JMIR Publications

ABSTRACT

Background:

First responders, military personnel and veterans face a disproportionate risk for mental health and wellness issues due to the stress of their occupations. Stigma and confidentiality concerns are common barriers to use of traditional mental health services. Digital interventions offer a promising alternative, as they can be anonymous, convenient, and cost-effective.

Objective:

This study aimed to test GUIDE, a digital wellness app designed for first responders, military personnel, and veterans. We explored the impact of GUIDE on various aspects of wellness, emotional wellbeing, mental health, social connectedness, and personal growth.

Methods:

This randomized waitlist-controlled trial enrolled 115 participants allocated into 3 groups: GUIDE with financial incentives (GUIDE+Incentives, n=37), GUIDE-only (n=39), or waitlisted GUIDE control (waitlist, n=39). Surveys assessed baseline and post-trial wellness (PERMA total score, WHO-5 score, Personal Wellbeing Score, PERMA Health sub-scale score), emotional wellbeing (PERMA Positive, Negative, and Happiness sub-scale scores; Difficulties in Emotion Regulation Scale), mental health/health (PHQ-8 for depression and GAD-7 for anxiety), social connectedness (PERMA Relationships and Loneliness sub-scale scores), and personal growth (PERMA Accomplishment, Meaning, and Engagement sub-scale scores). App engagement and technical merit were also evaluated.

Results:

Overall, 93.04% of enrolled participants (107/115) completed the post-trial assessment and were included in our intent-to-treat analyses. In repeated measures ANOVAs, there were no significant group × time interactions. In post-hoc pairwise comparisons of pre-post deltas per group, the GUIDE-only group improved significantly over the Waitlist in wellness, emotional wellbeing, and mental health. No group differences were significant for social connectedness or personal growth measures. Of participants allocated to GUIDE intervention groups, 67.10% (51/76) completed at least three activities per week for all four weeks. GUIDE+Incentives completed significantly more activities, posts and replies compared to the GUIDE-only group – but not lessons, likes, or mood surveys. App engagement was correlated with improvements on wellness, emotional wellbeing, mental health, and personal growth measures, driven mostly by lessons, posts and replies – the educational and peer support aspects of GUIDE. Participants who engaged more felt more accomplished, regardless of feature used. Participants gave GUIDE good appropriateness and feasibility scores, and satisfactory acceptability and usability scores. Exploratory subgroup analyses suggest the app may be most beneficial to military-affiliated individuals and males.

Conclusions:

This trial indicates that GUIDE-only participants improved significantly compared to the waitlist and that GUIDE is a feasible and appropriate intervention with the potential to improve mental health and wellbeing of first responders, veterans and active military. Financial incentives increased engagement with peer support aspects of GUIDE, but did not lead to significant improvements over the waitlist. Future research should test the effect of longer-term GUIDE use and whether improvements sustain. Clinical Trial: clinicaltrials.gov (NCT06336967)