MHealth in the Wild: Using Novel Data to Examine the Reach, Use, and Impact of PTSD Coach

Overview

Journal JMIR Ment Health

Specialties Health Services
Psychiatry
Psychology

Date 2015 Nov 7

PMID 26543913

Citations 100

Authors

Jason E Owen

Beth K Jaworski

Eric Kuhn

Kerry N Makin-Byrd

Kelly M Ramsey

Julia E Hoffman

Affiliations

Soon will be listed here.

Abstract

Background: A majority of Americans (58%) now use smartphones, making it possible for mobile mental health apps to reach large numbers of those who are living with untreated, or under-treated, mental health symptoms. Although early trials suggest positive effects for mobile health (mHealth) interventions, little is known about the potential public health impact of mobile mental health apps.

Objective: The purpose of this study was to characterize reach, use, and impact of "PTSD Coach", a free, broadly disseminated mental health app for managing posttraumatic stress disorder (PTSD) symptoms.

Methods: Using a mixed-methods approach, aggregate mobile analytics data from 153,834 downloads of PTSD Coach were analyzed in conjunction with 156 user reviews.

Results: Over 60% of users engaged with PTSD Coach on multiple occasions (mean=6.3 sessions). User reviews reflected gratitude for the availability of the app and being able to use the app specifically during moments of need. PTSD Coach users reported relatively high levels of trauma symptoms (mean PTSD Checklist Score=57.2, SD=15.7). For users who chose to use a symptom management tool, distress declined significantly for both first-time users (mean=1.6 points, SD=2.6 on the 10-point distress thermometer) and return-visit users (mean=2.0, SD=2.3). Analysis of app session data identified common points of attrition, with only 80% of first-time users reaching the app's home screen and 37% accessing one of the app's primary content areas.

Conclusions: These findings suggest that PTSD Coach has achieved substantial and sustained reach in the population, is being used as intended, and has been favorably received. PTSD Coach is a unique platform for the delivery of mobile mental health education and treatment, and continuing evaluation and improvement of the app could further strengthen its public health impact.

Citing Articles

Patterns of Skills Review in Smartphone Cognitive Behavioral Therapy for Depression: Observational Study of Intervention Content Use.

Bernstein E, Daniel K, Miyares P, Hoeppner S, Bentley K, Snorrason I JMIR Ment Health. 2025; 12:e63497.

PMID: 39993308 PMC: 11894344. DOI: 10.2196/63497.

PTSD Coach as an early mobile intervention to improve cancer-related anxiety and psychosocial oncology uptake in patients newly diagnosed with head and neck cancer: pilot randomized controlled trial.

Ducharme L, Lo C, Hier M, Zeitouni A, Kost K, Mlynarek A Pilot Feasibility Stud. 2024; 10(1):153.

PMID: 39709459 PMC: 11662848. DOI: 10.1186/s40814-024-01556-7.

When and Why Adults Abandon Lifestyle Behavior and Mental Health Mobile Apps: Scoping Review.

Kidman P, Curtis R, Watson A, Maher C J Med Internet Res. 2024; 26:e56897.

PMID: 39693620 PMC: 11694054. DOI: 10.2196/56897.

Patient and Health Care Professional Perspectives About Referral, Self-Reported Use, and Perceived Importance of Digital Mental Health App Attributes in a Diverse Integrated Health System: Cross-Sectional Survey Study.

Miller M, Eberhart L, Heliste J, Tripuraneni B JMIR Form Res. 2024; 8:e59831.

PMID: 39546791 PMC: 11607546. DOI: 10.2196/59831.

Assessing acceptance and feasibility of a conversational agent to support individuals living with post-traumatic stress disorder.

Han H, Mendu S, Jaworski B, Owen J, Abdullah S Digit Health. 2024; 10:20552076241286133.

PMID: 39381805 PMC: 11459533. DOI: 10.1177/20552076241286133.

References

Proudfoot J, Clarke J, Birch M, Whitton A, Parker G, Manicavasagar V . Impact of a mobile phone and web program on symptom and functional outcomes for people with mild-to-moderate depression, anxiety and stress: a randomised controlled trial. BMC Psychiatry. 2013; 13:312. PMC: 4225666. DOI: 10.1186/1471-244X-13-312. View

Abrams D, Orleans C, Niaura R, Goldstein M, Prochaska J, Velicer W . Integrating individual and public health perspectives for treatment of tobacco dependence under managed health care: a combined stepped-care and matching model. Ann Behav Med. 1996; 18(4):290-304. DOI: 10.1007/BF02895291. View

Albright K, Gechter K, Kempe A . Importance of mixed methods in pragmatic trials and dissemination and implementation research. Acad Pediatr. 2013; 13(5):400-7. DOI: 10.1016/j.acap.2013.06.010. View

Patrick K, Griswold W, Raab F, Intille S . Health and the mobile phone. Am J Prev Med. 2008; 35(2):177-81. PMC: 2527290. DOI: 10.1016/j.amepre.2008.05.001. View

Free C, Phillips G, Watson L, Galli L, Felix L, Edwards P . The effectiveness of mobile-health technologies to improve health care service delivery processes: a systematic review and meta-analysis. PLoS Med. 2013; 10(1):e1001363. PMC: 3566926. DOI: 10.1371/journal.pmed.1001363. View

Pietrzak R, Johnson D, Goldstein M, Malley J, Southwick S . Perceived stigma and barriers to mental health care utilization among OEF-OIF veterans. Psychiatr Serv. 2009; 60(8):1118-22. DOI: 10.1176/ps.2009.60.8.1118. View

Spoont M, Murdoch M, Hodges J, Nugent S . Treatment receipt by veterans after a PTSD diagnosis in PTSD, mental health, or general medical clinics. Psychiatr Serv. 2010; 61(1):58-63. DOI: 10.1176/ps.2010.61.1.58. View

Ben-Zeev D, Schueller S, Begale M, Duffecy J, Kane J, Mohr D . Strategies for mHealth research: lessons from 3 mobile intervention studies. Adm Policy Ment Health. 2014; 42(2):157-67. PMC: 4232479. DOI: 10.1007/s10488-014-0556-2. View

Donovan K, Grassi L, McGinty H, Jacobsen P . Validation of the distress thermometer worldwide: state of the science. Psychooncology. 2014; 23(3):241-50. DOI: 10.1002/pon.3430. View

10.

Donkin L, Christensen H, Naismith S, Neal B, Hickie I, Glozier N . A systematic review of the impact of adherence on the effectiveness of e-therapies. J Med Internet Res. 2011; 13(3):e52. PMC: 3222162. DOI: 10.2196/jmir.1772. View

11.

Adkins J, Weathers F, McDevitt-Murphy M, Daniels J . Psychometric properties of seven self-report measures of posttraumatic stress disorder in college students with mixed civilian trauma exposure. J Anxiety Disord. 2008; 22(8):1393-402. DOI: 10.1016/j.janxdis.2008.02.002. View

12.

Eysenbach G . The law of attrition. J Med Internet Res. 2005; 7(1):e11. PMC: 1550631. DOI: 10.2196/jmir.7.1.e11. View

13.

Steinberg D, Levine E, Lane I, Askew S, Foley P, Puleo E . Adherence to self-monitoring via interactive voice response technology in an eHealth intervention targeting weight gain prevention among Black women: randomized controlled trial. J Med Internet Res. 2014; 16(4):e114. PMC: 4019773. DOI: 10.2196/jmir.2996. View

14.

Kelders S, Kok R, Ossebaard H, van Gemert-Pijnen J . Persuasive system design does matter: a systematic review of adherence to web-based interventions. J Med Internet Res. 2012; 14(6):e152. PMC: 3510730. DOI: 10.2196/jmir.2104. View

15.

Landis J, Koch G . The measurement of observer agreement for categorical data. Biometrics. 1977; 33(1):159-74. View

16.

Wilkins K, Lang A, Norman S . Synthesis of the psychometric properties of the PTSD checklist (PCL) military, civilian, and specific versions. Depress Anxiety. 2011; 28(7):596-606. PMC: 3128669. DOI: 10.1002/da.20837. View

17.

Elnitsky C, Andresen E, Clark M, McGarity S, Hall C, Kerns R . Access to the US Department of Veterans Affairs health system: self-reported barriers to care among returnees of Operations Enduring Freedom and Iraqi Freedom. BMC Health Serv Res. 2013; 13:498. PMC: 3893594. DOI: 10.1186/1472-6963-13-498. View

18.

Kuhn E, Greene C, Hoffman J, Nguyen T, Wald L, Schmidt J . Preliminary evaluation of PTSD Coach, a smartphone app for post-traumatic stress symptoms. Mil Med. 2014; 179(1):12-8. DOI: 10.7205/MILMED-D-13-00271. View