Improving mental health in U.S. Veterans using mHealth tools: A pilot study

Rates of PTSD remain elevated among U.S. Veterans, highlighting a need for innovative management tools. Previous studies have shown mobile apps to have positive effects on PTSD symptoms, but few apps have been examined systematically. This pilot study evaluated the perceived effectiveness and usability of Mindset, a novel mobile app that monitors user stress level via heart rate to encourage e-therapy use. The study sample included 30 community-residing Veterans who completed baseline assessments. They used the Mindset app and associated smartwatch until their approximate 1-month follow-up. Self-reported assessments included pre- and post-deployment experiences; experience with Mindset; and standard screeners for PTSD (PCL-M), anxiety (GAD-7), depression (PHQ-9), and alcohol use problems (AUDIT). Among the 24 participants who completed follow-up interviews, a significant decrease ( p < 0.05) was found in PCL-M, PHQ-9, and modified AUDIT scores. Respondents reported moderate to high acceptance and satisfaction with Mindset features, though considerable frustration with the associated smartwatch. These findings highlight mHealth apps such as Mindset as potentially useful tools for PTSD and depression symptom management. These findings are also encouraging in the context of the current COVID-19 pandemic, which may accelerate further innovation and implementation of mHealth technologies to improve mental health self-care.

Download Full-text

Efficacy and Moderation of Mobile App–Based Programs for Mindfulness-Based Training, Self-Compassion Training, and Cognitive Behavioral Psychoeducation on Mental Health: Randomized Controlled Noninferiority Trial

JMIR Mental Health ◽

10.2196/mental.8597 ◽

2018 ◽

Vol 5 (4) ◽

pp. e60 ◽

Cited By ~ 25

Author(s):

Winnie WS Mak ◽

Alan CY Tong ◽

Sindy YC Yip ◽

Wacy WS Lui ◽

Floria HN Chio ◽

...

Keyword(s):

Mental Health ◽

Psychological Distress ◽

Mobile Apps ◽

Well Being ◽

Mobile App ◽

Cognitive Behavioral ◽

Mindful Awareness ◽

Self Compassion ◽

Mental Well Being

Background Mindfulness-based interventions, self-compassion training, and cognitive behavioral therapy have garnered much evidence in its salutary effects on mental health. With increasing application of smartphone and mobile technology on health promotion, this study investigated the efficacy and possible moderators of mindfulness, self-compassion, and cognitive behavioral psychoeducation training mobile apps in the improvement of mental health. Objective The aim of this study was to examine the efficacy of 3 mobile app–based programs: mindfulness-based program, self-compassion program, and cognitive behavioral psychoeducation program in improving mental well-being and reducing psychological distress. Changes in mindful awareness and self-compassion were also assessed. To further delineate the suitability of each program for different types of individuals, individual difference variables (ie, discomfort with emotions and tolerance for ambiguity) were explored for potential moderation. Methods This study was a 3-arm, randomized, controlled, noninferiority trial examining the efficacy of mindfulness-based program, self-compassion program, and cognitive behavioral psychoeducation. Participants were randomized into either 1 of the 3 conditions. Throughout the 4-week, 28-session program, participants spent 10-15 min daily reviewing the course content and practicing various related exercises. At preprogram, postprogram, and 3-month follow-up, participants also completed Web-based measures of mental well-being, psychological distress, mindful-awareness, and self-compassion as well as the proposed moderators. Results Among the 2161 study participants, 508 and 349 completed the post- and 3-month follow-up assessment, respectively. All 3 conditions (mindfulness-based program: N=703; cognitive behavioral psychoeducation: N=753; self-compassion program: N=705) were found to be efficacious in improving mental well-being and reducing psychological distress. All conditions enhanced mindful awareness at postprogram. Significant interaction effect was found on self-compassion; cognitive behavioral psychoeducation and self-compassion program, but not mindfulness-based program, significantly enhanced self-compassion at postprogram. No significant differences regarding usage and users’ satisfaction were found among the 3 conditions. None of the proposed moderators were found to be significant. Conclusions Mindfulness-based, self-compassion, and cognitive behavioral psychoeducation mobile apps were efficacious in improving mental well-being and reducing psychological distress among adults at postprogram and 3-month follow-up. Future app-based psychological training programs should consider gamification and personalization of content or feedback to enhance engagement and mitigate the high attrition rates that are common in app-based health promotion programs. Trial Registration Chinese Clinical Trial Registry (ChiCTR) ChiCTR-TRC-13003468; http://www.chictr.org.cn/hvshowproject.aspx?id=6220 (Archived by WebCite at http://www.webcitation.org/734PlOz50)

Download Full-text

Predicting Uptake of the COVID Coach App Among U.S. Military Veterans: A Funnel Analysis Using a Probability-Based Panel (Preprint)

10.2196/preprints.36217 ◽

2022 ◽

Author(s):

Beth K Jaworski ◽

Katherine Taylor ◽

Kelly M Ramsey ◽

Adrienne J Heinz ◽

Sarah Steinmetz ◽

...

Keyword(s):

Mental Health ◽

Older Adults ◽

Mobile Apps ◽

Military Veterans ◽

Total Sample ◽

Mobile App ◽

Future Research ◽

Nationally Representative ◽

Managing Stress ◽

Usage Data

BACKGROUND Although the pandemic has not led to a uniform increase of mental health concerns among older adults, there is evidence to suggest that some older veterans did experience an exacerbation of pre-existing mental health conditions, and that mental health difficulties were associated with a lack of social support and increasing numbers of pandemic-related stressors. Mobile mental health apps are scalable, may be a helpful resource for managing stress during the pandemic and beyond, and could potentially provide services that are not accessible due to the pandemic. However, overall comfort with mobile devices and factors influencing the uptake and usage of mobile apps during the pandemic among older veterans are not well known. COVID Coach is a free, evidence-informed mobile app designed for pandemic-related stress. Public usage data have been evaluated, but its uptake and usage among older veterans has not been explored. OBJECTIVE The purpose of the current study was to characterize smartphone ownership rates among U.S. veterans, identify veteran characteristics associated with downloading and use of COVID Coach, and characterize key content usage within the app. METHODS Data were analyzed from the 2019-2020 National Health and Resilience in Veterans Study (NHRVS), which surveyed a nationally representative, prospective cohort of 3,078 U.S. military veterans before and one year into the pandemic. The NHRVS sample was drawn from KnowledgePanel®, a research panel of more than 50,000 households maintained by Ipsos, Inc. Median time to complete the survey was nearly 32 minutes. The research version of COVID Coach was offered to all veterans who completed the peri-pandemic follow-up assessment on a mobile device (n = 814; weighted 34.2% of total sample). App usage data from all respondents who downloaded the app (n = 34; weighted 3.3% of the mobile completers sample) were collected between November 14, 2020 and November 7, 2021. RESULTS We found that most U.S. veterans own smartphones and veterans with higher education, greater number of adverse childhood experiences, higher extraversion, and greater severity of pandemic-related PTSD symptoms were more likely to download COVID Coach. Although uptake and usage of COVID Coach was relatively low (3.3% of eligible participants, n = 34), 50% of the participants returned to the app for more than one day of use. The interactive tools for managing stress were used most frequently. CONCLUSIONS Although the coronavirus pandemic has increased the need for and creation of digital mental health tools, these resources may require tailoring for older veteran populations. Future research is needed to better understand how to optimize digital mental health tools, such as apps, to ensure uptake and usage among older adults, particularly those who have experienced traumas across the lifespan.

Download Full-text

Posttraumatic stress disorder predicts poor health-related quality of life in cardiac patients in Palestine

PLoS ONE ◽

10.1371/journal.pone.0255077 ◽

2021 ◽

Vol 16 (7) ◽

pp. e0255077

Author(s):

Hala Allabadi ◽

Abdulsalam Alkaiyat ◽

Tamer Zahdeh ◽

Alaa Assadi ◽

Aya Ghanayim ◽

...

Keyword(s):

Quality Of Life ◽

Mental Health ◽

Stress Disorder ◽

Cardiac Patients ◽

Ptsd Symptoms ◽

Health Related Quality ◽

Related Quality ◽

Health Related

Background The longitudinal association of posttraumatic stress disorder (PTSD) with health-related quality of life (HRQL) in cardiac patients’ remains poorly studied, particularly in conflict-affected settings. Materials and methods For this cohort study, we used baseline and one-year follow-up data collected from patients 30 to 80 years old consecutively admitted with a cardiac diagnosis to four major hospitals in Nablus, Palestine. All subjects were screened for PTSD and HRQL using the PTSD Checklist Specific and the HeartQoL questionnaire. We used a generalized structural equation model (GSEM) to examine the independent predictive association of PTSD at baseline with HRQL at follow-up. We also examined the mediating roles of depression, anxiety, and stress at baseline. Results The prevalence of moderate-to-high PTSD symptoms among 1022 patients at baseline was 27∙0%. Patients with PTSD symptoms reported an approximate 20∙0% lower HRQL at follow-up. The PTSD and HRQL relationship was largely mediated by depressive and anxiety symptoms. It was not materially altered by adjustment for socio-demographic, clinical, and lifestyle factors. Discussion Our findings suggest that individuals with a combination of PTSD and depression, or anxiety are potentially faced with poor HRQL as a longer-term outcome of their cardiac disease. In Palestine, psychological disorders are often stigmatized; however, integration of mental health care with cardiac care may offer an entry door for addressing psychological problems in the population. Further studies need to assess the effective mental health interventions for improving quality of life in cardiac patients.

Download Full-text

Outcomes for Treatment of Hypersexual Behavior Provided by Specialized Social Welfare Units

Research on Social Work Practice ◽

10.1177/1049731518757030 ◽

2018 ◽

Vol 29 (1) ◽

pp. 103-112 ◽

Cited By ~ 2

Author(s):

Cecilia Kjellgren

Keyword(s):

Mental Health ◽

Pilot Study ◽

Social Welfare ◽

Quantitative Data ◽

Self Report ◽

Hypersexual Behavior ◽

Group Design ◽

The Social ◽

Seeking Help

Purpose: This study explores outcomes of treatment provided by specialized units within the social welfare sector in Sweden to clients seeking help with hypersexual behavior. Method: The participants were 27 males and 1 female ( M = 40.3 years) who sought help from one of the three specialized units within social welfare in Sweden. A pretest–posttest group design was used to assess changes after treatment. Quantitative data were collected through interviews and self-report forms. Results: At posttreatment stage (on average a 10-month follow-up), mental health was significantly improved and hypersexual behavior reportedly reduced. The treatment at the specialized units appeared to help the clients. Conclusions: The specialized units seemed to deliver favorable service without shaming and stigmatizing participants. As this study can be considered a pilot study, it needs to be replicated.

Download Full-text

Parents welcome follow-up using mobile devices: A survey of acceptability at an Australian tertiary paediatric centre

Anaesthesia and Intensive Care ◽

10.1177/0310057x19839941 ◽

2019 ◽

Vol 47 (2) ◽

pp. 189-192 ◽

Cited By ~ 2

Author(s):

Harry E Smallbone ◽

Thomas FE Drake-Brockman ◽

Britta S von Ungern-Sternberg

Keyword(s):

Mobile Devices ◽

Electronic Communication ◽

Mobile Apps ◽

Paediatric Population ◽

Mobile App ◽

Success Rates ◽

Online Forms ◽

Almost All ◽

To Receive

Follow-up for ongoing management and monitoring of patients is important in clinical practice and research. While common, telephone follow-up is resource intensive and, in our experience, yields low success rates. Electronic communication using mobile devices including smartphones and tablets can provide efficient alternatives — including SMS (text), online forms and mobile apps. To assess attitudes towards electronic follow-up, we surveyed 642 parents and carers at Perth Children’s Hospital, targeting demographics, device ownership and attitudes towards electronic follow-up. Mobile phone ownership was effectively universal. Almost all respondents were happy to communicate electronically with the hospital. Promisingly, 93.2% of respondents were happy to receive follow-up SMSs from the hospital and 80.3% were happy to reply to SMS questions. There was less enthusiasm regarding other modalities, with 59.9% happy to use a website and 69.0% happy to use a mobile app. The results support the introduction of electronic communication for follow-up in our paediatric population.

Download Full-text

Efficacy of mobile application interventions for the treatment of post-traumatic stress disorder: A systematic review

Digital Health ◽

10.1177/2055207619842986 ◽

2019 ◽

Vol 5 ◽

pp. 205520761984298 ◽

Cited By ~ 8

Author(s):

Alice Wickersham ◽

Petros Minas Petrides ◽

Victoria Williamson ◽

Daniel Leightley

Keyword(s):

Post Traumatic Stress Disorder ◽

Traumatic Stress ◽

Stress Disorder ◽

Mobile Apps ◽

Healthcare Services ◽

Mobile App ◽

Small Sample ◽

Ptsd Symptoms ◽

Post Traumatic Stress ◽

Post Traumatic

Background Many adults with post-traumatic stress disorder (PTSD) are unable to access healthcare services for treatment due to logistical, social, and attitudinal barriers. Interventions delivered via mobile applications (apps) may help overcome these barriers. Objective The aim of this study is to systematically evaluate the most recent evidence from trials investigating the efficacy of mobile apps for treating PTSD. Methods PubMed, Web of Science, Embase, PsycINFO, and Medline were searched in February 2018. Randomised controlled trials (RCTs) were included if they quantitatively evaluated the efficacy of a mobile app for treating PTSD as part of the primary aim. Findings were presented in a narrative synthesis. Results In the five identified RCTs, the use of app-based interventions appeared to be associated with reductions in PTSD symptoms. However, the strength of evidence for this association appeared to be inconsistent, and there was little evidence that those using the apps experienced greater reductions in PTSD symptoms than those in control conditions. Nonetheless, there was some evidence that app-based interventions are both a feasible and acceptable treatment pathway option. Conclusions Included studies were often limited by small sample sizes, brief intervention, and follow-up periods, and self-reported measures of PTSD. Evidence for the efficacy of mobile interventions for treating PTSD was inconclusive, but promising. Healthcare professionals should exercise caution in recommending app-based interventions until the potentially adverse effects of app use are better understood and larger-scale studies have taken place.

Download Full-text

Effectiveness of Cognitive Behavioral Group Intervention on Acculturation

Research on Social Work Practice ◽

10.1177/1049731516646857 ◽

2016 ◽

Vol 27 (1) ◽

pp. 68-79 ◽

Cited By ~ 9

Author(s):

Jia-Yan Pan ◽

Petrus Ng ◽

Daniel Kim-Wan Young ◽

Schoepf Caroline

Keyword(s):

Mental Health ◽

Hong Kong ◽

Psychological Distress ◽

University Students ◽

Acculturative Stress ◽

Group Intervention ◽

Positive Emotions ◽

Cognitive Behavioral ◽

Positive Effects

Objective: This study examined the effectiveness of group cognitive behavioral intervention (CBI) in improving mental health and promoting postmigration growth for Mainland university students in Hong Kong. Methods: Thirty-six Mainland students with mild-to-moderate levels of psychological distress have completed a 8-session CBI group. Various mental health measures have been administered at the pre-, post-, and 3-month follow-up tests. Results: The levels of psychological distress, acculturative stress, and negative emotions and negative thoughts of the participants were significantly reduced, while their positive emotions and postmigration growth were significantly increased upon completion of the CBI group. The positive effects were maintained at 3-month follow-up. Conclusions: CBI group appears to be an effective intervention approach for improving the mental health and promoting postmigration growth for Mainland university students in Hong Kong. Implications for social work practices when engaging with Chinese international students were provided.

Download Full-text

Intake Follow-Up of “No Service” Cases

The Canadian Journal of Psychiatry ◽

10.1177/070674378102600309 ◽

1981 ◽

Vol 26 (3) ◽

pp. 183-185 ◽

Cited By ~ 4

Author(s):

Arlette Lefebvre ◽

Elliott Weiss ◽

Nancy Cohen ◽

Suzanne Waldron

Keyword(s):

Mental Health ◽

Pilot Study ◽

Local Community ◽

Community Resources ◽

Mental Health Clinics ◽

Health Clinics ◽

Number Of Patients ◽

Central Resource ◽

Sick Children

At The Hospital for Sick Children in Toronto, an attempt was made to bypass long pre-assessment waiting lists by referring an increasing number of patients to local community resources at the point of the initial intake call. During the pilot study, we contacted 40 families who had been redirected along these lines between January and June 1979. We found that 31 (78%)families had followed our recommendations and most were satisfied with the treatment they were receiving. This suggests that “re-referral” upon intake can often be a highly effective and useful service when provided by a central resource and consultation centre. A further systematic follow-up of all applications to children's mental health clinics, including a careful appraisal of no-show cases (families who are accepted for assessment but cancel or fail to attend), is essential so that we can tailor our services to the specific child psychiatry needs of our varied clientèle.

Download Full-text

Digital Tools Fill a Gap in Mental Health Screening and Support, Particularly for Women Lacking Strong Social Networks

Iproceedings ◽

10.2196/15207 ◽

2019 ◽

Vol 5 (1) ◽

pp. e15207

Author(s):

Dani Bradley ◽

Christina Cobb ◽

Adam Wolfberg

Keyword(s):

Mental Health ◽

Social Networks ◽

Healthcare Provider ◽

Mobile Apps ◽

Single Women ◽

Health Screening ◽

Mental Health Screening ◽

Married Women ◽

Mobile App ◽

Screening Tools

Background Roughly 11% of women suffer from postpartum depression nationwide; however, many believe the condition to be widely underreported, in part due to inadequate screening and stigma associated with the condition. Social support networks can help to prevent or mitigate symptoms related to postpartum depression. Single mothers tend to suffer from this condition at a higher rate than married women as they tend to have weaker social networks compared to married women. Objective The primary objective ws to determine whether gaps exist in mental health screening and whether digital screening tools can help to fill these gaps. The secondary objective ws to determine whether digitally delivered support proves to be more or less beneficial to subsets of women, namely based on their marital status. Methods A survey about mental health history, support, experience with mental health screeners, and characteristics of social networks was sent by email to users of the Ovia Fertility, Ovia Pregnancy, and Ovia Parenting mobile apps. Respondents were all 18 years of age or older and living in the United States. The study was granted exemption by our institutional review board. Results Of the 2016 respondents, 39% reported that they were never screened by their healthcare provider for mental health conditions (26% of women with children and 52% of women without children). Among women who reported never being screened by a healthcare provider, 17% reported that they have completed at least one of the screeners (PHQ-9 or Edinburgh Postnatal Depression Scale [EPDS]) in an Ovia mobile app. Of the 2016 respondents, 86% reported being married or in a domestic partnership. Among the single respondents, 32% reported either having children, being pregnant, or currently trying to conceive. More single women who have children, are pregnant, or are actively trying to conceive reported that they would feel most supported by a mobile appl (namely, one of Ovia Health’s three mobile apps) and to seek treatment for mental health concerns compared to married women (19% compared to 14% of married women; P=.03). Additionally, single women who have children, are pregnant, or are actively trying to conceive reported more often than married women that they feel their mental health is best supported by a mobile appl (16% compared to 10% of married women; P=.007). However, both groups of women selected their healthcare provider and their friends/family as the first and second ranking support systems for both seeking mental health treatment and for mental health related support, with the mobile app ranking last. Conclusions Screening for mental health conditions during the reproductive health journey is lacking. Digital solutions that deliver clinically validated screening tools help to screen women who are missed in a clinical setting. Women who report being single throughout parenting, pregnancy, or while trying to conceive find more value in mobile app–provided mental health support compared to married women. These findings highlight two gaps that digital technologies, like Ovia Health, can fill: low mental health screening rates during reproductive years and suboptimal social systems.

Download Full-text

Clinician Perspectives and Design Implications in Using Patient-Generated Health Data to Improve Mental Health Practices: Mixed Methods Study

JMIR Formative Research ◽

10.2196/18123 ◽

2020 ◽

Vol 4 (8) ◽

pp. e18123

Author(s):

Danny T Y Wu ◽

Chen Xin ◽

Shwetha Bindhu ◽

Catherine Xu ◽

Jyoti Sachdeva ◽

...

Keyword(s):

Mental Health ◽

Mixed Methods ◽

Collaborative Care ◽

Mobile Apps ◽

Data Interpretation ◽

Health Data ◽

Design Guidelines ◽

Mixed Methods Study ◽

Semistructured Interviews ◽

Mhealth Apps

Background Patient-generated health data (PGHD) have been largely collected through mobile health (mHealth) apps and wearable devices. PGHD can be especially helpful in mental health, as patients’ illness history and symptom narratives are vital to developing diagnoses and treatment plans. However, the extent to which clinicians use mental health–related PGHD is unknown. Objective A mixed methods study was conducted to understand clinicians’ perspectives on PGHD and current mental health apps. This approach uses information gathered from semistructured interviews, workflow analysis, and user-written mental health app reviews to answer the following research questions: (1) What is the current workflow of mental health practice and how are PGHD integrated into this workflow, (2) what are clinicians’ perspectives on PGHD and how do they choose mobile apps for their patients, (3) and what are the features of current mobile apps in terms of interpreting and sharing PGHD? Methods The study consists of semistructured interviews with 12 psychiatrists and clinical psychologists from a large academic hospital. These interviews were thematically and qualitatively analyzed for common themes and workflow elements. User-posted reviews of 56 sleep and mood tracking apps were analyzed to understand app features in comparison with the information gathered from interviews. Results The results showed that PGHD have been part of the workflow, but its integration and use are not optimized. Mental health clinicians supported the use of PGHD but had concerns regarding data reliability and accuracy. They also identified challenges in selecting suitable apps for their patients. From the app review, it was discovered that mHealth apps had limited features to support personalization and collaborative care as well as data interpretation and sharing. Conclusions This study investigates clinicians’ perspectives on PGHD use and explored existing app features using the app review data in the mental health setting. A total of 3 design guidelines were generated: (1) improve data interpretation and sharing mechanisms, (2) consider clinical workflow and electronic health record integration, and (3) support personalized and collaborative care. More research is needed to demonstrate the best practices of PGHD use and to evaluate their effectiveness in improving patient outcomes.

Download Full-text