https://aub.ie/MilitaryREACH-VanStolk-Cooke2023

van Stolk-Cooke, K., Wielgosz, J., Wu Hallenbeck, H., Chang, A., Rosen, C., Owen, J., & Kuhn, E. (2023). The PTSD Family Coach app in veteran family members: Pilot randomized controlled trial. JMIR Formative Research, 7, Article e42053. https://doi.org/10.2196/42053

The PTSD Family Coach 1.0 app was designed to support the loved ones of Veterans with posttraumatic stress disorder (PTSD). PTSD Family Coach 1.0 provided information on PTSD, self-care, and relationship functioning, as well as stress management tools, a stress self-assessment, and resources for connecting to other military families or professionals. This study examined the app’s feasibility (i.e., app engagement), acceptability (i.e., satisfaction and perceived helpfulness), and efficacy (i.e., treatment effects). 200 participants – primarily spouses – who lived with a Veteran with PTSD were randomly assigned to use either PTSD Family Coach 1.0 (n = 104) or a psychoeducation app (n = 96) for 4 weeks. Overall, the two apps were similar in terms of their feasibility, acceptability, and efficacy. Qualitative feedback informed improvements for the PTSD Family Coach app version 2.0.

https://doi.org/10.2196/42053

Couples
Mental health
Programming
Trauma
Veterans

Air Force
Army
Marine Corps
Navy
Multiple branches

Veteran

Other
Spouse of service member or veteran

Adulthood (18 yrs & older)
Young adulthood (18 - 29 yrs)
Thirties (30 - 39 yrs)
Middle age (40 - 64 yrs)

Longitudinal Study
Quantitative Study

van Stolk-Cooke, Katherine, Wielgosz, Joseph, Hallenbeck, Haijing Wu, Chang, Andrew, Rosen, Craig, Owen, Jason, Kuhn, Eric

Background: Posttraumatic stress disorder (PTSD) among US military veterans can adversely impact their concerned significant others (CSOs; eg, family members and romantic partners). Mobile apps can be tailored to support CSO mental health through psychoeducation, coping skills, and stress monitoring. Objective: This study assessed the feasibility, acceptability, and potential efficacy of PTSD Family Coach 1.0, a free, publicly available app that includes psychoeducation, stress management tools, self-assessments, and features for connecting to alternative supports, compared with a psychoeducation-only version of the app for cohabitating CSOs of veterans with PTSD. Methods: A total of 200 participants with an average age of 39 (SD 8.44) years, primarily female (193/200, 97%), and White (160/200, 80%) were randomized to self-guided use of either PTSD Family Coach 1.0 (n=104) or a psychoeducation-only app (n=96) for 4 weeks. Caregiver burden, stress, depression, anxiety, beliefs about treatment, CSO self-efficacy, and relationship functioning assessed using measures of dyadic adjustment, social constraints, and communication danger signs were administered via a web survey at baseline and after treatment. User satisfaction and app helpfulness were assessed after treatment. Data were analyzed using linear mixed methods. Results: Overall, 50.5% (101/200) of randomized participants used their allocated app. Participants found PTSD Family Coach 1.0 somewhat satisfying (mean 4.88, SD 1.11) and moderately helpful (mean 2.99, SD 0.97) to use. Linear mixed effects models revealed no significant differences in outcomes by condition for caregiver burden (P=.45; Cohen d=0.1, 95% CI −0.2 to 0.4), stress (P=.64; Cohen d=0.1, 95% CI −0.4 to 0.6), depression (P=.93; Cohen d= 0.0, 95% CI −0.3 to 0.3), anxiety (P=.55; Cohen d=−0.1, 95% CI −0.4 to 0.2), beliefs about treatment (P=.71; Cohen d=0.1, 95% CI −0.2 to 0.3), partner self-efficacy (P=.59; Cohen d=−0.1, 95% CI −0.4 to 0.2), dyadic adjustment (P=.08; Cohen d=−0.2, 95% CI −0.5 to 0.0), social constraints (P=.05; Cohen d=0.3, 95% CI 0.0-0.6), or communication danger signs (P=.90; Cohen d=−0.0, 95% CI −0.3 to 0.3). Post hoc analyses collapsing across conditions revealed a significant between-group effect on stress for app users versus nonusers (β=−3.62; t281=−2.27; P=.02). Conclusions: Approximately half of the randomized participants never used their allocated app, and participants in the PTSD Family Coach 1.0 condition only opened the app approximately 4 times over 4 weeks, suggesting limitations to this app version’s feasibility. PTSD Family Coach 1.0 users reported moderately favorable impressions of the app, suggesting preliminary acceptability. Regarding efficacy, no significant difference was found between PTSD Family Coach 1.0 users and psychoeducation app users across any outcome of interest. Post hoc analyses suggested that app use regardless of treatment condition was associated with reduced stress. Further research that improves app feasibility and establishes efficacy in targeting the domains most relevant to CSOs is warranted.

Article
REACH Publication

coach app, veteran families, posttraumatic stress disorder, PTSD

https://formative.jmir.org/2023/1/e42053

Research Summary

  April 2023