Ong Laura E, Speicher Sarah, Villasenor Diana, Kim Jamie, Jacobs Adam, Macia Kathryn S, Cloitre Marylene
Department of Psychology, Northern Illinois University, DeKalb, IL, United States.
National Center for Posttraumatic Stress Disorder, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, United States.
J Med Internet Res. 2024 Oct 2;26:e52130. doi: 10.2196/52130.
Peer-supported mobile health (mHealth) programs hold the promise of providing a low-burden approach to increasing access to care and improving mental health. While peer support has been shown to improve engagement in care, there is limited investigation into the impact of peers on symptom outcomes. Trauma-exposed populations frequently endure co-occurring posttraumatic stress and depressive symptoms as well as difficulties in day-to-day functioning. This study evaluated the potential benefits of a peer-supported, transdiagnostic mHealth program on symptom outcomes and functioning.
This randomized controlled trial tested the effectiveness of Brief Peer-Supported (BPS) web-based Skills Training in Affective and Interpersonal Regulation (webSTAIR), a 6-module transdiagnostic digital program derived from Skills Training in Affective and Interpersonal Regulation and compared to waitlist control in a community sample of veterans who screened positive for either posttraumatic stress disorder (PTSD) or depression.
A total of 178 veterans were enrolled in this study using a 2:1 randomization scheme with 117 assigned to BPS webSTAIR and 61 assigned to waitlist control. PTSD and depressive symptoms as well as emotion regulation and psychosocial functioning were assessed at pretreatment, posttreatment, and 8-week follow-up time points. Mixed-effects models were used to assess change in outcome measures across time points. Exploratory analyses were conducted to determine whether the type and number of peer interactions influenced outcomes.
Significant interaction effects were observed for all outcomes such that participants randomized to BPS webSTAIR reported significantly greater improvement at the posttreatment time point compared to waitlist control with moderate effect sizes for PTSD (d=0.48), depression (d=0.64), emotion regulation (d=0.61), and functional impairment (d=0.61); gains were maintained at 8-week follow-up. An initial cohort of participants who were required to engage with a peer coach to progress through the modules interacted more frequently with peers but completed fewer modules compared to a later cohort for whom peer engagement was optional. Overall, those who completed more modules reported greater improvement in all outcomes.
BPS webSTAIR was effective in improving PTSD and depression symptoms, emotion regulation, and psychosocial functioning in community veterans. Peer-supported, transdiagnostic mHealth programs may be a particularly efficient, effective, and low-burden approach to improving mental health among trauma-exposed populations. Investigation of peer-supported programs among other populations is necessary to evaluate the generalizability of the findings. Analyses comparing peer support that was required versus optional indicated that some veterans may not need or want peer support. Future research should evaluate how best to deliver peer support and for whom it is most beneficial. If successful, peer-supported tech programs may increase the Veteran Affairs workforce as well as improve veteran mental health services and outcomes.
ClinicalTrials.gov NCT04286165; https://clinicaltrials.gov/study/NCT04286165.
同伴支持的移动健康（mHealth）项目有望提供一种低负担的方法，以增加获得护理的机会并改善心理健康。虽然同伴支持已被证明可提高护理参与度，但对于同伴对症状结果的影响的研究有限。经历过创伤的人群经常同时遭受创伤后应激和抑郁症状以及日常功能方面的困难。本研究评估了同伴支持的跨诊断mHealth项目对症状结果和功能的潜在益处。
这项随机对照试验测试了简短同伴支持（BPS）基于网络的情感和人际调节技能培训（webSTAIR）的有效性，这是一个由情感和人际调节技能培训衍生而来的6模块跨诊断数字项目，并在筛查出创伤后应激障碍（PTSD）或抑郁症呈阳性的退伍军人社区样本中与等待名单对照组进行了比较。
本研究共招募了178名退伍军人，采用2:1随机分组方案，117人被分配到BPS webSTAIR组，61人被分配到等待名单对照组。在治疗前、治疗后和8周随访时间点评估PTSD和抑郁症状以及情绪调节和心理社会功能。使用混合效应模型评估各时间点结局指标的变化。进行探索性分析以确定同伴互动的类型和数量是否会影响结局。
在所有结局指标上均观察到显著的交互作用，即与等待名单对照组相比，随机分配到BPS webSTAIR组的参与者在治疗后时间点报告的改善显著更大，PTSD（d = 0.48）、抑郁症（d = 0.64）、情绪调节（d =
0.61）和功能损害（d = 0.61）的效应大小适中；在8周随访时仍保持改善。与后期队列相比，最初一批需要与同伴教练互动以完成各模块的参与者与同伴的互动更频繁，但完成的模块更少，后期队列中同伴参与是可选的。总体而言，完成更多模块的参与者在所有结局指标上的改善更大。
BPS webSTAIR在改善社区退伍军人的PTSD和抑郁症状、情绪调节以及心理社会功能方面是有效的。同伴支持的跨诊断mHealth项目可能是改善经历过创伤人群心理健康的一种特别高效、有效且低负担的方法。有必要在其他人群中对同伴支持项目进行研究，以评估研究结果的普遍性。比较必需与可选同伴支持的分析表明，一些退伍军人可能不需要或不想要同伴支持。未来的研究应评估如何最好地提供同伴支持以及对谁最有益。如果成功，同伴支持的技术项目可能会增加退伍军人事务部的工作人员，并改善退伍军人心理健康服务和结局。
ClinicalTrials.gov NCT04286165；https://clinicaltrials.gov/study/NCT042861
