JMIR Publications

ABSTRACT

Background:

With widespread smartphone ownership, mobile health (mHealth) apps can expand access to evidence-based interventions for mental health conditions, including posttraumatic stress disorder (PTSD). Research to evaluate new features and capabilities in these apps is critical but lags behind app development. The initial release of PTSD Coach, a free self-management app developed by the U.S. Departments of Veterans Affairs (VA) and Defense (DoD), was found to have a positive public health impact. However, major stakeholder-driven updates to the app have yet to be evaluated.

Objective:

We sought to characterize the reach, use, and potential impact of PTSD Coach Version 3.1 in the general public. As part of characterizing use, we investigated the use of specific app features, which extended prior work on PTSD Coach.

Methods:

We examined naturalistic usage of PTSD Coach during a one-year observation period between April 20, 2020 and April 19, 2021, using anonymous in-app event data to generate summary metrics for users.

Results:

During the observation period, PTSD Coach was broadly disseminated to the public, reaching approximately 150,000 total users and 20,000 users per month. On average, users used the app three times across three separate days for 18 minutes total, with steep drop-offs in use over time; a subset of users, however, demonstrated high or sustained engagement. Over 60% of users accessed one or more main content areas of the app (i.e., Manage Symptoms, Track Progress, Learn, or Get Support). Among content areas, features under Manage Symptoms (including coping tools) were accessed most frequently, by over 40% of users. Users who provided initial distress ratings (44.3% of users, n = 56,971) endorsed relatively high momentary distress (M = 6.03, SD = 2.52, on a 0-10 scale), and use of coping tool modestly improved momentary distress (M = -1.38, SD = 1.70). Among users who completed at least one PTSD Checklist for DSM-5 (PCL-5; 13.7% of users, n = 17,589), PTSD symptoms were largely above clinical threshold (M = 49.80, SD = 16.36). Among users who completed at least two PCL-5s (3.9% of users, n = 4,989), PTSD symptoms decreased from the first to last assessment (M = -4.35, SD = 15.29), with approximately a third of these users (n = 1,585) experiencing clinically significant improvements.

Conclusions:

PTSD Coach continues to fulfill its mission as a public health resource. Version 3.1 compares favorably with Version 1 on most metrics related to reach, use, and potential impact. Although benefits appear modest on an individual basis, the app provides these benefits to a large population. For mHealth apps to reach their full potential in supporting trauma recovery, future research should aim to understand the utility of individual app features and identify strategies to maximize overall effectiveness and engagement.