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Ong LE, Speicher S, Villasenor D, Kim J, Jacobs A, Macia KS, Cloitre M. Brief Peer-Supported webSTAIR for Trauma-Exposed Veterans in the Community: Randomized Controlled Trial. J Med Internet Res 2024. [PMID: 39012722 DOI: 10.2196/52130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2024] Open
Abstract
BACKGROUND Peer-supported mobile health (mhealth) programs hold the promise of providing a low-burden approach to increasing access to care and improving mental health. While peer support has been shown to improve engagement into care, there is limited investigation about the impact of peers on symptom outcome. Trauma-exposed populations frequently suffer from co-occurring posttraumatic stress and depressive symptoms as well as difficulties in day-to-day functioning. This study evaluated the potential benefits of a peer-supported transdiagnostic mhealth program on symptom outcomes and functioning. OBJECTIVE This randomized controlled trial tested the effectiveness of Brief Peer-Supported (BPS) webSTAIR, a 6-module transdiagnostic online program derived from Skills Training in Affective and Interpersonal Regulation (STAIR) compared to waitlist control (WL) in a community sample of Veterans who screened positive for either post-traumatic stress disorder (PTSD) and/or depression. METHODS A total of 178 eligible Veterans were enrolled in the study using a 2:1 randomization scheme with 117 assigned to BPS webSTAIR and 61 assigned to WL. PTSD and depressive symptoms as well as emotion regulation, and psychosocial functioning were assessed via phone at pretreatment, posttreatment, and 8-week follow-up. Mixed-effects models were used to assess change in outcome measures across timepoints and evaluate the impact of module completion on outcomes. Exploratory analyses were conducted to determine whether the type and number of peer interactions influenced outcomes. RESULTS Significant interaction effects were observed for all outcomes such that participants randomized to BPS webSTAIR reported significantly greater improvement at posttreatment compared to WL with moderate effect sizes for PTSD (PCL-5 d = -0.48) depression (PHQ- 8 d = -0.64), emotion regulation (DERS-16 d = 0.61) and functional impairment (WSAS d = 0.61); gains were maintained at 8-week follow-up. Those who completed more modules reported greater improvement on all outcomes. An initial cohort of participants who were required to engage with a peer coach to progress through the modules interacted more frequently with peers but completed fewer modules compared to a later cohort for whom peer engagement was optional. CONCLUSIONS BPS webSTAIR was effective in improving PTSD and depression symptoms, emotion regulation, and psychosocial functioning in community Veterans. Peer-supported transdiagnostic mhealth programs may be a particularly efficient, effective, and low-burden approach to improving mental health among trauma-exposed populations. Investigation of peer-supported programs among other populations is necessary to evaluate the generalizability of the findings. Analyses comparing peer support that was required versus optional indicated that some veterans may not need or want peer support. Future research should evaluate how best to deliver peer support and for whom it is most beneficial. If successful, peer-supported tech programs may increase the VA workforce as well as improve veteran mental health services and outcomes. CLINICALTRIAL ClinicalTrials.gov NCT04286165.
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Affiliation(s)
- Laura E Ong
- National Center for PTSD, Veterans Affairs Palo Alto Health Care System, 3801 Miranda Ave, Palo Alto, US
| | - Sarah Speicher
- National Center for PTSD, Veterans Affairs Palo Alto Health Care System, 3801 Miranda Ave, Palo Alto, US
| | - Diana Villasenor
- National Center for PTSD, Veterans Affairs Palo Alto Health Care System, 3801 Miranda Ave, Palo Alto, US
| | - Jamie Kim
- National Center for PTSD, Veterans Affairs Palo Alto Health Care System, 3801 Miranda Ave, Palo Alto, US
| | - Adam Jacobs
- National Center for PTSD, Veterans Affairs Palo Alto Health Care System, 3801 Miranda Ave, Palo Alto, US
| | - Kathryn S Macia
- National Center for PTSD, Veterans Affairs Palo Alto Health Care System, 3801 Miranda Ave, Palo Alto, US
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, US
- HSR&D Center for Innovation to Implementation (Ci2i), Veterans Affairs Palo Alto Health Care System, Palo Alto, US
| | - Marylene Cloitre
- National Center for PTSD, Veterans Affairs Palo Alto Health Care System, 3801 Miranda Ave, Palo Alto, US
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Fitzke RE, Bouskill KE, Sedano A, Tran DD, Saba SK, Buch K, Hummer JF, Davis JP, Pedersen ER. Barriers and Facilitators to Behavioral Healthcare for Women Veterans: a Mixed-Methods Analysis of the Current Landscape. J Behav Health Serv Res 2024; 51:164-184. [PMID: 37798569 PMCID: PMC10940443 DOI: 10.1007/s11414-023-09862-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2023] [Indexed: 10/07/2023]
Abstract
Women veterans have historically faced barriers to behavioral health treatment, particularly through the VA. In conjunction, there have been changes in behavioral healthcare delivery resulting from efforts to improve care for women veterans and the COVID-19 pandemic (e.g., widespread telehealth implementation). The current study draws on a quantitative and qualitative study centering current perspectives of women veterans in their choices to seek or not seek behavioral healthcare in VA and non-VA settings through interviewing 18 women recruited from a larger survey study on veteran behavioral health (n = 83 women, n = 882 men) on their experiences with behavioral health care access and satisfaction, including barriers and facilitators to seeking care. Quantitative findings are descriptively reported from the larger study, which outlined screening for behavioral health problems, behavioral health utilization, treatment modality preferences, and barriers/facilitators to care. While women in the survey sample screened for various behavioral health disorders, rates of treatment seeking remained relatively low. Women reported positive and negative experiences with telehealth and endorsed many barriers to treatment seeking in interviews not captured by survey findings, including lack of women-specific care (e.g., care for military sexual trauma, women-only groups), reports of stranger harassment at the VA, and lack of female providers. Women veterans continue to face barriers to behavioral healthcare; however, ongoing efforts to improve care access and quality, including the implementation of telehealth, show promise in reducing these obstacles. Continued efforts are needed to ensure diverse treatment modalities continue to reach women veterans as this population grows.
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Affiliation(s)
- Reagan E Fitzke
- Department of Psychiatry and Behavioral Sciences, University of Southern California Keck School of Medicine, 2250 Alcazar St., Suite 2200, Los Angeles, CA, 90089, USA.
| | | | - Angeles Sedano
- University of Southern California, Suzanne Dworak-Peck School of Social Work, 669 W. 34th St, Los Angeles, CA, 90089, USA
| | - Denise D Tran
- Department of Psychiatry and Behavioral Sciences, University of Southern California Keck School of Medicine, 2250 Alcazar St., Suite 2200, Los Angeles, CA, 90089, USA
| | - Shaddy K Saba
- University of Southern California, Suzanne Dworak-Peck School of Social Work, 669 W. 34th St, Los Angeles, CA, 90089, USA
| | - Keegan Buch
- Department of Psychiatry and Behavioral Sciences, University of Southern California Keck School of Medicine, 2250 Alcazar St., Suite 2200, Los Angeles, CA, 90089, USA
| | - Justin F Hummer
- RAND Corporation, 1776 Main St, Santa Monica, CA, 90401, USA
| | - Jordan P Davis
- University of Southern California, Suzanne Dworak-Peck School of Social Work, 669 W. 34th St, Los Angeles, CA, 90089, USA
| | - Eric R Pedersen
- Department of Psychiatry and Behavioral Sciences, University of Southern California Keck School of Medicine, 2250 Alcazar St., Suite 2200, Los Angeles, CA, 90089, USA
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Ryan AT, Stearns-Yoder KA, Brenner LA. Real-World User Demographics of Three Web-Based Digital Mental Health Interventions Provided by the US Department of Veterans Affairs: Observational Study Using Web Analytics Data. JMIR Form Res 2023; 7:e48365. [PMID: 37851501 PMCID: PMC10620633 DOI: 10.2196/48365] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 07/12/2023] [Accepted: 08/01/2023] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND Unguided digital mental health interventions (UDMHIs) have the potential to provide low-cost and effective mental health care at scale. Controlled trials have demonstrated the efficacy of UDMHIs to address mental health symptoms and conditions. However, few previous publications have described the demographics of real-world users of UDMHIs that are freely available to the public. The US Department of Veterans Affairs has created and hosts several UDMHIs on its Veteran Training Portal website. These web-based, free-to-use, and publicly available UDMHIs include Path to Better Sleep, Anger and Irritability Management Skills, and Moving Forward, which focus on insomnia, problematic anger, and depression symptoms, respectively. OBJECTIVE This study aimed to examine the user demographics of these 3 UDMHIs in the year 2021. In addition, it aimed to compare the age and gender distribution of the users of those 3 UDMHIs with one another and with the age and gender distribution of the total US veteran population. METHODS Google Analytics was used to collect user data for each of the 3 UDMHIs. The age and gender distribution of the users of each UDMHI was compared with that of the other UDMHIs as well as with that of the overall US veteran population using chi-square tests. Information on the total number of users, the country they were in, and the devices they used to access the UDMHIs was also collected and reported. RESULTS In 2021, the 3 UDMHIs together recorded 29,306 unique users. The estimated age range and gender were available for 24.12% (7068/29,306) of those users. Each UDMHI's age and gender distribution significantly differed from that of the other UDMHIs and from that of the overall US veteran population (P<.001 on all chi-square tests). Women and younger age groups were overrepresented among UDMHI users compared with the overall US veteran population. The majority of devices used to access the UDMHIs were desktop or laptop devices, although a substantial proportion of devices used were mobile devices (10,199/29,752, 34.28%). Most users (27,789/29,748, 93.41%) were located in the United States, with users from Canada, the United Kingdom, and Australia accounting for another 2.61% (775/29,748) of total users. CONCLUSIONS Our use of Google Analytics data provided useful information about the users of 3 free and publicly available UDMHIs provided by the US Department of Veterans Affairs. Although our findings should be considered in light of the limitations of autonomously collected web analytics data, they still offer useful information for health care policy makers, administrators, and UDMHI developers.
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Affiliation(s)
- Arthur T Ryan
- Rocky Mountain Mental Illness Research, Education and Clinical Center for Suicide Prevention, Department of Veterans Affairs, Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, CO, United States
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Kelly A Stearns-Yoder
- Rocky Mountain Mental Illness Research, Education and Clinical Center for Suicide Prevention, Department of Veterans Affairs, Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, CO, United States
- Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Lisa A Brenner
- Rocky Mountain Mental Illness Research, Education and Clinical Center for Suicide Prevention, Department of Veterans Affairs, Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, CO, United States
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
- Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
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Gromatsky M, Sullivan SR, Greene AL, Govindarajulu U, Mitchell EL, Edwards ER, Lane R, Hamerling-Potts KK, Spears AP, Goodman M. An open trial of VA CONNECT: Caring for Our Nation's Needs Electronically during the COVID-19 Transition. PSYCHIATRY RESEARCH COMMUNICATIONS 2023; 3:100122. [PMID: 37101559 PMCID: PMC10108571 DOI: 10.1016/j.psycom.2023.100122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 03/29/2023] [Accepted: 04/15/2023] [Indexed: 04/28/2023]
Abstract
The COVID-19 pandemic impacted emotional well-being due to safety concerns, grief, employment impacts, and social interaction limitations. Face-to-face mental health treatment restrictions were especially impactful to veterans who often gain social enrichment from Veterans Health Administration (VHA) care. We present results from a novel group-based telehealth intervention, VA Caring for Our Nation's Needs Electronically during the COVID-19 Transition (VA CONNECT), which integrates skills training and social support to develop a COVID-19 Safety & Resilience Plan. Veterans (n = 29) experiencing COVID-related stress participated in an open trial of this 10-session, manualized group VHA telehealth intervention. We examined whether COVID-19-related stress, adjustment disorder symptoms, and loneliness decreased, and coping strategy use increased after participation in VA CONNECT. Between baseline and two-month follow-up, participants reported a significant reduction in perceived stress and adjustment disorder symptoms, and an increase in planning coping skills use. Significant changes were not observed in loneliness or other specific coping strategies. Findings may support the utility of VA CONNECT as an intervention for pandemic-related stress and improving certain coping skills. Future research should explore group-based telehealth interventions like VA CONNECT with other populations within and outside of the VA, which have value during major disruptions to face-to-face mental healthcare access.
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Affiliation(s)
- Molly Gromatsky
- VISN 2 Mental Illness Research, Education and Clinical Center (MIRECC), James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sarah R Sullivan
- VISN 2 Mental Illness Research, Education and Clinical Center (MIRECC), James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA
- Hunter College and The Graduate Center, City University of New York, New York, NY, USA
| | - Ashley L Greene
- VISN 2 Mental Illness Research, Education and Clinical Center (MIRECC), James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Usha Govindarajulu
- Department of Population Health Science and Policy, Center for Biostatistics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Emily L Mitchell
- VISN 2 Mental Illness Research, Education and Clinical Center (MIRECC), James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA
| | - Emily R Edwards
- VISN 2 Mental Illness Research, Education and Clinical Center (MIRECC), James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Robert Lane
- VISN 2 Mental Illness Research, Education and Clinical Center (MIRECC), James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kyra K Hamerling-Potts
- VISN 2 Mental Illness Research, Education and Clinical Center (MIRECC), James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA
| | - Angela Page Spears
- VISN 2 Mental Illness Research, Education and Clinical Center (MIRECC), James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA
- Department of Counseling & Clinical Psychology, Teachers College, Columbia University, New York, NY, USA
| | - Marianne Goodman
- VISN 2 Mental Illness Research, Education and Clinical Center (MIRECC), James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Teo AR, Call AA, Hooker ER, Fong C, Karras E, Dobscha SK. Feasibility of recruitment and retention in a remote trial of gatekeeper training for close supports of military veterans: Mixed methods study. Contemp Clin Trials Commun 2022; 30:100993. [PMID: 36159001 PMCID: PMC9489752 DOI: 10.1016/j.conctc.2022.100993] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 08/18/2022] [Accepted: 08/29/2022] [Indexed: 11/02/2022] Open
Abstract
Background VA S.A.V.E. (Signs; Ask; Validate; Encourage/Expedite) is a gatekeeper training, designed to teach individuals how to identify and assist military veterans at risk for suicide. The aim of this pilot was to determine feasibility, barriers, and facilitators of recruitment and retention in a remote trial of VA S.A.V.E. Methods We recruited close supports (family and friends) of veterans through Facebook sponsored ads, automatically randomized them to VA S.A.V.E. or an unrelated video training, and followed them for six months. A subgroup completed interviews, and we used a mixed methods framework to integrate quantitative and qualitative findings. Results Of 214 participants, 61% were spouses or partners of veterans and 48% knew at least one veteran who had died by suicide. Of the three a priori feasibility benchmarks, two were achieved (enrollment, on average, of twenty participants per week and less than 50% loss to follow-up at the 6-month study endpoint) and one was not (enrollment of at least 50% of eligible individuals). There were three barriers (generic ads, ad text referring to "research," and Facebook as an ad platform) and five facilitators (audience segmentation focused on veterans' family members and friends, an urgent call to action to help a veteran, prior exposure to suicide, emphasizing the benefit of receiving training, and using a university as the campaign messenger) to study participation. Conclusion A fully remote trial of VA S.A.V.E. gatekeeper training was feasible in a population of close supports of veterans. Several strategies may further enhance study participation.
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Affiliation(s)
- Alan R. Teo
- VA Portland Health Care System, HSR&D Center to Improve Veteran Involvement in Care (CIVIC), 3710 SW US Veterans Hospital Rd (R&D 66), Portland, OR, 97239, United States
- Oregon Health & Science University, Department of Psychiatry, 3181 SW Sam Jackson Park Rd (Multnomah Pavilion, Room 2316), Portland, OR, 97239, United States
| | - Aaron A. Call
- VA Portland Health Care System, HSR&D Center to Improve Veteran Involvement in Care (CIVIC), 3710 SW US Veterans Hospital Rd (R&D 66), Portland, OR, 97239, United States
| | - Elizabeth R. Hooker
- VA Portland Health Care System, HSR&D Center to Improve Veteran Involvement in Care (CIVIC), 3710 SW US Veterans Hospital Rd (R&D 66), Portland, OR, 97239, United States
| | - Clarissa Fong
- Oregon Health & Science University, OHSU Brain Institute, 3181 S.W. Sam Jackson Park Road, Portland, OR, 97239, United States
| | - Elizabeth Karras
- Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, 400 Fort Hill Ave, Canandaigua, NY, 14424, United States
| | - Steven K. Dobscha
- VA Portland Health Care System, HSR&D Center to Improve Veteran Involvement in Care (CIVIC), 3710 SW US Veterans Hospital Rd (R&D 66), Portland, OR, 97239, United States
- Oregon Health & Science University, Department of Psychiatry, 3181 SW Sam Jackson Park Rd (Multnomah Pavilion, Room 2316), Portland, OR, 97239, United States
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