This Small Business Innovation Research (SBIR) Phase II research project seeks to determine the feasibility and effectiveness of a Web-based software that provides depression treatment for Veterans returning from Iraq and Afghanistan. A recent Pentagon study concluded that returning Iraqi and Afghanistan veterans are currently suffering from "daunting and growing mental health problems" with nearly 1/3 of these military personnel reporting symptoms of mental illness upon their return from combat. A lack of adequate available resources combined with a fear of stigmatization inherent in seeking face-to-face treatment, prevent as many as 77% of these military personnel from ever getting the treatment they need. The proposed innovation will enable the military's mental health professionals to offer an effective, evidence-based and drug-free depression intervention which will effectively mitigate stigma concerns faced by military personnel and will provide treatment at a fraction of the cost of the typical depression interventions available today.
The key innovation in this proposed research has the potential to create significant value by 1) allowing VA mental health professionals to provide an easily-accessible, evidence-based and drug-free depression treatment to returning military personnel suffering from depression 2) enabling veterans to seek treatment without having to face the fear of stigmatization inherent in seeking face-to-face treatment within the confines of a mental health care facility 3) reducing the economic burden on the military health care system by providing an effective and scalable depression treatment at a fraction the cost of today's typical depression interventions. With an estimated 5 million veterans and 20 million civilians in the U.S.A suffering from depression, cost-effective and innovative methods to help address this burgeoning healthcare problem are critical. Through further research, this Web-based framework has the potential to extend to many mental health problems that plague our country such as PTSD, Drug Abuse, Anxiety and Alcoholism.
Project Outcome: This Small Business Innovation Research (SBIR) project sought to determine the feasibility and effectiveness of a Web-based software program that provides treatment for combat stress related mental health issues affecting Veterans and Active Duty Service Members returning from Iraq and Afghanistan. The results of our research have created a novel avenue to offer an effective, evidence-based and drug-free mood disorders intervention which effectively mitigates stigma concerns faced by military personnel and provides an avenue for treatment at a fraction of the cost of the typical depression interventions currently available. Background / Explanation: A recent Pentagon study concluded that returning Iraqi and Afghanistan Veterans are currently suffering from "daunting and growing mental health problems" with nearly 1/3 of these military personnel reporting symptoms of mental illness upon their return from combat. A lack of adequate available resources, combined with a fear of stigmatization which is inherent in seeking face-to-face treatment, prevent as many as 77% of these military personnel from ever receiving the treatment they need. Prevails suite of behavioral health programs effectively deliver highly-tailored cognitive behavioral therapy (CBT) integrated with peer support, which primarily target symptoms of stress, depression, anxiety disorder, Post Traumatic Stress Disorder (PTSD), and other co-morbid mood disorders. Evidence-based CBT and peer support have also shown efficacy in treating personality and eating disorders, substance abuse, addiction, and other chronic illnesses. Our programs, developed under this NSF SBIR collaboration and with numerous additional partners, have been clinically proven to significantly lower the perceived stigma of seeking treatment while providing those who are afflicted with high quality initial care. Intellectual Merit / Clinical Achievements: Over the course of our research we conducted a range of usability tests, pilots, and clinical research studies to provide evidence-based feedback on the effectiveness of our model. Usability testing conducted in April of 2010 with a group of 500 Veterans demonstrated strong user interest and aided in the development of protocols and procedures to be used in future clinical trials. Our initial clinical trial exposed a diverse group of 50 Veterans to our program, while evaluating the change in self-reported mental health symptoms and stigma associated with seeking treatment. After successful findings, the trial was published in the VA’s Journal of Rehabilitation Research and Development. Starting on December 15th, 2011 we launched our first large scale national pilot with the goal of exposing 6,856 users to our model so that we could evaluate its clinical effectiveness, assess the perceived relevance, and further develop our system. As of January 2013 we had enrolled 6,500 users into our web-based intervention model. Using clinical measures such as the Center for Epidemiologic Studies–Depression (CES-D 10) and the Posttraumatic Stress Disorder Checklist, Military version (PCL-M) we found statistically significant improvement in symptoms of both depression and PTSD within the users exposed to our model. In every measure users improved from their baseline scores, with significant improvements seen within the CES-D 10 and PCL-M. A common way to quantify the clinical impact of an intervention is by providing the effect size (a statistical calculation using pre- and post-measures on a given scale). At last tally, the effect sizes related to Vets Prevail are -0.6 for PTSD and -0.9 for Depression (considered to be in the "moderate" and "large" ranges, respectively). Of note, effect sizes of this magnitude are generally only associated with interventions involving face-to-face support by a mental health professional, and there has never been an online program that has achieved clinical results of this magnitude with such a low-cost, scalable model. Broader Impact / Future Implications: After taking our model from concept to application within the sphere of Military/Veteran mental health care, we now are actively conducting research to further expand the scope and berth to include a much wider range of applicability within the field of study. Moving forward, we will begin to develop and modify numerous versions of our program designed to meet the increasingly obvious need for low-cost and reliable mental health care within the broader marketplace. Thanks to this grant and our partnerships with numerous supporters, we have successfully been able to address the extremely serious issue of Veteran and Active Duty Service Member mental fitness with significant success. With further development we hope to broaden the influence of our model and make a positive impact upon thousands if not millions of those in need.
