Pilot study of Internet-based early intervention for combat-related mental distress

Abstract

Abstract-This article evaluates an Internet-based early intervention combining online cognitive-behavioral therapy (CBT) with electronic peer-to-peer support intended to promote mental health and well-being among combat veterans. We conducted a phase 1 clinical trial of 50 Iraq and Afghanistan veterans using a pre and post single-arm design. We evaluated feasibility and changes in mental health symptoms (depression and posttraumatic stress disorder [PTSD]), functional status, and attitudes toward treatment seeking at baseline and weeks 4, 8, and 12. A diverse group of veterans was enrolled (26% ethnic minority, 90% male, 66% with income <$30,000/year, 88% with no prior treatment for depression). Participants completed a mean of 4 of 6 lessons (standard deviation = 2.54). From baseline to week 12, there were significant declines in the Center for Epidemiologic Studies-Depression scale score (effect size [ES] = 0.41) and PTSD Checklist-Military version score (ES = 0.53). There were significant improvements in willingness to accept diagnosis (ES = 1.08) and perceived social norms and stigma regarding friends (ES = 1.51). Although lack of a control group is a limitation, the Internet-based program combining CBT-based coping skills training and peer-topeer support demonstrated potential feasibility and evidenced benefit in symptom remediation for depression and PTSD.Clinical Trial Registration: ClinicalTrials.gov; NCT01231711, "Improving Quality-of-life and Depressive Symptoms of Combat Veterans Via Internet-based Interventions"; http://www.clinicaltrials.gov.

Marital Satisfaction, Family Support, and Pre-Deployment Resiliency Factors Related to Mental Health Outcomes for Reserve and National Guard Soldiers

“…However, evidence from our study suggests that unit support may be a resiliency factor for anger. Other work has demonstrated that greater perceived support and connection with peers is a potential protective factor against depression (Brenner, Homaifar, Adler, Wolfman, & Kemp, 2009; Pietrzak et al, 2010; Van Voorhees, Gollan, & Fogel, 2012) and ameliorates difficulties encountered during transitions between military and civilian life (Ahern et al, 2015). We also know from previous work that veterans report feeling more comfortable speaking about their experiences with other veterans who understand them (Hinojosa & Hinojosa, 2011; Laffaye et al, 2008).…”

Exercise for Everyone: A Randomized Controlled Trial of Project Workout on Wheels in Promoting Exercise Among Wheelchair Users

“…The innovative use of technology such as computers/tablets/smartphones may help increase adoption through facilitating virtual social and professional support while avoiding transportation barriers. 55 Others have successfully used peer-support 56, 57 within internet-based interventions promoting behavior change.…”

E-mental health preferences of Veterans with and without probable posttraumatic stress disorder

“…Additionally, the intervention can serve a variety of purposes, such as real-time symptom monitoring and homework assignment [23]. For example, an Internet-based intervention for combat-related mental distress that included facilitated peer support was found to decrease depression symptoms and social stigma related to mental health issues among combat Veterans [24]. Mental health providers' direct clinical involvement in self-guided Internet interventions varies greatly, and most current interventions are used as adjunct to or in lieu of traditional psychotherapy.…”

“…The first aim was to address the current gaps in research by identifying willingness to use a variety of emental health modalities as a means for accessing mental health services in diverse Veterans with and without a positive screen for PTSD. Based on previous studies that indicate that Veterans with PTSD are interested in using e-health modalities [22,24,40] and drawing from Andersen's Behavioral Model [47], we hypothesized that Veterans with PTSD would report greater willingness to use emental health than Veterans without PTSD. Additionally, research has not examined interest in e-health modalities in Veterans who express a need for traditional mental health services.…”