JMIR Publications

ABSTRACT

Background:

A necessary shift from in-person to remote delivery of psychotherapy (e.g., teletherapy, eHealth, videoconferencing) has occurred due to the COVID-19 pandemic. A corollary benefit is potential fit in terms of the need for equitable and timely access to mental health (MH) services in remote and rural locations. COVID-19 may increase the need of Trauma-affected populations (TAPs), including public safety personnel (PSP; e.g., paramedics, police, fire, correctional officers), military members (MMs), and Veterans, for timely virtual-delivery services. There is a lack of evidence on the question of whether digital delivery of trauma-therapies for MMs, Veterans, and PSP leads to similar outcomes to in-person delivery. There is also a paucity of information on barriers and facilitators, and a lack of recommendations regarding virtual-delivery.

Objective:

To 1) evaluate the scope and quality of peer-reviewed literature on psychotherapeutic digital health interventions delivered remotely to MMs, Veterans, and PSP, and; 2) synthesize knowledge of needs, gaps, barriers to, and facilitators for virtual-assessment of and virtual-interventions for PTSI.

Methods:

Identification of relevant studies comprising searching Medline, Embase, APA Psycinfo, CINAHL Plus with Full Text, and Military & Government Collection. Collation, analysis, summarizing, and reporting of results used the Critical Skills Appraisal Program (CASP) Qualitative Checklist, PEDro Scale, Level of Evidence Hierarchy, PRISMA-ScR, and narrative synthesis.

Results:

This review process yielded 38 studies for inclusion. Evidence for effectiveness of digital delivery of prolonged exposure therapy, cognitive processing therapy, Behavioural Activation Treatment with Therapeutic Exposure toMMs, Veterans, and PSP was rated Level 1a, while evidence for cognitive behavioral therapy was conflicting. The narrative synthesis indicated virtual delivery of these therapies can be as effective as in-person, but may reduce stigma and cost while increasing access to therapy. Issues of risk, safety, potential harms (suicidality, enabling avoidance), privacy, security, and the match between therapist, modality and patient warrant further consideration. There is a paucity of studies on influences of gender, racial and cultural factors that may result in differential outcomes, preferences, and/or needs. Investigation into additional therapies that may be suitable for digital delivery are needed.

Conclusions:

Digital delivery of trauma therapies for MMs, Veterans, and PSP is a critical area for further research. Although promising evidence exists regarding the effectiveness of digital health within these populations, many questions remain and a cautious approach to more widespread implementation is warranted. Additional work is needed to address “the digital divide”.