Rashell R. Allen

Background: Accessible mental health support is essential for military members (MMs), veterans, and public safety personnel (PSP) who are at an increased risk of mental health challenges. Unique barriers to care, however, often leave these populations going untreated. Mental health treatment delivered via apps or websites (ie, digital mental health interventions [DMHIs]) offers an accessible alternative to in-person therapy. Objective: We aimed to synthesize the current literature on apps and web-based programs focused on enhancing MMs’, PSPs’, and veterans’ resilience or well-being. A multidimensional well-being model, I-COPPE (interpersonal, community, occupational, physical, psychological, economic, and overall well-being), was used as a framework guiding the scoping review. Methods: A search of 6 databases was conducted using key terms related to (1) population, (2) resilience and well-being constructs, and (3) web- or mobile-based programs. At all levels of screening, at least 2 researchers (RRA, MAM, and CA) reviewed each paper independently. Data were extracted and recorded to include relevant study characteristics including program name and description, target population, number of participants, therapeutic approach, results, limitations, and I-COPPE dimension supported. A narrative synthesis was performed to summarize the eligible studies. Results: In total, 44 papers were included in the study and 39 unique resilience or well-being apps or web-based programs identified for MMs, PSP, or veterans. The programs largely focused on veteran populations (28/44, 64%). In total, 51% (20/39) of programs relied on cognitive behavioral approaches and most aimed to support posttraumatic stress disorder–related symptoms. In consideration of the I-COPPE model, a majority supported psychological well-being, followed by interpersonal and physical well-being. Most apps were believed to support more than 1 domain of well-being. The main methodologies used in the literature to evaluate digital mental health interventions include randomized controlled trials, secondary analyses, and pilot randomized controlled trials with evaluations of feasibility, acceptability, satisfaction, or qualitative feedback. Generalizability of findings was commonly limited by attrition rates and small sample sizes. Conclusions: DMHIs for MMs, PSP, and veterans appear promising due to their accessibility and scalability. More research is needed, however, to determine whether DMHIs are an effective alternative to in-person mental health care. The current review contributes to the literature by compiling evidence of DMHIs and the domains of well-being supported by, and the therapeutic orientation of, these programs. Our review revealed that more research is needed to determine the effectiveness and efficacy of DMHIs offered to these populations.

Background: Accessible mental health care, delivered via mobile apps or web-based services, may be essential for military members, public safety personnel (PSP), and veterans, as they report numerous barriers to seeking in-person care and are at an increased risk for a number of psychological disorders. Objective: We aimed to identify, describe, and evaluate apps, resource banks (RBs), and web-based programs (WBPs), referred to as digital mental health interventions (DMHIs), recommended for military members, PSP, and veterans. A multidimensional and multisystemic view of resilience and well-being were maintained throughout this environmental scan. Methods: Information was gathered from a comprehensive review of peer-reviewed literature, a Google search, and a targeted search of websites relevant to the study populations. DMHIs aimed at supporting resilience or well-being were included in the review, including those published in peer-reviewed articles, and those offered to these populations without research or literature backing their use. Results: In total, 69 DMHIs were identified in this study, including 42 apps, 19 RBs, and 8 WBPs, and were described based on 3 questions related to purpose, strategies, and evidence from the adapted Mobile App Rating Scale and the Mobile App Rating Scale. Each WBP and RB was then reviewed via the adapted Mobile App Rating Scale and each app via the Alberta Rating Index for Apps (ARIA). Overall, 24 (35%) of the DMHIs were recommended for military members, 20 (29%) for PSP, and 41 (59%) for veterans. The most common aim across apps, RBs, and WBPs was to increase happiness and well-being, and the most common strategies were advice, tips, and skills training. In total, 2 apps recommended for military members—PTSD Coach and Virtual Hope Box—received a high rating on the ARIA subscales and have also been trialed in pilot randomized control trial (RCT) and RCT evaluations, respectively, with positive initial results. Similarly, 2 apps recommended for PSP—PeerConnect and R2MR—have been trialed in non-RCT studies, with partially positive outcomes or little to no contradictory evidence and received a high rating on the ARIA. Finally, 2 apps recommended for veteran populations—PTSD Coach and VetChange—received high ratings on the ARIA and have been trialed via pilot-RCT and RCT studies, respectively, with positive outcomes. Conclusions: In conclusion, there is a need for efficacy and effectiveness trials for DMHIs for military members, PSP, and veterans to ensure that they are effectively meeting the population’s needs. While there appears to be many promising DMHIs, further research is needed before these interventions continue to be promoted as effective and widely distributed.

The digital delivery of mental health services became increasingly common following the onset of the COVID-19 pandemic. There is still much to learn regarding tailoring interventions for trauma-affected populations (military members, Veterans, public safety personnel). Through the current pilot study, we explored the perceptions of digitally delivered psychotherapies utilized for trauma-affected populations, as reported by Canadian military members, Veterans, and public safety personnel who completed such interventions. Quantitative data were collected from 11 Canadian clients (military members, Veterans, and public safety personnel with posttraumatic stress injury). Survey questions were based on the Alberta Quality Matrix of Health and the Unified Theory of Acceptance and Use of Technology model. As a follow-up, clients were invited to partake in a semi-structured interview to further explore their perspectives on digitally delivered trauma-focused and adjunct therapies. Four clients participated in an interview. The client participants reported that digitally delivered trauma and adjunct therapies offered similar treatment effectiveness to in-person delivery while also improving treatment access. The participants indicated several unique advantages of digital delivery, including the increased accessibility of treatment, cost-effectiveness, and more efficient use of resources, although the small sample size limits the generalizability of our findings. Further research with a larger, more diverse population is required to corroborate our results and identify other avenues in which psychotherapies utilized for trauma-affected populations can be engaged with and improved upon.

Many clinical sites shifted towards digital delivery of mental health services during the COVID-19 pandemic. There is still much to learn regarding tailoring digitally delivered interventions for trauma-affected populations. The current study examined the perceptions of Canadian mental health clinicians who provided digitally delivered psychotherapies utilized for trauma-affected populations. Specifically, we explored the shift to digital health use, what changed with this rapid shift, what needs, problems, and solutions arose, and important future considerations associated with delivering trauma-focused and adjunct treatments digitally. Survey data were collected from 12 Canadian mental health clinician participants. Surveys were adapted from the Alberta Quality Matrix of Health and Unified Theory of Acceptance and Use of Technology model. As a follow-up, the participants were invited to participate in either a semi-structured qualitative interview or focus group to further explore their perspectives on digitally delivered trauma-focused and adjunct therapies. Twenty-four clinician participants partook in an interview or focus group. The participants in this study supported the use of digitally delivered psychotherapies utilized for trauma-affected populations, sharing that these interventions appeared to offer similar quality of care to in-person delivery. Further research is required to address clinicians’ concerns with digital delivery (e.g., patient safety) and identify other avenues in which digitally delivered psychotherapies utilized for trauma-affected populations can be engaged with and improved upon.

Introduction: Following the initial outbreak of the COVID-19 pandemic, mental health clinicians rapidly shifted service delivery from in-person to digital. This pivot was instrumental in maintaining continuity of care and meeting increased mental health service demands. Many mental health services have continued to be offered via digital delivery. The long-term implications of delivering services via digital media remain unclear and need to be addressed. Objectives: This study aimed to identify current micro (i.e., clinician–patient interactions), meso (i.e., clinician–clinic manager interactions), and macro (i.e., government–policy maker interactions) level issues surrounding the use of digital mental health interventions (DMHI). Such integrated assessments are important for optimizing services to improve treatment outcomes and client satisfaction. Methods: Participants were recruited between January 2022 and April 2023. Quantitative data were collected using a survey informed by the Hexagon Tool. Qualitative data were collected from online semi-structured interviews and focus groups and analyzed using rapid thematic analysis. Results: Survey data were collected from 11 client and 11 clinician participants. Twenty-six community partner participants were interviewed for this study. Client and clinician participants expressed satisfaction with the implementation of DMHI. Community partner participants generally agreed, reporting that such services will play an integral role in mental healthcare moving forward. Community partners shared that certain issues, such as uncertainty surrounding policies and regulations related to digital delivery, must be addressed in the future. Conclusions: Participants in this study supported the use of DMHI despite difficulties implementing these programs, asserting that such services are not a temporary fix but a pivotal cornerstone in the future of mental healthcare service delivery.

BACKGROUND Accessible mental health care, delivered via mobile apps or web-based services, may be essential for military members, public safety personnel (PSP), and veterans, as they report numerous barriers to seeking in-person care and are at an increased risk for a number of psychological disorders. OBJECTIVE We aimed to identify, describe, and evaluate apps, resource banks (RBs), and web-based programs (WBPs), referred to as digital mental health interventions (DMHIs), recommended for military members, PSP, and veterans. A multidimensional and multisystemic view of resilience and well-being were maintained throughout this environmental scan. METHODS Information was gathered from a comprehensive review of peer-reviewed literature, a Google search, and a targeted search of websites relevant to the study populations. DMHIs aimed at supporting resilience or well-being were included in the review, including those published in peer-reviewed articles, and those offered to these populations without research or literature backing their use. RESULTS In total, 69 DMHIs were identified in this study, including 42 apps, 19 RBs, and 8 WBPs, and were described based on 3 questions related to purpose, strategies, and evidence from the adapted Mobile App Rating Scale and the Mobile App Rating Scale. Each WBP and RB was then reviewed via the adapted Mobile App Rating Scale and each app via the Alberta Rating Index for Apps (ARIA). Overall, 24 (35%) of the DMHIs were recommended for military members, 20 (29%) for PSP, and 41 (59%) for veterans. The most common aim across apps, RBs, and WBPs was to increase happiness and well-being, and the most common strategies were advice, tips, and skills training. In total, 2 apps recommended for military members—PTSD Coach and Virtual Hope Box—received a high rating on the ARIA subscales and have also been trialed in pilot randomized control trial (RCT) and RCT evaluations, respectively, with positive initial results. Similarly, 2 apps recommended for PSP—PeerConnect and R2MR—have been trialed in non-RCT studies, with partially positive outcomes or little to no contradictory evidence and received a high rating on the ARIA. Finally, 2 apps recommended for veteran populations—PTSD Coach and VetChange—received high ratings on the ARIA and have been trialed via pilot-RCT and RCT studies, respectively, with positive outcomes. CONCLUSIONS In conclusion, there is a need for efficacy and effectiveness trials for DMHIs for military members, PSP, and veterans to ensure that they are effectively meeting the population’s needs. While there appears to be many promising DMHIs, further research is needed before these interventions continue to be promoted as effective and widely distributed.