPO Box 9998, Brisbane, QLD 4001, Australia
- Attained Success Consulting, GPO Box 2728, Melbourne, Vic 3001, Australia
| | - Samantha Jackson
- Mental Health Strategy & Research, Joint Health Command, CP3-7-100, Northcott Drive, Campbell, ACT 2600, Australia
| | - Jess Styles
- Mental Health Strategy & Research, Joint Health Command, CP3-7-100, Northcott Drive, Campbell, ACT 2600, Australia
| | - David J. Kavanagh
- Institute of Health & Biomedical Innovation, School of Psychology & Counselling, Queensland University of Technology, GPO Box 2434, Brisbane, Qld 4001, Australia
- Centre for Children's Health Research, Queensland University of Technology, 62 Raymond Terrace, South Brisbane, Qld 4101, Australia
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Livingston NA, Mahoney CT, Ameral V, Brief D, Rubin A, Enggasser J, Litwack S, Helmuth E, Roy M, Solhan M, Rosenbloom D, Keane T. Changes in alcohol use, PTSD hyperarousal symptoms, and intervention dropout following veterans' use of VetChange. Addict Behav 2020; 107:106401. [PMID: 32272356 DOI: 10.1016/j.addbeh.2020.106401] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 03/02/2020] [Accepted: 03/17/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Veterans of Iraq and Afghanistan conflicts report high rates of drinking, PTSD, and low rates of treatment engagement. Web interventions may help address unmet treatment need; unfortunately, little is known regarding outcomes or adherence to these interventions. In this study, we examined VetChange treatment outcomes and downstream effects of alcohol reduction on PTSD symptoms and intervention dropout rates over six months. METHOD Participants included 222 veterans (77.5% men, 78.3% White) between 22 and 57 (mean age = 36.02, SD = 7.19). All VetChange users completed a brief alcohol assessment and received personal feedback, then received full access to intervention content including psychoeducation; motivational and cognitive-behavioral modules for relapse prevention, goal-setting, social support, stress, anger, and sleep management; and mood and drink tracking. Veterans completed self-report measures of alcohol use and PTSD symptoms at baseline, one, three, and six months. RESULTS Alcohol use dropped by 43% over six months, p < .001, with the largest decrease occurring within the first month. Greater alcohol reduction in the first month predicted higher subsequent PTSD hyperarousal severity. Over half (52.3%) dropped out by month one, followed by 12.2% and 37.6% by months three and six. Hyperarousal symptoms, hypervigilance specifically, but not alcohol use predicted subsequent intervention dropout. CONCLUSION These results highlight the importance of attending to the association between alcohol use and PTSD symptom change in web-based interventions for veterans. The fact that hyperarousal symptoms were associated with elevated risk for intervention dropout signifies the need for online intervention refinement aimed at tailoring content to time-varying symptom presentations.
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Affiliation(s)
- Nicholas A Livingston
- National Center for PTSD, Behavioral Science Division, Boston, MA, USA; Department of Psychiatry, Boston University, School of Medicine, USA; U.S. Department of Veteran Affairs, VA Boston Healthcare System, Boston, MA, USA.
| | - Colin T Mahoney
- National Center for PTSD, Behavioral Science Division, Boston, MA, USA; Department of Psychiatry, Boston University, School of Medicine, USA; U.S. Department of Veteran Affairs, VA Boston Healthcare System, Boston, MA, USA
| | - Victoria Ameral
- Department of Psychiatry, Boston University, School of Medicine, USA; U.S. Department of Veteran Affairs, VA Boston Healthcare System, Boston, MA, USA
| | - Deborah Brief
- Department of Psychiatry, Boston University, School of Medicine, USA; U.S. Department of Veteran Affairs, VA Boston Healthcare System, Boston, MA, USA
| | - Amy Rubin
- Department of Psychiatry, Boston University, School of Medicine, USA; U.S. Department of Veteran Affairs, VA Boston Healthcare System, Boston, MA, USA
| | - Justin Enggasser
- Department of Psychiatry, Boston University, School of Medicine, USA; U.S. Department of Veteran Affairs, VA Boston Healthcare System, Boston, MA, USA
| | - Scott Litwack
- Department of Psychiatry, Boston University, School of Medicine, USA; U.S. Department of Veteran Affairs, VA Boston Healthcare System, Boston, MA, USA
| | | | - Monica Roy
- Department of Psychiatry, Boston University, School of Medicine, USA; U.S. Department of Veteran Affairs, VA Boston Healthcare System, Boston, MA, USA
| | - Marika Solhan
- Department of Psychiatry, Boston University, School of Medicine, USA; U.S. Department of Veteran Affairs, VA Boston Healthcare System, Boston, MA, USA
| | | | - Terence Keane
- National Center for PTSD, Behavioral Science Division, Boston, MA, USA; Department of Psychiatry, Boston University, School of Medicine, USA; U.S. Department of Veteran Affairs, VA Boston Healthcare System, Boston, MA, USA
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50
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Fung HW, Chan C, Ross CA. A Web-based Psychoeducation Program for People with Pathological Dissociation: Development and Pilot Testing. JOURNAL OF EVIDENCE-BASED SOCIAL WORK (2019) 2020; 17:427-442. [PMID: 32410503 DOI: 10.1080/26408066.2020.1760990] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
PURPOSE Although people with pathological dissociation (PD) can benefit from specific interventions, there are challenges in providing suitable interventions for them in the field (e.g., high cost, lack of specialized services, stigma). Many people with PD cannot receive dissociation-focused services in their current service locations. It is important to develop easily-accessible interventions that can support people with PD, especially for those who cannot access dissociation-specific treatment. The authors developed a web-based psychoeducation program to support people with PD, and examined its feasibility and acceptability. METHOD A single-group pretest-posttest pilot study was conducted. RESULTS Findings showed that most of the intended psychosocial outcomes were achieved as planned, which initially proved the feasibility and acceptability of the program. DISCUSSION This is one of the first studies that report the use of web-based interventions to support people with PD, especially those who are in the early stages of recovery. The findings suggest that information and communication technology can contribute to different aspects of clinical practice, including recruitment, engagement, assessment and interventions. Further discussion and research are required.
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Affiliation(s)
- Hong Wang Fung
- The Department of Applied Social Sciences, The Hong Kong Polytechnic University , Hung Hom, Hong Kong
| | - Chitat Chan
- The Department of Applied Social Sciences, The Hong Kong Polytechnic University , Hung Hom, Hong Kong
| | - Colin A Ross
- The Colin A. Ross Institute for Psychological Trauma , Richardson, Texas, USA
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