JMIR Publications

ABSTRACT

Background:

Computerized psychological interventions (CPIs) can overcome logistical and psychosocial barri-ers to utilization of mental health care in veterans affairs (VA) and department of defense (DoD) settings.

Objective:

In this systematic review we outline the existing literature, with the goal of describing: 1) the scope and quality of the available literature, 2) intervention characteristics, study methods and outcomes, and 3) study limitations and potential directions for future research.

Methods:

Systematic searches of two databases (PsychINFO and PubMed,) were conducted from inception until November 15, 2020. The following inclusion criteria were used 1) the study was published in an English-language peer-reviewed journal, 2) participants were randomly allocated to a CPI or a control group (non-CPI active treatment or non-active control group), 3) an intervention in at least one treatment arm was primarily delivered through the computer/internet with or without additional support, 4) participants were veterans or service members, and 5) the study used validated measures to examine the effect of treatment on psychological outcomes.

Results:

The review included 23 studies which met pre-defined inclusion criteria. The majority of studies were at high risk for bias. Targeted outcomes, participant characteristics, type of support delivered, adherence and participant satisfaction are described. Most examined interventions (19 out of 24) yielded positive results. Study limitations include participant characteristics limiting study infer-ence, high rates of attrition and an over-reliance on self-reported outcomes.

Conclusions:

Relatively few high-quality studies were identified, and more rigorous investigations are needed. Several recommendations for future research are discussed, including adopting methods that mini-mize attrition, optimize usage and allow for personalization of treatment.