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Mental Health
Vets Go Online to Fight Mental Illness
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Sep 15, 2015 - 12:35:19 PM

(HealthNewsDigest.com) - A new online intervention can significantly reduce post-traumatic stress disorder and depression in veterans with mild to moderate symptoms and significantly decrease the cost of their care, according to a new study by psychological experts at Rush University Medical Center.

"This data shows that an anonymous, online program can circumvent many barriers to care that veterans face and could effectively address the dire mental health needs of veterans," says Stevan Hobfoll, PhD, principal investigator of the study and chairperson of the Department of Behavioral Sciences at Rush.

The study was the first randomized clinical trial of a new interactive online program offered anonymously to veterans. The study results were published in the July 30 issue of the Journal of Consulting and Clinical Psychology.

Gaming out a solution

The three-year study assessed changes in depression and post-traumatic stress disorder, or PTSD, among veterans and tested the safety and efficacy of an online cognitive behavioral therapy intervention. The study compared the interactive, computer-based therapy to veterans on a waiting list who may or may not have been receiving care for their PTSD and depression.

Named Vets Prevail, the intervention was developed by Prevail Health, a Chicago company that creates behavioral health technology. Using the therapy, veterans work through interactive online modules in a gamelike sequence that tailors the care to their responses. Veterans also can enter monitored peer chat rooms, and peers are also online for motivation, encouragement and aiding the referral process.

The study compared the results for 209 veterans randomized to receive computer-based therapy using Vets Prevail with 94 veterans in the waiting group.

The study results showed a 31 percent reduction in depression symptoms and a 27 percent reduction in PTSDsymptoms among those in the Vets Prevail group, and little change or worsening in participants who did not receive the intervention. These findings also held for women compared to men, for ethnic minority individuals compared to non-minority individuals, as well as for those who were exposed to more or less combat.

The participants were non-active duty veterans who served after Sept. 11, 2011. Veterans who were at least 18 years of age, spoke and read English, had regular access to a cell phone and broadband Internet, and met criteria for at least mild to moderate distress based on scores on screening assessments were eligible for the randomized clinical trial.

Increased access, decreased costs

Past research indicates that despite heightened rates of depression and PTSD among Iraq and Afghanistan veterans, the majority of distressed veterans will not receive mental health care. According to the National Alliance on Mental Illness, the diagnosis rate for PTSD among veterans is 20 percent, followed by 14 percent for depression.

Other studies show that these estimates are grossly underestimated, as they do not account for the fact that many veterans do not seek care for PTSD and depression symptoms because of barriers to treatment, according to Hobfoll.

"There are several barriers to care among veterans, including the ability to take time off of work, not knowing where to access care and the stigma associated with needing mental health services," Hobfoll says. "Veterans need more flexible treatment options that they can access on their own time, at little to no cost and protect their privacy."

The study results also show that decreases in PTSD symptoms were sustained three months post-baseline. "It will be important to look at more long-term gains," says Hobfoll. "If you compare the results of this study to the existing literature, we have favorable findings, which suggest that the treatment had more than an immediate positive impact."

Hobfoll adds that computer-based therapy has the potential to reduce the significant financial burden associated with PTSD, depression and face-to-face mental health care. He points out that in 2008, the two-year estimated financial burden associated with PTSD and depression was $6.2 billion according to a study conducted by the Rand Corp.

A simple cost comparison of Vets Prevail cost per user at scale is estimated to be as little as $25 to $50 compared with an average estimated cost of $7,033.00 to deliver prolonged exposure therapy in a VA setting. Further, once the VA or other institutions adopt the programming, the costs per patient become cheaper, as most of the cost is in program development and making the Web-based platform operable.

Also, with an online format, the computer-based therapy can be administered to veterans without long wait times. "With everyone having access to smart phones, computers and the Internet, this type of computer based therapy has great potential in treating veterans as well as others," Hobfoll says.

Nonetheless, the study authors suggest that many of veterans could benefit from individual face-to-face treatment. In fact, their success with Vets Prevail may motivate them to believe in the efficacy of treatment and help them overcome the perceived stigma of treatment. In such cases, Vets Prevail is not a comprehensive stand-alone treatment, but a part of a sequence of treatment steps that can be vital to overcome PTSD and depression related to combat trauma.

The study was funded by Goldman Sachs Gives and the Bristol-Myers Squibb Foundation.

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