A Randomized Clinical Trial of Clinician-Supported PTSD Coach in VA Primary Care Patients.

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.

Web-Based Problem-solving Training With and Without Peer Support in Veterans With Unmet Mental Health Needs: Pilot Study of Feasibility, User Acceptability, and Participant Engagement.

BACKGROUND: eHealth tools have the potential to meet the mental health needs of individuals who experience barriers to accessing in-person treatment. However, most users have less than optimal engagement with eHealth tools. Coaching from peer specialists may increase their engagement with eHealth. OBJECTIVE: This pilot study aims to test the feasibility and acceptability of a novel, completely automated web-based system to recruit, screen, enroll, assess, randomize, and then deliver an intervention to a national sample of military veterans with unmet mental health needs; investigate whether phone-based peer support increases the use of web-based problem-solving training compared with self-directed use; and generate hypotheses about potential mechanisms of action for problem-solving and peer support for future full-scale research. METHODS: Veterans (N=81) with unmet mental health needs were recruited via social media advertising and enrolled and randomized to the self-directed use of a web-based problem-solving training called Moving Forward (28/81, 35%), peer-supported Moving Forward (27/81, 33%), or waitlist control (26/81, 32%). The objective use of Moving Forward was measured with the number of log-ins. Participants completed pre- and poststudy measures of mental health symptoms and problem-solving confidence. Satisfaction was also assessed post treatment. RESULTS: Automated recruitment, enrollment, and initial assessment methods were feasible and resulted in a diverse sample of veterans with unmet mental health needs from 38 states. Automated follow-up methods resulted in 46% (37/81) of participants completing follow-up assessments. Peer support was delivered with high fidelity and was associated with favorable participant satisfaction. Participants randomized to receive peer support had significantly more Moving Forward log-ins than those of self-directed Moving Forward participants, and those who received peer support had a greater decrease in depression. Problem-solving confidence was associated with greater Moving Forward use and improvements in mental health symptoms among participants both with and without peer support. CONCLUSIONS: Enrolling and assessing individuals in eHealth studies without human contact is feasible; however, different methods or designs are necessary to achieve acceptable participant engagement and follow-up rates. Peer support shows potential for increasing engagement in web-based interventions and reducing symptoms. Future research should investigate when and for whom peer support for eHealth is helpful. Problem-solving confidence should be further investigated as a mechanism of action for web-based problem-solving training. TRIAL REGISTRATION: ClinicalTrials.gov NCT03555435; http://clinicaltrials.gov/ct2/show/NCT03555435.

The feasibility, acceptability, and preliminary efficacy of an mHealth mindfulness therapy for caregivers of adults with cognitive impairment.

Objectives: To examine the feasibility, acceptability, and preliminary efficacy of Mindfulness Coach, an mHealth Mindfulness Therapy intervention.Methods: We recruited 58 informal caregivers of older adults with cognitive impairment for this pilot feasibility trial. Participants completed measures of caregiver burden, stress, anxiety, and depression at baseline, 2 weeks, 4 weeks, and 8 weeks as well as acceptability and usability data at 8-weeks. The mobile app collected in-app use data including minutes spent using the app and number of unique visits to the app.Results: Users found the app acceptable to use and were satisfied with its design and usability. Over the course of the study period, depression, anxiety, caregiver burden and perceived stress improved. These outcome variables also improved more as caregivers spent more time using the Mindfulness Therapy mHealth intervention.Conclusions: Our results suggest that mHealth mindfulness therapy with caregivers of older adults with cognitive impairment is both feasible and acceptable to users, and that it successfully reduces psychological symptoms. Future work should focus on determining the appropriate doses of the mHealth therapy for particular outcomes and strategies to integrate it into routine care. Mindfulness Therapy delivered in an mHealth format may increase access to psychological treatment for caregivers.

Exploring Usage of COVID Coach, a Public Mental Health App Designed for the COVID-19 Pandemic: Evaluation of Analytics Data.

BACKGROUND: The COVID-19 pandemic has significantly impacted mental health and well-being. Mobile mental health apps can be scalable and useful tools in large-scale disaster responses and are particularly promising for reaching vulnerable populations. COVID Coach is a free, evidence-informed mobile app designed specifically to provide tools and resources for addressing COVID-19-related stress. OBJECTIVE: The purpose of this study was to characterize the overall usage of COVID Coach, explore retention and return usage, and assess whether the app was reaching individuals who may benefit from mental health resources. METHODS: Anonymous usage data collected from COVID Coach between May 1, 2020, through October 31, 2020, were extracted and analyzed for this study. The sample included 49,287 unique user codes and 3,368,931 in-app events. RESULTS: Usage of interactive tools for coping and stress management comprised the majority of key app events (n=325,691, 70.4%), and the majority of app users tried a tool for managing stress (n=28,009, 58.8%). COVID Coach was utilized for ≤3 days by 80.9% (n=34,611) of the sample whose first day of app use occurred within the 6-month observation window. Usage of the key content in COVID Coach predicted returning to the app for a second day. Among those who tried at least one coping tool on their first day of app use, 57.2% (n=11,444) returned for a second visit; whereas only 46.3% (n=10,546) of those who did not try a tool returned (P<.001). Symptoms of anxiety, depression, and posttraumatic stress disorder (PTSD) were prevalent among app users. For example, among app users who completed an anxiety assessment on their first day of app use (n=4870, 11.4% of users), 55.1% (n=2680) reported levels of anxiety that were moderate to severe, and 29.9% (n=1455) of scores fell into the severe symptom range. On average, those with moderate levels of depression on their first day of app use returned to the app for a greater number of days (mean 3.72 days) than those with minimal symptoms (mean 3.08 days; t1=3.01, P=.003). Individuals with significant PTSD symptoms on their first day of app use utilized the app for a significantly greater number of days (mean 3.79 days) than those with fewer symptoms (mean 3.13 days; t1=2.29, P=.02). CONCLUSIONS: As the mental health impacts of the pandemic continue to be widespread and increasing, digital health resources, such as apps like COVID Coach, are a scalable way to provide evidence-informed tools and resources. Future research is needed to better understand for whom and under what conditions the app is most helpful and how to increase and sustain engagement.

Mobile Mental Health Apps from the National Center for PTSD: Digital Self-Management Tools for Co-Occurring Disorders.

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.

Clinician Perceptions Related to the Use of the CBT-I Coach Mobile App.

Objective: Clinicians' perceptions of CBT-I Coach, a patient-facing mobile app for cognitive-behavioral therapy for insomnia (CBT-I), are critical to its adoption and integration into practice. Diffusion of innovations theory emphasizes the influence of perceptions, including the relative advantage to current practice, the compatibility to clinicians' needs, the complexity, the innovation's trialability, and observability. This study intended to evaluate the use and perceptions of CBT-I Coach among Veterans Affairs (VA)-trained CBT-I clinicians. Participants and Methods: Clinicians (N = 108) were surveyed about their use, feedback, and perceptions of CBT-I Coach a year after the app became available. Results: Overall perceptions of CBT-I Coach were favorable. Fifty percent of clinicians reported using CBT-I Coach, with 98% intending to continue use. The app was perceived to increase sleep diary completion and homework compliance. Clinicians viewed the app as providing accessibility to helpful tools and improving patient engagement. Of those not using the app, 83% endorsed intention to use it. Reasons for nonuse were lack of patient access to smart phones, not being aware of the app, not having time to learn it, and inability to directly access app data. Those who reported using CBT-I Coach had more favorable perceptions across all constructs (p < .01 - p < .001), except relative advantage, compared to nonusers. Users perceived it as less complex and more compatible with their practice than nonusers. Conclusions: Continued efforts are needed to increase adoption and enhance use of CBT-I Coach, as well as study if reported benefits can be evidenced more directly.

Randomized Trial of a Social Networking Intervention for Cancer-Related Distress.

BACKGROUND: Web and mobile technologies appear to hold promise for delivering evidence-informed and evidence-based intervention to cancer survivors and others living with trauma and other psychological concerns. Health-space.net was developed as a comprehensive online social networking and coping skills training program for cancer survivors living with distress. PURPOSE: The purpose of this study was to evaluate the effects of a 12-week social networking intervention on distress, depression, anxiety, vigor, and fatigue in cancer survivors reporting high levels of cancer-related distress. METHODS: We recruited 347 participants from a local cancer registry and internet, and all were randomized to either a 12-week waiting list control group or to immediate access to the intervention. Intervention participants received secure access to the study website, which provided extensive social networking capabilities and coping skills training exercises facilitated by a professional facilitator. RESULTS: Across time, the prevalence of clinically significant depression symptoms declined from 67 to 34 % in both conditions. The health-space.net intervention had greater declines in fatigue than the waitlist control group, but the intervention did not improve outcomes for depression, trauma-related anxiety symptoms, or overall mood disturbance. For those with more severe levels of anxiety at baseline, greater engagement with the intervention was associated with higher levels of symptom reduction over time. CONCLUSIONS: The intervention resulted in small but significant effects on fatigue but not other primary or secondary outcomes. Results suggest that this social networking intervention may be most effective for those who have distress that is not associated with high levels of anxiety symptoms or very poor overall psychological functioning. TRIAL REGISTRATION NUMBER: The trial was registered with the ClinicalTrials.gov database ( ClinicalTrials.gov #NCT01976949).

Personal responsibility, regret, and medical stigma among individuals living with lung cancer.

Understanding the degree to which adults with lung cancer perceive personal responsibility for their disease, personal regret for actions that may have contributed to lung cancer, and potential stigmatization from others is important, because these perceptions and experiences may be linked with treatment nonadherence, feelings of isolation, avoidance of healthcare providers, and poor quality of life. The purpose of this study was to evaluate rates and intensity of these types of experiences and to characterize the extent to which they are linked with smoking status and psychological adjustment in those living with lung cancer. Adults with lung cancer (N = 213) were recruited from two major cancer centers to complete a mail survey. Perceived responsibility was frequent in those who had ever smoked (74-80%), whereas regret and feelings of stigmatization were less frequent. When present, however, personal regret and stigmatization were associated with adverse psychological outcomes, particularly for never smokers. These results are consistent with the theory of stereotype threat and have clinical implications for management of people with lung cancer.

Engagement with a social networking intervention for cancer-related distress.

BACKGROUND: Understanding patterns and predictors of engagement could improve the efficacy of Internet interventions. PURPOSE: The purpose of the study was to characterize engagement in a multi-component Internet intervention for cancer survivors with distress. METHODS: Data were derived from 296 cancer survivors provided with access to the Internet intervention and included self-report measures and directly-measured engagement with each component of the intervention. RESULTS: Over 12 weeks, average total engagement was 7.3 h (sd = 11.7), and 42 % of participants spent >3 h on the website. Participants spent more time using social networking components than structured intervention content. Greater early and total engagement was associated with previous chemotherapy, being female, and being recruited via the Internet. Early engagement was associated with greater fatigue and more social constraints. CONCLUSIONS: For many users, engagement with an Internet intervention was quite high. Reducing attrition and tailoring content to better meet the needs of those who do not engage should be a focus of future efforts.

Internet-based interventions for cancer-related distress: exploring the experiences of those whose needs are not met.

OBJECTIVE: Low levels of engagement in Internet-based interventions are common. Understanding users' experiences with these interventions is a key to improving efficacy. Although qualitative methods are well-suited for this purpose, few qualitative studies have been conducted in this area. In the present study, we assessed experiences with an Internet-based intervention among cancer survivors who made minimal use of the intervention. METHODS: Semi-structured interviews were conducted with 25 cancer survivors who were minimally engaged (i.e., spent around 1 h total on website) with the online intervention, health-space.net. The intervention was a 12-week, facilitated support group with social and informational components. Interviews were analyzed using an interpretive descriptive design. RESULTS: Three broad categories, consisting of 18 specific themes, were identified from the interviews, which included connecting with similar others, individual expectations, and problems with the site (Κ = 0.88). The 'similar others' category reflected the significance of interacting with relatable survivors (i.e., same cancer type), the 'individual expectations' category reflected the significance of participants' expectations about using online interventions (i.e., personally relevant information), and the 'problems with the site' category reflected the significance of study procedures (i.e., website structure). CONCLUSIONS: The data indicate that minimally engaged participants have high variability regarding their needs and preferences for Internet-based interventions. Using qualitative methodologies to identify and incorporate these needs into the next generation of interventions has the potential to increase engagement and outcomes. The current study provides a foundation for future research to characterize survivors' needs and offer suggestions for better meeting these needs.

How language affects peer responsiveness in an online cancer support group: implications for treatment design and facilitation.

OBJECTIVE: Little is known about how positive group interactions develop in online support groups. Previous research suggests that message content, self-disclosure, and emotional expression may be central to this process. The purpose of this study was to identify linguistic and qualitative characteristics of participants' messages that predict how other participants respond in an asynchronous discussion board for cancer-related distress. METHODS: 525 discussion board messages posted by 116 participants in the health-space.net trial were collected. Linguistic Inquiry and Word Count (2001) was used to identify linguistic markers of emotional expression and pronoun use. Message topics were identified using qualitative analysis. Logistic regression and chi-square analyses were used to evaluate whether linguistic characteristics and message topics predicted receiving a response from other survivors in the online group. RESULTS: Messages were more likely to receive a reply if they had higher word count, OR=1.30, p=0.001, or fewer second-person pronouns, OR=0.923, p=0.040. Messages with high levels of positive emotion were less likely to receive a reply, OR=0.94, p=0.03. Common message topics related to self-disclosure (51%), the support group (38.5%), medical experiences (30.9%), and experiences with the website (30.1%). Several message topics were associated with greater likelihood of a reply: self-disclosure (p<0.001), medical experiences (p=0.01), relationship issues (p=0.05), and introductory posts (p<0.01). CONCLUSIONS: Informing participants how to introduce themselves to the group (i.e., detailed and self-focused messages discussing personal issues such as the effects of illness on life and relationships) could promote cohesion and enhance overall engagement with Internet-based support groups or interventions.

Modeling intention to participate in face-to-face and online lung cancer support groups.

BACKGROUND: Lung cancer patients and survivors are significantly less likely to use support groups than those with other cancers. In this study, we evaluated the utility and specificity of the Behavioral Model for Vulnerable Populations for modeling intention to participate in face-to-face (F2F) and online lung cancer support groups. METHODS: Adults diagnosed with lung cancer (n = 230) completed measures assessing predisposing, enabling, and need factors associated with intention to use support services. RESULTS: Intention to join a F2F support group (found among 36.4% of survivors) was associated with positive attitude about F2F support groups, fewer perceived time constraints, less travel time from the clinic, and not having enough social support. Intention to join an online support group (34% of survivors) was associated with having more positive attitudes about online support, greater use of avoidance coping strategies, more comfort using computers, and fewer perceived time constraints. Demographics, medical history, health status, and psychological status were not associated with intention to join either type of group. CONCLUSIONS: Reducing barriers to participation and addressing attitudes about support services may be the most effective ways to increase utilization of lung cancer support services.

Representativeness of two sampling procedures for an internet intervention targeting cancer-related distress: a comparison of convenience and registry samples.

Internet interventions often rely on convenience sampling, yet convenience samples may differ in important ways from systematic recruitment approaches. The purpose of this study was to evaluate potential demographic, medical, and psychosocial differences between Internet-recruited and registry-recruited cancer survivors in an Internet-based intervention. Participants were recruited from a cancer registry (n = 80) and via broad Internet outreach efforts (n = 160). Participants completed a set of self-report questionnaires, and both samples were compared to a population-based sample of cancer survivors (n = 5,150). The Internet sample was younger, better educated, more likely to be female, had longer time since diagnosis, and had more advanced stage of disease (p's < .001), and the registry-sample was over-represented by men and those with prostate or other cancer types (p's < .001). The Internet sample also exhibited lower quality of life and social support and greater mood disturbance (p's < .001). Understanding how convenience and systematic samples differ has important implications for external validity and potential for dissemination of Internet-based interventions.

Information-seeking in cancer survivors: application of the Comprehensive Model of Information Seeking to HINTS 2007 data.

Despite health care providers' best efforts, many cancer survivors have unmet informational and support needs. As a result, cancer survivors often have to meet these needs themselves, and how they approach this process is poorly understood. The authors aimed to validate and extend the Comprehensive Model of Information Seeking to examine information-seeking behaviors across a variety of channels of information delivery and to explore the impact of health-related factors on levels of information seeking. The data of 459 cancer survivors were drawn from the National Cancer Institute's 2007 Health Information National Trends Survey. Structural equation modeling was used to evaluate the associations among health-related factors, information-carrier factors, and information-seeking behavior. Results confirmed direct effects of direct experience, salience, and information-carrier characteristics on information-carrier utility. However, the direct impact of demographics and beliefs on information-carrier utility was not confirmed, nor were the effects of information-carrier factors on information-seeking behavior. Contrary to expectations, salience had direct effect on information-seeking behavior and on information-carrier characteristics. These results show that understanding antecedents of information seeking will inform the development and implementation of systems of care that will help providers better meet cancer survivors' needs.

Preliminary Evaluation of a Conversational Agent to Support Self-management of Individuals Living With Posttraumatic Stress Disorder: Interview Study With Clinical Experts.

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.

Feasibility, acceptability and preliminary efficacy of a mental health self-management app in clinicians working during the COVID-19 pandemic: A pilot randomised controlled trial.

COVID-19 affected the well-being of healthcare workers (HCWs) globally. Mental health app interventions (MHAIs) may offer appropriate and accessible means to support HCWs' mental health. We conducted a pilot randomised controlled crossover trial involving 34 clinicians randomised to either a MHAI or a waitlisted group. After one month, outcome assessments were repeated and the waitlisted group then crossed over to the MHAI; they again completed outcome assessments after a month. The primary outcomes were feasibility, assessed with the Systems Usability Scale (SUS), and acceptability, assessed with the Client Satisfaction Questionnaire (CSQ). Secondary outcomes included efficacy for various mental health parameters. The SUS and CSQ scores indicated above average feasibility and acceptability. There was a significant difference in anxiety from baseline to 1-month follow-up between the groups, with greater improvement in the MHAI group. The groups differed in resilience and patient-related burnout from baseline to 1-month follow-up, with a trend towards significance, with greater improvements in the MHAI group. Anxiety and acute stress disorder severity improved significantly from pre- to post-intervention. We demonstrated that MHAIs hold potential for improving well-being of HCWs, although these findings will need to be replicated in adequately powered trials.

The PTSD Family Coach App in Veteran Family Members: Pilot Randomized Controlled Trial.

BACKGROUND: Posttraumatic stress disorder (PTSD) among US military veterans can adversely impact their concerned significant others (CSOs; eg, family members and romantic partners). Mobile apps can be tailored to support CSO mental health through psychoeducation, coping skills, and stress monitoring. OBJECTIVE: This study assessed the feasibility, acceptability, and potential efficacy of PTSD Family Coach 1.0, a free, publicly available app that includes psychoeducation, stress management tools, self-assessments, and features for connecting to alternative supports, compared with a psychoeducation-only version of the app for cohabitating CSOs of veterans with PTSD. METHODS: A total of 200 participants with an average age of 39 (SD 8.44) years, primarily female (193/200, 97%), and White (160/200, 80%) were randomized to self-guided use of either PTSD Family Coach 1.0 (n=104) or a psychoeducation-only app (n=96) for 4 weeks. Caregiver burden, stress, depression, anxiety, beliefs about treatment, CSO self-efficacy, and relationship functioning assessed using measures of dyadic adjustment, social constraints, and communication danger signs were administered via a web survey at baseline and after treatment. User satisfaction and app helpfulness were assessed after treatment. Data were analyzed using linear mixed methods. RESULTS: Overall, 50.5% (101/200) of randomized participants used their allocated app. Participants found PTSD Family Coach 1.0 somewhat satisfying (mean 4.88, SD 1.11) and moderately helpful (mean 2.99, SD 0.97) to use. Linear mixed effects models revealed no significant differences in outcomes by condition for caregiver burden (P=.45; Cohen d=0.1, 95% CI -0.2 to 0.4), stress (P=.64; Cohen d=0.1, 95% CI -0.4 to 0.6), depression (P=.93; Cohen d= 0.0, 95% CI -0.3 to 0.3), anxiety (P=.55; Cohen d=-0.1, 95% CI -0.4 to 0.2), beliefs about treatment (P=.71; Cohen d=0.1, 95% CI -0.2 to 0.3), partner self-efficacy (P=.59; Cohen d=-0.1, 95% CI -0.4 to 0.2), dyadic adjustment (P=.08; Cohen d=-0.2, 95% CI -0.5 to 0.0), social constraints (P=.05; Cohen d=0.3, 95% CI 0.0-0.6), or communication danger signs (P=.90; Cohen d=-0.0, 95% CI -0.3 to 0.3). Post hoc analyses collapsing across conditions revealed a significant between-group effect on stress for app users versus nonusers (ß=-3.62; t281=-2.27; P=.02). CONCLUSIONS: Approximately half of the randomized participants never used their allocated app, and participants in the PTSD Family Coach 1.0 condition only opened the app approximately 4 times over 4 weeks, suggesting limitations to this app version's feasibility. PTSD Family Coach 1.0 users reported moderately favorable impressions of the app, suggesting preliminary acceptability. Regarding efficacy, no significant difference was found between PTSD Family Coach 1.0 users and psychoeducation app users across any outcome of interest. Post hoc analyses suggested that app use regardless of treatment condition was associated with reduced stress. Further research that improves app feasibility and establishes efficacy in targeting the domains most relevant to CSOs is warranted. TRIAL REGISTRATION: ClinicalTrials.gov NCT02486705; https://clinicaltrials.gov/ct2/show/NCT02486705.

Peer-supported mobile mental health for veterans in primary care: A pilot study.

One in four veteran primary care patients suffers from a mental health condition; however, most do not receive any treatment for these problems. Mobile health (mHealth) can overcome barriers to care access, but poor patient engagement limits the effectiveness and implementation of these tools. Peers may facilitate patient engagement with mHealth. We designed a protocol for peers to support implementation of mobile mental health tools in primary care and tested the feasibility, acceptability, and clinical utility of this approach. Thirty-nine patients across two Veterans Affairs sites who screened positive for depression during a primary care visit and were not currently in mental health treatment were enrolled. Participants were scheduled for four phone sessions with a peer over 8 weeks and introduced to five mobile apps for a range of transdiagnostic mental health issues (stress, low mood, sleep problems, anger, and trauma). Pre/post phone interviews using quantitative and qualitative approaches assessed participants' self-reported app use, satisfaction with the intervention, symptom change (stress, anxiety, depression, insomnia), and progress with personal health goals. On average, patients reported using 3.04 apps (SD = 1.46). Per the Client Satisfaction Questionnaire, global satisfaction with the intervention was high (M = 25.71 out of 32, SD = 3.95). Pre to post participants reported significant improvements in their level of stress, based on a quantitative measure (p = .008), and 87% reported progress on at least one personal health goal. Findings support the feasibility, acceptability, and clinical utility of peer-supported mobile mental health for veterans in primary care. A randomized controlled trial of an adaptive version of this intervention is recommended. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Development of a mobile mindfulness smartphone app for post-traumatic stress disorder and alcohol use problems for veterans: Beta test results and study protocol for a pilot randomized controlled trial.

BACKGROUND: Post-traumatic stress disorder (PTSD) and alcohol use disorder (AUD) are highly prevalent, and co-occurring among post-9/11 veterans. Mobile health (mHealth) applications, specifically those focused on mindfulness-based techniques, may be an effective avenue to intervene with veterans who cannot or will not seek care at traditional in-person settings. Thus, to address areas of improvement in mHealth for veterans, we developed Mind Guide and prepared it for testing in a pilot randomized controlled trial (RCT) with veterans. METHODS: We have completed phase 1 (treatment development) and Phase 2 (beta test) of our mobile mHealth app, Mind Guide. In this paper we describe the methods for Phase 1 as well as results for our beta test (n = 16; inclusion criteria included screen for PTSD, AUD, a post-9/11 veteran, and not currently receiving treatment) for Mind Guide as well as outline procedures for our pilot RCT of Mind Guide (Phase 3). The PTSD Checklist, self-reported alcohol use, the Perceived Stress Scale, Penn Alcohol Craving Scale, and the Emotion Regulation Questionnaire were used. RESULTS: Results of our beta test of Mind Guide show promising past 30 day effects on PTSD (d = -1.12), frequency of alcohol use (d = -0.54), and alcohol problems (d = -0.44), and related mechanisms of craving (d = -0.53), perceived stress (d = -0.88), and emotion regulation (d = -1.22). CONCLUSION: Our initial beta-test of Mind Guide shows promise for reducing PTSD and alcohol related problems among veterans. Recruitment is ongoing for our pilot RCT in which 200 veterans will be recruited and followed up for 3 months. CLINICALTRIALS: gov Identifier: NCT04769986.

Mental health apps and U.S. military veterans: Perceived importance and utilization of the National Center for Posttraumatic Stress Disorder app portfolio.

U.S. veterans have historically experienced more mental health concerns as compared to the general population, yet face a variety of barriers to accessing care. Evidence-based and accessible resources, such as mobile apps, are needed to respond to the unique needs of a diverse veteran population. The U.S. Department of Veterans Affairs (VA's) National Center for Posttraumatic Stress Disorder has created a one-of-a-kind portfolio of mental health apps to target the needs of veterans and support the self-management of common concerns related to posttraumatic stress disorder. Using data from a nationally representative sample of U.S. veterans, the present study sought to examine how veterans perceived the importance of making each self-management app available to other Veterans; factors impacting veterans' intent to try each app; and actual uptake of each app. Results revealed that while 46.7%-75.0% of veterans reported that the apps are important for veterans, 5.8%-19.2% reported that they would be likely to download the apps, and only 5.0% reported having ever used any of them. Veterans who used any of the apps were more likely to be employed, have served two or more deployments, be married or partnered, use the VA as their primary source of health care, had more medical conditions, and were less likely to identify as Black. With respect to future app use, Black veterans were to 2-5 times more likely than White veterans to indicate a desire to download each of the apps. Other variables that showed consistent associations with increased likelihood of app download included greater smartphone utilization, being married or having a partner, lower household income, and history of mental health treatment. Implications of these results for the broader dissemination of mental health apps and promotion of their uptake are discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).