Testing an Adaptive Intervention for Peer-Supported Mobile Health for Primary Care Veterans With Psychological Distress

Many Veterans experience psychological distress including depression, post-traumatic stress disorder (PTSD), anxiety and problems with sleep and anger. Services to address these problems need to be easy for Veterans to access. VA mobile health applications (mHealth apps) that teach skills to manage psychological distress are widely available. However, Veterans rarely use these apps enough to experience health benefits. Peer specialists are VA employees who are trained to use their lived experiences in mental health recovery to help other Veterans. Peers can provide support and accountability to Veterans as they use mHealth apps. Peers working in VA primary care settings are easily accessible to Veterans who receive VA services. This study aims to improve the health of Veterans by testing the effectiveness of peer-supported mHealth in reducing psychological distress. It will also test how much peer support Veterans need to improve their health with using mHealth apps.

Inclusion Criteria: * Veteran enrolled in primary care at one of 3 VA facilities (Philadelphia, PA; Ann Arbor, MI; and Bedford, MA) * clinically significant psychological distress on at least one DASS-21 subscale (Depression =\> 10, Anxiety =\> 8, Stress =\> 13) Exclusion Criteria: * symptoms that may preclude active engagement in the intervention such as gross cognitive impairment or current symptoms of mania or psychosis * suicide risk as measured by the P4 Suicide Assessment * plan to engage in psychotherapy during the intervention period * started or changed the dose of a psychotropic medication in the last two months * voice a preference to be directly referred to mental health specialty care