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Zhou Y, Bai Z, Wu W, Fan Z, Wu C, Li L, Li S. Impacts of Internet-Based Interventions for Veterans With PTSD: A Systematic Review and Meta-Analysis. Front Psychol 2021; 12:711652. [PMID: 34899460 PMCID: PMC8652137 DOI: 10.3389/fpsyg.2021.711652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 10/26/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Veterans who did not seek and complete treatment as intended have been shown to have an elevated risk of experiencing and being exposed to post-traumatic stress disorder (PTSD). Internet-based interventions (IBIs) provide more confidentiality and fewer treatment barriers, and they are regarded as potential treatments to reduce PTSD in veterans. However, the effects of IBI for veterans with PTSD are inconclusive. Objectives: IBI is defined as any internet-based series of psychosocial interventions, of which the internet works as a way of delivery. Psychosocial content and reduction of PTSD symptoms in veterans have been recognized as two core elements of this intervention. This study aimed to (1) examine the effects of IBI on veterans' PTSD outcomes and (2) distinguish between the elements of IBI that play an important role for veterans with PTSD. Methods: Web of Science, PubMed, EMBASE, PsycINFO, Cochrane, Wanfang Data, CNKI, and CQVIP databases were searched for randomized controlled trials (RCT) in IBI programs for veterans with PTSD, covering all studies in English and Chinese published from January 1990 to November 2020. Also, related studies tracking citations were identified. Studies met the following inclusion criteria of (1) being RCTs; (2) containing IBI in the full text; (3) having IBI conducted on veterans as participants; and (4) being on PTSD. All processes followed PRISMA. The risk of bias of the studies was assessed by the Cochrane Systematic Review Handbook. The confidence of outcomes of this review was valued according to the GRADE (Grading of Recommendations Assessment, Development, and Evaluation). The meta-analysis was done by RevMan 5.13. Two teams of reviewers independently searched the literature, made the assessment, and extracted the data. Results: A total of 1,493 citations were identified after initial searching, of which the full texts of 66 studies were screened. Eventually, six RCT studies met the inclusion criteria. Beneficial effects of IBI were found on the overall PTSD outcome (-0.29; 95% CI-0.48 to -0.11, p<0.01). Particularly, IBI based on cognitive behavioral therapy (CBT) with peer support was found to be effective for PTSD outcomes (-0.36; 95% CI-0.61 to -0.11, p<0.01). The subgroup analysis demonstrated that scores of PTSD outcome measured by a PCL (PTSD Checklist) decreased to an average score of 0.38 (95% CI -0.60 to -0.15, p=0.001). The intervention had a positive effect on the PTSD outcome on veterans with comorbid psychological disorders (-0.30; 95% CI -0.61 to -0.11, p<0.01). Overall, the six studies included were evaluated with a low risk of bias, and the outcomes of the meta-analysis were proven with high confidence. Conclusion: On the whole, IBIs have a positive effect on the overall PTSD outcome of veterans. The results encouraged us to focus on IBI with CBT with peer support for veterans, on specific instruments for veterans with PTSD, and on veterans with comorbid psychological disorders. This study, however, has limits. Only six studies with a Western population were included, which might result in cultural bias on IBI effects. In future, more high-qualified research and diverse cultural background of RCTs is needed to prove the effectiveness of IBI on veterans with PTSD.
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Affiliation(s)
- Yang Zhou
- Department of Sociology, School of Public Affairs, Nanjing University of Science and Technology, Nanjing, China
| | - Zhenggang Bai
- Department of Sociology, School of Public Affairs, Nanjing University of Science and Technology, Nanjing, China
| | - Wei Wu
- Department of Sociology, School of Public Affairs, Nanjing University of Science and Technology, Nanjing, China
| | - Zijia Fan
- Department of Sociology, School of Public Affairs, Nanjing University of Science and Technology, Nanjing, China
| | - Cuiying Wu
- Department of Sociology, School of Public Affairs, Nanjing University of Science and Technology, Nanjing, China
| | - Longyi Li
- Department of Sociology, School of Public Affairs, Nanjing University of Science and Technology, Nanjing, China
| | - Siyu Li
- Department of Sociology, School of Public Affairs, Nanjing University of Science and Technology, Nanjing, China
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Azarang A, Pakyurek M, Giroux C, Nordahl TE, Yellowlees P. Information Technologies: An Augmentation to Post-Traumatic Stress Disorder Treatment Among Trauma Survivors. Telemed J E Health 2019; 25:263-271. [DOI: 10.1089/tmj.2018.0068] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Affiliation(s)
- Atoosa Azarang
- MIND Institute, University of California-Davis Medical Center, Sacramento, California
| | - Murat Pakyurek
- Department of Psychiatry and Behavioral Sciences, University of California-Davis, School of Medicine, Sacramento, California
| | - Caroline Giroux
- Department of Psychiatry and Behavioral Sciences, University of California-Davis, School of Medicine, Sacramento, California
| | - Thomas E. Nordahl
- Department of Psychiatry and Behavioral Sciences, University of California-Davis, School of Medicine, Sacramento, California
| | - Peter Yellowlees
- Department of Psychiatry and Behavioral Sciences, University of California-Davis, School of Medicine, Sacramento, California
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Yeager CM, Benight CC. If we build it, will they come? Issues of engagement with digital health interventions for trauma recovery. Mhealth 2018; 4:37. [PMID: 30363749 PMCID: PMC6182033 DOI: 10.21037/mhealth.2018.08.04] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 08/17/2018] [Indexed: 12/12/2022] Open
Abstract
Exposure to traumatic events is extremely common with nearly 75% reported to have experienced one or more traumatic events worldwide. A significant number of those exposed will develop posttraumatic stress disorder (PTSD) along with depression, anxiety, and substance use disorders. Globally, trauma-related mental health disorders are the leading cause of global disability burden, and many of these disorders are caused, or worsened, by exposure to wars, natural and human-caused disasters, and other traumatic events. Significant barriers to treatment exist including logistical, geographical, financial, stigma, and other attitudinal challenges. One opportune approach to overcoming these barriers is the provision of mental health interventions via technology that can be readily standardized for wide dissemination of evidence-based care. However, engagement with technology-based interventions is a concern and limited participation and high attrition rates are common. This may be especially true for trauma survivors who often experience symptoms of avoidance and hyperarousal. Engagement is regarded as an essential component of intervention efficacy and has been demonstrated to be associated with more positive clinical outcomes, yet theoretically based research in this area is sparse. This review focuses on the complex issue of engagement with digital health interventions (DHIs). Specifically, we review the conceptualization and measurement of engagement, predictors of engagement, and importantly, the relationship of engagement with intervention effectiveness. Finally, a theoretically based model of engagement is proposed that considers the unique challenges of trauma recovery. This review is not intended to provide a systematic or exhaustive set of recommendations, rather it is intended to highlight the challenges of engagement research including its definition, measurement, and modeling. Future engagement research that includes valid and reliable measures of engagement will enable consistent exploration of engagement predictors that can then inform methods for increasing engagement and, ultimately, intervention effectiveness.
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Affiliation(s)
- Carolyn M. Yeager
- Psychology Department, University of Colorado Colorado Springs, Colorado Springs, CO 80918, USA
- Trauma, Health, & Hazards Center, University of Colorado Colorado Springs, Colorado Springs, CO 80918, USA
| | - Charles C. Benight
- Psychology Department, University of Colorado Colorado Springs, Colorado Springs, CO 80918, USA
- Trauma, Health, & Hazards Center, University of Colorado Colorado Springs, Colorado Springs, CO 80918, USA
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Gaebel W, Großimlinghaus I, Mucic D, Maercker A, Zielasek J, Kerst A. EPA guidance on eMental health interventions in the treatment of posttraumatic stress disorder (PTSD). Eur Psychiatry 2017; 41:140-152. [PMID: 28242486 DOI: 10.1016/j.eurpsy.2017.01.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 01/04/2017] [Accepted: 01/09/2017] [Indexed: 10/20/2022] Open
Abstract
The aim of this EPA guidance was to develop recommendations on eMental health interventions in the treatment of posttraumatic stress disorder (PTSD). A systematic literature search was performed and 40 articles were retrieved and assessed with regard to study characteristics, applied technologies, therapeutic approaches, diagnostic ascertainment, efficacy, sustainability of clinical effects, practicability and acceptance, attrition rates, safety, clinician-supported vs. non-supported interventions and active vs. waiting-list controls. The reviewed studies showed a great heterogeneity concerning study type, study samples, interventions and outcome measures. Based on these findings, five graded recommendations dealing with symptom reduction, acceptability, type of administration, clinician support, self-efficacy and coping were developed.
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Affiliation(s)
- W Gaebel
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany; LVR Institute for Healthcare Research, Cologne, Germany; WHO Collaborating Center for Quality Assurance and Empowerment in Mental Health, Düsseldorf, Germany.
| | - I Großimlinghaus
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany; LVR Institute for Healthcare Research, Cologne, Germany; WHO Collaborating Center for Quality Assurance and Empowerment in Mental Health, Düsseldorf, Germany
| | - D Mucic
- Treatment Centre Little Prince, Copenhagen, Denmark
| | - A Maercker
- Psychopathology and Clinical Intervention, University of Zürich, Zürich, Switzerland
| | - J Zielasek
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany; LVR Institute for Healthcare Research, Cologne, Germany; WHO Collaborating Center for Quality Assurance and Empowerment in Mental Health, Düsseldorf, Germany
| | - A Kerst
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany; WHO Collaborating Center for Quality Assurance and Empowerment in Mental Health, Düsseldorf, Germany
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