JMIR Publications

ABSTRACT

Background:

Public safety personnel (PSP) report frequent exposures to potentially psychologically traumatic events and, consequently, elevated mental health concerns such as anxiety, depression, and posttraumatic stress. Therapist-guided internet-delivered cognitive behavioral therapy (ICBT) is an effective treatment for PSP that can overcome common barriers to care such as cost, distance to services, mental health stigma, and more. Yet, little is known about the prevalence of alcohol misuse among Canadian PSP nor the potential alcohol benefits of ICBT.

Objective:

To fill this void, alcohol misuse was examined among Canadian PSP and its associations with ICBT engagement, outcomes, and satisfaction.

Methods:

This retrospective observational study included 910 Canadian PSP enrolled in PSPNET's therapist-guided PSP Wellbeing Course between November 2019 and March 2024. Alcohol misuse was classified at screening using the Alcohol Use Disorders Identification Test. Associations were examined between alcohol misuse and sample characteristics as well as treatment engagement, outcomes, and satisfaction using crosstabulations, logistic regression, and a multivariate analysis of variance on standardized residual change scores (n = 684).

Results:

At screening, 10.5% (n = 96) of participants abstained from alcohol and 31.1% (n = 283) met criteria for alcohol misuse. Participants meeting misuse criteria were more likely to screen positive for clinical depression (65.0% vs. 56.6%; PHQ-9 > 10), generalized anxiety (56.2% vs. 49.0%; GAD-7 > 10), and clinical posttraumatic stress (41.0% vs. 32.5%; PCL-5 > 33). Although the overall logistic regression model was significant, χ²(3) = 11.07, p = .011, none of the individual mental health measures significantly increased the likelihood of meeting misuse criteria. Alcohol misuse was not associated with sample characteristics or treatment engagement, and overall treatment satisfaction was comparable, although participants meeting misuse criteria were slightly less likely to report that the Course was worth their time (96.2%) or recommend it to others (96.6%), Alcohol misuse was associated with smaller 8-week improvements in depressive and posttraumatic stress symptoms, but not anxiety.

Conclusions:

Overall, findings highlight the prevalence of alcohol misuse among Canadian PSP seeking ICBT and its associations with clinical depression, posttraumatic stress, and anxiety at screening and smaller improvements in depressive and posttraumatic stress symptoms at 8-weeks post-enrollment. Future research should examine whether alcohol-specific or integrated ICBT approaches may better address the needs of PSP experiencing alcohol misuse. Clinical Trial: Clinicaltrials.gov (NCT04127032)