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

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.

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Opportunities to Integrate Mobile App–Based Interventions Into Mental Health and Substance Use Disorder Treatment Services in the Wake of COVID-19

American Journal of Health Promotion ◽

10.1177/08901171211055314 ◽

2021 ◽

pp. 089011712110553

Author(s):

Derek D. Satre ◽

Meredith C. Meacham ◽

Lauren D. Asarnow ◽

Weston S. Fisher ◽

Lisa R. Fortuna ◽

...

Keyword(s):

Mental Health ◽

Substance Use ◽

Substance Use Disorder ◽

Mental Health Problems ◽

Mobile Apps ◽

Mobile App ◽

Future Research ◽

Substance Use Disorder Treatment ◽

Disorder Treatment ◽

The Impact

The COVID-19 pandemic has heightened concerns about the impact of depression, anxiety, alcohol, and drug use on public health. Mobile apps to address these problems were increasingly popular even before the pandemic, and may help reach people who otherwise have limited treatment access. In this review, we describe pandemic-related substance use and mental health problems, the growing evidence for mobile app efficacy, how health systems can integrate apps into patient care, and future research directions. If equity in access and effective implementation can be addressed, mobile apps are likely to play an important role in mental health and substance use disorder treatment.

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COVID Coach: Exploring Usage of a Public Mental Health App Designed for the COVID-19 Pandemic (Preprint)

10.2196/preprints.26559 ◽

2020 ◽

Author(s):

Beth K Jaworski ◽

Katherine Taylor ◽

Kelly M Ramsey ◽

Adrienne Heinz ◽

Sarah Steinmetz ◽

...

Keyword(s):

Mental Health ◽

Large Scale ◽

Digital Health ◽

Public Mental Health ◽

Health Resources ◽

Well Being ◽

Mobile App ◽

Future Research ◽

Observation Window ◽

Managing Stress

BACKGROUND The COVID-19 pandemic has significantly impacted mental health and well-being. Mobile mental health apps can be scalable, 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 the current study was to characterize overall usage of COVID Coach, explore retention and return usage, and assess whether the app was reaching individuals that 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 (70.4%) and the majority of app users tried a tool for managing stress (58.8%). COVID Coach was utilized for 3 days or fewer among 80.9% 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% returned for a second visit; whereas only 46.3% of those who did not try a tool returned (P < .001). Symptoms of anxiety, depression, and PTSD were prevalent among app users. For example, among app users that completed an anxiety assessment on their first day of app use (n = 4,870; 11.4% of users), 55.1% (n = 2,680) reported levels of anxiety that were moderate to severe, and 29.9% (n = 1,455) of scores fell into the severe symptom range. 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.

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Pathways to Mental Health–Related Treatment Among Caregiving Spouses

Innovation in Aging ◽

10.1093/geroni/igaa057.1151 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 358-358

Author(s):

Hyojin Choi ◽

Kristin Litzelman ◽

Molly Maher ◽

Autumn Harnish

Keyword(s):

Mental Health ◽

Primary Care ◽

Mental Healthcare ◽

Health Condition ◽

Future Research ◽

Provider Type ◽

Hospital Emergency Room ◽

Health Related ◽

Nationally Representative

Abstract Spouses of cancer survivors are 33% less likely to receive guideline-concordant depression treatment than other married adults. However, depression is only one of many manifestations of psychological distress for caregivers. This exploratory study sought to assess the paths by which caregivers access mental health-related treatment. Using nationally representative data from the Medical Expenditures Panel Survey, we assessed the proportion of caregivers who received a mental health-related prescription or psychotherapy visit across care settings (office based versus outpatient hospital, emergency room, or inpatient visit), provider type (psychiatric, primary care, other specialty, or other), and visit purpose (regular checkup, diagnosis and treatment, follow-up, psychotherapy, other). In addition, we assessed the health condition(s) associated with the treatment. The findings indicate that a plurality of caregivers accessed mental health-related treatment through an office-based visit (90%) with a primary care provider (47%). A minority accessed this care through a psychologist or psychiatrist (11%) or a physician with another specialty (12%) or other provider types. Nearly a third accessed treatment as part of a regular check-up (32%). These patterns did not differ from the general population after controlling for sociodemographic characteristics. Interestingly, mental health-related treatments were associated with a mental health diagnosis in only a minority of caregivers. The findings confirm the importance of regular primary care as a door way to mental healthcare, and highlight the range of potential paths to care. Future research will examine the correlates of accessing care across path types.

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Coprescribing of Benzodiazepines and Opioids in Older Adults: Rates, Correlates, and National Trends

The Journals of Gerontology Series A ◽

10.1093/gerona/gly283 ◽

2018 ◽

Vol 74 (12) ◽

pp. 1910-1915 ◽

Cited By ~ 8

Author(s):

Taeho Greg Rhee

Keyword(s):

Older Adults ◽

Future Research ◽

Physician Visits ◽

Prescribing Trends ◽

Clinical Diagnoses ◽

Nationally Representative ◽

Using Data ◽

National Trends ◽

Ambulatory Medical Care ◽

Over Time

Abstract Background To estimate prescribing trends of and correlates independently associated with coprescribing of benzodiazepines and opioids among adults aged 65 years or older in office-based outpatient visits. Methods I examined a nationally representative sample of office-based physician visits by older adults between 2006 and 2015 (n = 109,149 unweighted) using data from the National Ambulatory Medical Care Surveys (NAMCS). National rates and prescribing trends were estimated. Then, I used multivariable logistic regression analyses to identify demographic and clinical factors associated with coprescriptions of benzodiazepines and opioids. Results From 2006 to 2015, 15,954 (14.6%) out of 109,149 visits, representative of 39.3 million visits nationally, listed benzodiazepine, opioid, or both medications prescribed. The rate of prescription benzodiazepines only increased monotonically from 4.8% in 2006–2007 to 6.2% in 2014–2015 (p < .001), and the rate of prescription opioids only increased monotonically from 5.9% in 2006–2007 to 10.0% in 2014–2015 (p < .001). The coprescribing rate of benzodiazepines and opioids increased over time from 1.1% in 2006–2007 to 2.7% in 2014–2015 (p < .001). Correlates independently associated with a higher likelihood of both benzodiazepine and opioid prescriptions included: female sex, a visit for chronic care, receipt of six or more concomitantly prescribed medications, and clinical diagnoses of anxiety and pain (p < .01 for all). Conclusion The coprescribing rate of benzodiazepines and opioids increased monotonically over time in outpatient care settings. Because couse of benzodiazepines and opioids is associated with medication burdens and potential harms, future research is needed to address medication safety in these vulnerable populations.

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Quality of Mobile Apps for Care Partners of People with Alzheimer’s Disease and Related Dementias: Mobile App Rating Scale Evaluation (Preprint)

10.2196/preprints.33863 ◽

2021 ◽

Author(s):

Nicole E Werner ◽

Janetta C Brown ◽

Priya Loganathar ◽

Richard J Holden

Keyword(s):

Rating Scale ◽

Mobile Apps ◽

Mobile App ◽

Future Research ◽

App Development ◽

Care Partners ◽

Acceptable Quality ◽

The Us ◽

Google Play

BACKGROUND The over 11 million care partners in the US who provide care to people living with Alzheimer’s disease and related dementias (ADRD) cite persistent and pervasive unmet needs related to all aspects of their caregiving role. The proliferation of mobile applications (apps) for care partners has potential to meet the care partners’ needs, but the quality of apps is unknown. OBJECTIVE The present study aimed to 1) evaluate the quality of publicly available apps for care partners of people living with ADRD and 2) identify design features of low- and high-quality apps to guide future research and app development. METHODS We searched the US Apple and Google Play app stores with the criteria that the app needed to be 1) available in US Google play or Apple app stores, 2) directly accessible to users “out of the box”, 3) primarily intended for use by an informal (family, friend) caregiver or caregivers of a person with dementia. The included apps were then evaluated using the Mobile App Rating Scale (MARS), which includes descriptive app classification and rating using 23 items across five dimensions: engagement, functionality, aesthetics, information, and subjective quality. Next, we computed descriptive statistics for each rating. To identify recommendations for future research and app development, we categorized rater comments on the score driving factors for each item and what the app could have done to improve the score for that item. RESULTS We evaluated 17 apps (41% iOS only, 12% Android only, 47% both iOS and Android). We found that on average, the apps are of minimally acceptable quality. Although we identified apps above and below minimally acceptable quality, many apps had broken features and were rated as below acceptable for engagement and information. CONCLUSIONS Minimally acceptable quality is likely insufficient to meet care partner needs. Future research should establish minimum quality standards across dimensions for mobile apps for care partners. The design features of high-quality apps we identified in this research can provide the foundation for benchmarking those standards.

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Intimate Partner Violence Among Persons With Mental Health-Related Disabilities in Canada

Journal of Interpersonal Violence ◽

10.1177/0886260520912589 ◽

2020 ◽

pp. 088626052091258

Author(s):

Douglas A. Brownridge ◽

Tamara Taillieu ◽

Marcelo L. Urquia ◽

Alexandra Lysova ◽

Ko Ling Chan ◽

...

Keyword(s):

Mental Health ◽

Risk Factors ◽

Intimate Partner Violence ◽

Partner Violence ◽

General Social Survey ◽

Intimate Partner ◽

Elevated Risk ◽

Future Research ◽

Health Related ◽

Nationally Representative

This study examined the elevated risk of intimate partner violence (IPV) among persons with mental health-related disabilities (MH-RD) and the extent to which known risk factors accounted for this phenomenon. Data were drawn from a nationally representative sample of 33,127 Canadians collected in 2014 as part of Statistics Canada’s General Social Survey. Results showed that respondents with MH-RD had more than three-fold increased odds of both overall and severe IPV victimization. Although females were more likely to possess a MH-RD, males and females with MH-RD reported similarly elevated odds of IPV victimization. Risk factors that contributed to a significant reduction in elevated odds of IPV for respondents with MH-RD were child maltreatment (CM), respondents’ nonprescription drug abuse, and perpetrators’ jealous, monitoring, and socially isolating behaviors. The inability to test additional risk factors and bidirectionality in the relationship between MH-RD and IPV may have contributed to the failure to fully account for these respondents’ elevated odds of IPV. Future research is needed to understand the complex mechanisms contributing to the elevated risk of IPV and enhance prevention and intervention strategies for this underresearched and underserved vulnerable population.

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Historical and generational forces in the Iridescent Life Course of bisexual women, men, and gender diverse older adults

Sexualities ◽

10.1177/1363460720947313 ◽

2020 ◽

pp. 136346072094731

Author(s):

Karen Fredriksen Goldsen ◽

Sarah Jen ◽

Theresa Clark ◽

Hyun-Jun Kim ◽

Hyunzee Jung ◽

...

Keyword(s):

Mental Health ◽

Older Adults ◽

Identity Development ◽

Life Course ◽

Life Events ◽

Social Relationships ◽

Future Research ◽

Bisexual Women ◽

Gender Diverse ◽

And Gender

Purpose Little is known about the life course of bisexual older adults. This study examines life events and experiences of bisexuals by generation: Pride Generation, born 1950–1964; Silenced Generation, born 1935–1949; and Invisible Generation, born 1934 or earlier, as well as by gender among women, men, and gender diverse older adults. Methods Aging with Pride: National Health, Aging, and Sexuality/Gender Study is the first national longitudinal study of LGBTQ older adults in the US. We utilize the Iridescent Life Course to examine the life events and life course experiences of bisexual older adults ( N = 216) using 2014 survey data. The Iridescent Life Course frames this study for comparing generational and gender differences in five key areas: identity development; work; kin and social relationships; bias-related experiences; and physical and mental health. Findings The Invisible Generation, the oldest generation, compared to the two younger generations, reports significant risks related to social relationships, the lowest levels of openly disclosing, and fewer bias-related experiences. They also demonstrate important signs of resilience and better mental health. Bisexual men and gender diverse older adults report higher rates of bias-related experiences and fewer social resources than bisexual women. Conclusion Based on the Iridescent Life Course, we document important differences in the heterogeneity and intersectionality in bisexual lives, particularly for those in late life and those gender diverse. It is essential to document the distinct nature of bisexuals’ life course, as it provides both historical and contemporary insights into aging and the reframing of future research.

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Older Adults’ Perceptions of Using iPads for Improving Fruit and Vegetable Intake: An Exploratory Study

Care Management Journals ◽

10.1891/1521-0987.16.1.2 ◽

2015 ◽

Vol 16 (1) ◽

pp. 2-13 ◽

Cited By ~ 6

Author(s):

Ivan Watkins ◽

Bo Xie

Keyword(s):

Older Adults ◽

Focus Group ◽

Vegetable Intake ◽

Comparative Method ◽

Mobile App ◽

Future Research ◽

Theory Approach ◽

Fruit And Vegetable ◽

Group Interviews ◽

Ipad App

Fruit and vegetable (FV) consumption can improve older adults’ health outcomes, but conventional interventions can be resource demanding and make it difficult to provide just-in-time intervention content. iPad-based interventions may help overcome these limitations, but little is known about how older adults might perceive and use iPads for FV consumption. To address this gap in the literature, we conducted a qualitative study to explore older adults’ perceptions and use of iPads for improving FV consumption between February and August of 2012. Five focus group sessions each lasting 120 min were conducted with 22 older adult participants. During each session, participants received guided exposure and instruction on iPad use and then explored three iPad applications targeting FV consumption (MyFood, FiveADay Lite, and Whole Foods Market Recipes). Detailed notes from focus group interviews were analyzed with a grounded theory approach that applied a constant comparative method to enable themes to emerge from the data. Three themes were identified from the data regarding participants’ baseline perceptions of iPads. These included (a) limited knowledge on iPad’s functions, (b) iPads were intended for younger users, and (c) iPads were too expensive. Themes identified regarding participants’ perceptions of iPads after guided exposure included (a) the touchscreen was easier to use than a computer mouse, (b) tapping the interface required practice, (c) portability was an asset in conjunction with functionality, (d) portability and functionality supported personal interests, (e) the difficulty of learning an iPad’s functions varied, and (f) practice and instruction helped overcome fear of the iPad. Finally, participants recommended iPad app features that could help them overcome barriers to their FV intake. These included (a) locating inexpensive FV from nearby sources, (b) providing tailored food and recipe suggestions, and (c) tracking and communicating FV intake with a doctor. These findings have important implications for future research on mobile app-based eHealth interventions to improve older adults’ FV intake.

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Associations Between Perceived Environmental Pollution and Mental Health in Middle-Aged and Older Adults in East Asia

Asia Pacific Journal of Public Health ◽

10.1177/1010539520960993 ◽

2020 ◽

pp. 101053952096099

Author(s):

Takashi Yamashita ◽

Giyeon Kim ◽

Darren Liu ◽

Anthony R. Bardo

Keyword(s):

Mental Health ◽

Older Adults ◽

Environmental Pollution ◽

East Asian ◽

National Level ◽

Pollution Index ◽

Future Research ◽

Linear Regression Models ◽

Middle Aged ◽

Pollution Indicators

Given the widely used objective measures of environmental pollution in previous research, this study investigated subjective measures in relation to mental health among middle-aged and older adults in 3 East Asian countries—China, Japan, and South Korea. The samples from the 2010 East Asian Social Survey included 2502 Chinese, 1794 Japanese, and 871 South Korean adults aged 40 and older. Linear regression models were used to examine the associations between mental health measure (SF-12) and 4 perceived environmental pollution indicators (ie, air, water, noise, and pollution index). Greater perceived pollution indicators, as well as the perceived pollution index, were associated with poorer mental health, even after adjusting for covariates in all 3 countries. Although results need to be further verified in future research, national-level efforts to improve perceptions of environmental pollution may be useful to enhance the mental health of East Asian middle-aged and older adults.

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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.

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