title: mHealth in the Wild: Using Novel Data to Examine the Reach, Use, and Impact of PTSD Coach.
abstract: BACKGROUND
  A majority of Americans (58%) now use smartphones, making it possible for mobile mental health apps to reach large numbers of those who are living with untreated, or under-treated, mental health symptoms. Although early trials suggest positive effects for mobile health (mHealth) interventions, little is known about the potential public health impact of mobile mental health apps.
  
  
  OBJECTIVE
  The purpose of this study was to characterize reach, use, and impact of "PTSD Coach", a free, broadly disseminated mental health app for managing posttraumatic stress disorder (PTSD) symptoms.
  
  
  METHODS
  Using a mixed-methods approach, aggregate mobile analytics data from 153,834 downloads of PTSD Coach were analyzed in conjunction with 156 user reviews.
  
  
  RESULTS
  Over 60% of users engaged with PTSD Coach on multiple occasions (mean=6.3 sessions). User reviews reflected gratitude for the availability of the app and being able to use the app specifically during moments of need. PTSD Coach users reported relatively high levels of trauma symptoms (mean PTSD Checklist Score=57.2, SD=15.7). For users who chose to use a symptom management tool, distress declined significantly for both first-time users (mean=1.6 points, SD=2.6 on the 10-point distress thermometer) and return-visit users (mean=2.0, SD=2.3). Analysis of app session data identified common points of attrition, with only 80% of first-time users reaching the app's home screen and 37% accessing one of the app's primary content areas.
  
  
  CONCLUSIONS
  These findings suggest that PTSD Coach has achieved substantial and sustained reach in the population, is being used as intended, and has been favorably received. PTSD Coach is a unique platform for the delivery of mobile mental health education and treatment, and continuing evaluation and improvement of the app could further strengthen its public health impact.
authors.affiliation: National Center for PTSD Dissemination & Training Division Department of Veterans Affairs Palo Alto Health Care System Menlo Park, CA United States.
authors.forename: Jason E
authors.identifier: 0000-0002-1463-2469
authors.initials: JE
authors.lastname: Owen
authors.affiliation: National Center for PTSD Dissemination & Training Division Department of Veterans Affairs Palo Alto Health Care System Menlo Park, CA United States.
authors.forename: Beth K
authors.identifier: 0000-0001-9628-990X
authors.initials: BK
authors.lastname: Jaworski
authors.affiliation: National Center for PTSD Dissemination & Training Division Department of Veterans Affairs Palo Alto Health Care System Menlo Park, CA United States.
authors.forename: Eric
authors.identifier: 0000-0003-1687-4987
authors.initials: E
authors.lastname: Kuhn
authors.affiliation: National Center for PTSD Dissemination & Training Division Department of Veterans Affairs Palo Alto Health Care System Menlo Park, CA United States.
authors.forename: Kerry N
authors.identifier: 0000-0003-0670-3826
authors.initials: KN
authors.lastname: Makin-Byrd
authors.affiliation: National Center for PTSD Dissemination & Training Division Department of Veterans Affairs Palo Alto Health Care System Menlo Park, CA United States.
authors.forename: Kelly M
authors.identifier: 0000-0001-8668-2708
authors.initials: KM
authors.lastname: Ramsey
authors.affiliation: Mental Health Services US Department of Veterans Affairs Menlo Park, CA United States.
authors.forename: Julia E
authors.identifier: 0000-0001-8814-759X
authors.initials: JE
authors.lastname: Hoffman
keywords: PTSD; mHealth; mental heatlh; mobile app; public health; self-management; trauma