Given the substantial investment in the development of mental health mobile applications (apps), information about penetration in the patient populations of interest is critical. This study describes the proportion of veterans who are knowledgeable of and utilize the Department of Veteran Affairs (VA) and Department of Defense (DoD) mental health apps. A cross-sectional survey of 140 veterans was conducted in primary care and outpatient mental health clinics at a large VA facility. Ninety-one percent of veterans (n = 127) reported smartphone ownership. Of these, 42.5% and 20.4% had heard of and used at least one of the 22 VA/DoD mental health apps, respectively. When veterans were asked to pick the individual VA/DoD apps they had previously used from a list, the proportion of participants who reported prior use ranged from 0% (Moving Forward) to 6.5% (Mindfulness Coach). Treatment for psychiatric problems relevant to the apps did not predict veteran knowledge/use of the VA/DoD apps. Rates of app use remained low among veterans reporting symptoms/diagnoses apps were designed to address (e.g., 7.5% of veterans who reported posttraumatic stress disorder (PTSD) had used PTSD Coach). The most common barrier to app use (endorsed by 65.7% of participants) was awareness of the apps. Expansion of existing VA/DoD efforts to educate patients and providers treating relevant conditions is indicated. Evaluation of evidence-based mobile health support specialists in clinical settings may also be indicated. This study provides critical information to guide future dissemination efforts and to help evaluate the impact of investments to date. Impact StatementAmong treatment-engaged military veterans who owned a smartphone, only 43% had heard of and 20% had used any of the Department of Veterans Affairs or Department of Defense mental health mobile applications (apps). Public sector psychologists in a variety of settings may benefit from research on the rates of mental health app penetration in patient populations of interest to explore the need for strategic dissemination efforts.

Background Veterans with serious mental illnesses (SMIs) face barriers to accessing in-person evidence-based interventions that improve illness management. Mobile health (mHealth) has been demonstrated to be feasible, acceptable, effective, and engaging among individuals with SMIs in community mental health settings. mHealth for SMIs has not been tested within the Department of Veterans Affairs (VA). Objective This study examines the feasibility, acceptability, and preliminary effectiveness of an mHealth intervention for SMI in the context of VA outpatient care. Methods A total of 17 veterans with SMIs were enrolled in a 1-month pilot trial of FOCUS, a smartphone-based self-management intervention for SMI. At baseline and posttest, they completed measures examining symptoms and functional recovery. The participants provided qualitative feedback related to the usability and acceptability of the intervention. Results Veterans completed on an average of 85.0 (SD 96.1) interactions with FOCUS over the 1-month intervention period. They reported high satisfaction, usability, and acceptability, with nearly all participants (16/17, 94%) reporting that they would recommend the intervention to a fellow veteran. Clinicians consistently reported finding mHealth-related updates useful for informing their care. Qualitative feedback indicated that veterans thought mHealth complemented their existing VA services well and described potential opportunities to adapt FOCUS to specific subpopulations (eg, combat veterans) as well as specific delivery modalities (eg, groups). In the 1-month period, the participants experienced small improvements in self-assessed recovery, auditory hallucinations, and quality of life. Conclusions The FOCUS mHealth intervention is feasible, acceptable, and usable among veterans. Future work should develop and examine VA-specific implementation approaches of FOCUS for this population.

Highlights Open pilot trial of computerized anxiety sensitivity intervention among Veterans. High levels of acceptability and usability were found. Qualitative analyses revealed areas of strength/improvement for this intervention. Medium-large effects on depression, anxiety, PTSD, and suicidal ideation.

BACKGROUND Veterans with serious mental illnesses (SMI) face barriers to accessing in-person evidence-based interventions that improve illness management. Mobile health (mHealth) has been demonstrated to be feasible, acceptable, effective, and engaging among individuals with serious mental illness in community mental health settings. mHealth for SMI has not been tested within the VA. OBJECTIVE The present study examined the feasibility, acceptability and preliminary effectiveness of an mHealth intervention for serious mental illness in the context of VA outpatient care. METHODS Seventeen (n = 17) veterans with serious mental illnesses enrolled in a one-month pilot trial of FOCUS, a smartphone-based self-management intervention for serious mental illness. At baseline and post-test they completed measures examining symptoms and functional recovery. Participants provided qualitative feedback related to the usability and acceptability of the intervention. RESULTS Veterans completed on average 85.00 (SD = 96.11) interactions with FOCUS over the one-month intervention period. They reported high satisfaction, usability, and acceptability, with nearly all (n = 16, 94.1%) participants reporting that they would recommend the intervention to a fellow veteran. Qualitative feedback indicated that veterans thought mHealth complemented their existing VA services well and described potential opportunities to adapt FOCUS to specific subpopulations (e.g. combat veterans) as well as specific delivery modalities (e.g. groups). In the one-month period, participants experienced small improvements in self-assessed recovery, auditory hallucinations and quality of life. CONCLUSIONS The FOCUS mHealth intervention is feasible, acceptable, and usable among veterans. Future work should develop and examine VA-specific implementation approaches of FOCUS for this population.

Cyclooxygenases (COXs) are enzymes that catalyze the formation of prostaglandins. Prostaglandins are a class of lipid mediators that can promote inflammation, pain, and fever as well as maintain a variety of normal physiological functions. Cyclooxygenases exist in two forms, COX‐1 and COX‐2, both of which are localized to the luminal membrane of the endoplasmic reticulum. COX‐2 expression is usually induced in response to certain stimuli, such as infection. However, overexpression of COX‐2 has been correlated to numerous cancers, such as breast, colon and prostate cancer. COX‐2 exists as two major glycoforms of 72 and 74kDa, the latter resulting from an additional oligosaccharide chain at amino acid residue Asn580. Past studies from our lab have shown that this glycosylation regulates the COX‐2 protein turnover in the cell. The proteins E‐cadherin— a tumor suppressor— and b‐catenin—a tumor driver— are often regulated by COX‐2 expression. The purpose of this study is to determine if the glycosylation of COX‐2 at Asn580 affects the downstream expression of E‐ cadherin and b‐catenin and subsequent migratory potential in MCF‐7 breast cancer cells. MCF‐7 cells were transiently transfected with either the wild‐type or Asn580‐mutant COX‐2 gene or empty plasmid (control). RNA isolated from cells was subjected to semi‐quantitative RT‐PCR, and cell lysates were analyzed via western blotting following by immunostaining. Migratory potential was determined three days after transfection using in vitro transwell cell migration assays. No differences were found in migratory potential amongst the three cell groups. We found that E‐cadherin expression at both the transcriptional and translational levels was reduced in cells expressing the mutant COX‐2 gene for 72 hours. Interestingly, transcriptional expression of b‐catenin was also reduced after 48 and 72 hours of expression of the mutant COX‐2 gene, though protein expression appeared unchanged. These results indicate that although no changes in migratory potential could be discerned three days after transfection, glycosylation of COX‐2 at Asn580 did decrease the expression of both the tumor suppressor E‐cadherin and the tumor driver gene β‐catenin in the MCF‐7 breast cancer cell line, thus obscuring the role of COX‐2 in breast cancer progression.