Abstract
BackgroundA necessary shift from in-person to remote delivery of psychotherapy (eg, teletherapy, eHealth, videoconferencing) has occurred because of the COVID-19 pandemic. A corollary benefit is a potential fit in terms of the need for equitable and timely access to mental health services in remote and rural locations. Owing to COVID-19, there may be an increase in the demand for timely, virtual delivery of services among trauma-affected populations, including public safety personnel (PSP; eg, paramedics, police, fire, correctional officers), military members, and veterans. There is a lack of evidence on the question of whether digital delivery of trauma-therapies for military members, veterans, and PSP leads to similar outcomes to in-person delivery. Information on barriers and facilitators and recommendations regarding digital-delivery is also scarce.ObjectiveThis study aims to evaluate the scope and quality of peer-reviewed literature on psychotherapeutic digital health interventions delivered remotely to military members, veterans, and PSP and synthesize the knowledge of needs, gaps, barriers to, and facilitators for virtual assessment of and virtual interventions for posttraumatic stress injury.MethodsRelevant studies were identified using MEDLINE (Medical Literature Analysis and Retrieval System Online), EMBASE (Excerpta Medica dataBASE), APA (American Psychological Association) PsycINFO, CINAHL (Cumulative Index of Nursing and Allied Health Literature) Plus with Full Text, and Military & Government Collection. For collation, analysis, summarizing, and reporting of results, we used the CASP (Critical Skills Appraisal Program) qualitative checklist, PEDro (Physiotherapy Evidence Database) scale, level of evidence hierarchy, PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews), and narrative synthesis.ResultsA total of 38 studies were included in this review. Evidence for the effectiveness of digital delivery of prolonged exposure therapy, cognitive processing therapy, behavioral activation treatment with therapeutic exposure to military members, veterans, and PSP was rated level 1a, whereas evidence for cognitive behavioral therapy was conflicting. The narrative synthesis indicated that virtual delivery of these therapies can be as effective as in-person delivery but may reduce stigma and cost while increasing access to therapy. Issues of risk, safety, potential harm (ie, suicidality, enabling avoidance), privacy, security, and the match among the therapist, modality, and patient warrant further consideration. There is a lack of studies on the influences of gender, racial, and cultural factors that may result in differential outcomes, preferences, and/or needs. An investigation into other therapies that may be suitable for digital delivery is needed.ConclusionsDigital delivery of trauma therapies for military members, 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.
Highlights
BackgroundPhysical distancing during the COVID-19 pandemic has led to a rapid paradigm shift toward remote mental health service delivery and a surge in the use of digital health delivery [1,2]
Clinical, cultural, practical, and privacy and/or security issues remain to be addressed for delivering mental health services to trauma-affected populations, including public safety personnel (PSP; eg, border services, communications officials, correctional workers, firefighters, paramedics, police, etc), military members, and veterans [4]. mental health concerns and posttraumatic stress injuries (PTSIs) in these groups may be associated with professional service during, or exacerbated by, the COVID-19 pandemic
A total of 131 full-text documents were reviewed, with 93 being excluded (Figure 1) for reasons of including a therapeutic intervention not specific to traumatic stress-related disorders, not involving military members, veterans, or PSP, not being peer reviewed, the diagnosis not being related to trauma, or the administration of the therapeutic intervention not being via digital health
Summary
BackgroundPhysical distancing during the COVID-19 pandemic has led to a rapid paradigm shift toward remote mental health service delivery and a surge in the use of digital health delivery (eg, teletherapy, telemedicine, eHealth, and mobile health) [1,2]. Military members and PSP are frequently exposed to potentially high stress and traumatic experiences in the course of service [5]. Such exposures can impact their mental and psychosocial health and result in PTSIs, a range of challenges from posttraumatic stress disorder (PTSD) to symptom clusters that may not meet diagnostic criteria but interfere with daily functioning in social, work, or family activities [4]. Owing to COVID-19, there may be an increase in the demand for timely, virtual delivery of services among trauma-affected populations, including public safety personnel (PSP; eg, paramedics, police, fire, correctional officers), military members, and veterans. Information on barriers and facilitators and recommendations regarding digital-delivery is scarce
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