Digital Health Interventions for Military Members, Veterans, and Public Safety Personnel: Scoping Review

Abstract

Background: Accessible mental health support is essential for military members (MMs), veterans, and public safety personnel (PSP) who are at an increased risk of mental health challenges. Unique barriers to care, however, often leave these populations going untreated. Mental health treatment delivered via apps or websites (ie, digital mental health interventions [DMHIs]) offers an accessible alternative to in-person therapy. Objective: We aimed to synthesize the current literature on apps and web-based programs focused on enhancing MMs', PSPs', and veterans' resilience or well-being. A multidimensional well-being model, I-COPPE (interpersonal, community, occupational, physical, psychological, economic, and overall well-being), was used as a framework guiding the scoping review. Methods: A search of 6 databases was conducted using key terms related to (1) population, (2) resilience and well-being constructs, and (3) web- or mobile-based programs. At all levels of screening, at least 2 researchers (RRA, MAM, and CA) reviewed each paper independently. Data were extracted and recorded to include relevant study characteristics including program name and description, target population, number of participants, therapeutic approach, results, limitations, and I-COPPE dimension supported. A narrative synthesis was performed to summarize the eligible studies. Results: In total, 44 papers were included in the study and 39 unique resilience or well-being apps or web-based programs identified for MMs, PSP, or veterans. The programs largely focused on veteran populations (28/44, 64%). In total, 51% (20/39) of programs relied on cognitive behavioral approaches and most aimed to support posttraumatic stress disorder-related symptoms. In consideration of the I-COPPE model, a majority supported psychological well-being, followed by interpersonal and physical well-being. Most apps were believed to support more than 1 domain of well-being. The main methodologies used in the literature to evaluate digital mental health interventions include randomized controlled trials, secondary analyses, and pilot randomized controlled trials with evaluations of feasibility, acceptability, satisfaction, or qualitative feedback. Generalizability of findings was commonly limited by attrition rates and small sample sizes. Conclusions: DMHIs for MMs, PSP, and veterans appear promising due to their accessibility and scalability. More research is needed, however, to determine whether DMHIs are an effective alternative to in-person mental health care. The current review contributes to the literature by compiling evidence of DMHIs and the domains of well-being supported by, and the therapeutic orientation of, these programs. Our review revealed that more research is needed to determine the effectiveness and efficacy of DMHIs offered to these populations.

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