Post-disaster mental health recovery app proves successful

The aftermath of a disaster – whether natural or man-made – can be difficult. Survivors often face destroyed homes, missing loved ones and financial difficulty. In the midst of chaos, mental health often moves to the back burner.

According to Kenneth Ruggiero, Ph.D., a professor in the Medical University of South Carolina (MUSC) College of Nursing and the SmartState Endowed Chair of the Technology Application Center for Healthful Lifestyles, after a disaster, around 5% to 10% of people will develop significant anxiety, depression and sleep problems – yet only around 25% to 30% of those who develop these conditions will seek help.

Ruggiero set out to develop a resource to improve access to evidence-based support. His early research was inspired by the mental health impacts of the 9/11 attacks. He and his MUSC colleagues began testing internet educational tools that, at that time, were accessed via dial-up modem. Although the intervention was then limited in its abilities, it was well-received.

Ruggiero elaborated on why disasters are challenging to address through a mental health lens. He said that after a disaster, the health care system becomes flooded, and mental health services are typically backlogged.

“There’s probably a long waiting list for mental health care,” he added. “If it’s a big disaster like a hurricane that devastates a whole state, for example, they can’t keep up. This is part of the reason why we need additional resources.”

Ruggiero’s team has since expanded and geared the operation toward disasters, such as the devastating 2011 tornadoes in Joplin, Missouri, and northern Alabama. As published in a recent paper in the American Journal of Psychiatry, they found that the team’s internet educational and self-help videos and resources were incredibly impactful with adolescents, reducing their risks of developing post-traumatic stress disorder (PTSD) symptoms and depression. These findings influenced the development of the Bounce Back Now app, intended for survivors of disasters. These survivors were able to access it for symptom management tools that are designed to have short- (e.g., relaxation- or mindfulness-based) and long-term (e.g., skills-based) benefit. 

“That was the opportunity to address mental health problems for people who weren’t going to go get mental health treatment but needed it.” One of the app’s major features involves mood monitoring, where users can keep weekly logs of their mental well-being. This builds emotional awareness. Another feature provides different tools aimed at reducing active distress, such as guided breathing, progressive muscle relaxation and mindfulness activities.

The more intensive features involve repeated writing exercises focused on addressing anxiety; behavioral activation, where users can increase the frequency of fun and functional activities; and sleep hygiene techniques that help to improve their sleep efficiency.”

In an innovative approach to anxiety management, his team published a research article examining the effectiveness of the app for users through a randomized control of two groups – one that was provided a simpler app with more basic features, mostly suggesting links to mental health resources, and the other the full Bounce Back Now app.

“People could use the app however they wanted to. We found that a lot of times, people would access it to reduce distress in the moment, and that a smaller percentage would try to deal with some of those longer-term solutions,” he said.

“I think the issue is that people want to feel better in the moment, and if there are tools that can help them to do so, then that’s good enough. In some cases, because people have busy lives, they’ve got a lot going on,” he added, “and so, mental health often takes a backseat for people, unfortunately. I think sometimes, they know they need to deal with it, but they don’t want to invest a ton of time into it or don’t have enough experience with mental health treatment to recognize the long-term value of applying some of these skills.”

Ruggiero thinks that the way people find the app contributes to their perspectives on it, and that integrating it into broader healthcare initiatives in which it is recommended by a disaster response or healthcare professional could improve sustained usage and benefit.

“We work a lot with traumatic injury patients, for example, by delivering a provider-driven mental health program to address PTSD and depression,” he stated. “I think that patients would be likely to use the app if recommended by health care providers as part of a broader program. Having a trusted health care professional in the mix would increase patients’ trust of a tool like this versus situations in which people simply stumble upon it in the App Stores.”

Ruggiero said he would love for these types of intervention to be more integral to health care, specifically as it applies to disaster response frameworks. 

Ruggiero also stressed the importance of keeping an open line of communication with patients to include them as a part of the research team.

“If the population that you’re trying to reach helps you develop something, it’s going to be so much better for them and so much more valuable to them.”

Ruggiero said the team wanted to determine if using the app accelerated mental health recovery more than the basic control-group app. The answer was yes. The team assessed users immediately after they entered the study, then followed up 3, 6, and 12 months later. The researchers found that it did improve users’ mental health. Ruggiero sees this as promising for the future of digital mental health care and finds it vitally important information for the public. Additionally, it provides a more reasonable solution to already strained health care resources.

Currently, Ruggiero and his team continue to test the app in the context of seeking broader health care solutions for patients experiencing trauma.