Background: Although the COVID-19 pandemic has not led to a uniform increase of mental health concerns among older adults, there is evidence to suggest that some older veterans did experience an exacerbation of preexisting mental health conditions, and that mental health difficulties were associated with a lack of social support and increasing numbers of pandemic-related stressors. Mobile mental health apps are scalable, may be a helpful resource for managing stress during the pandemic and beyond, and could potentially provide services that are not accessible due to the pandemic. However, overall comfort with mobile devices and factors influencing the uptake and usage of mobile apps during the pandemic among older veterans are not well known. COVID Coach is a free, evidence-informed mobile app designed for pandemic-related stress. Public usage data have been evaluated; however, the uptake and usage of the app among older veterans have not been explored. Objective: The purpose of this study was to characterize smartphone ownership rates among US veterans, identify veteran characteristics associated with downloading and use of COVID Coach, and characterize key content usage within the app. Methods: Data were analyzed from the 2019-2020 National Health and Resilience in Veterans Study (NHRVS), which surveyed a nationally representative, prospective cohort of 3078 US military veterans before and 1 year into the pandemic. The NHRVS sample was drawn from KnowledgePanel, a research panel of more than 50,000 households maintained by Ipsos, Inc. The median time to complete the survey was nearly 32 minutes. The research version of COVID Coach was offered to all veterans who completed the peripandemic follow-up assessment on a mobile device (n=814; weighted 34.2% of total sample). App usage data from all respondents who downloaded the app (n=34; weighted 3.3% of the mobile completers sample) were collected between November 14, 2020, and November 7, 2021. Results: We found that most US veterans (81.5%) own smartphones, and that veterans with higher education, greater number of adverse childhood experiences, higher extraversion, and greater severity of pandemic-related posttraumatic stress disorder symptoms were more likely to download COVID Coach. Although uptake and usage of COVID Coach were relatively low (3.3% of eligible participants, n=34), 50% of the participants returned to the app for more than 1 day of use. The interactive tools for managing stress were used most frequently. Conclusions: The COVID-19 pandemic has increased the need for and creation of digital mental health tools. However, these resources may require tailoring for older veteran populations. Future research is needed to better understand how to optimize digital mental health tools such as apps to ensure uptake and usage among older adults, particularly those who have experienced traumas across the lifespan.

中文翻译：

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预测美国退伍军人使用 COVID Coach 应用程序：使用基于概率的面板进行漏斗分析

背景：尽管 COVID-19 大流行并未导致老年人心理健康问题的普遍增加，但有证据表明，一些老年退伍军人确实经历了先前存在的心理健康状况的恶化，并且心理健康困难与缺乏社会支持和越来越多的与流行病相关的压力源。移动心理健康应用程序具有可扩展性，可能是在大流行期间及以后管理压力的有用资源，并且可能提供因大流行而无法访问的服务。但是，在大流行期间，老年退伍军人对移动设备的总体舒适度以及影响移动应用程序使用和使用的因素尚不为人所知。COVID Coach 是一款免费的、以证据为依据的移动应用程序，专为应对与流行病相关的压力而设计。已评估公共使用数据；然而，尚未探讨老年退伍军人对该应用程序的接受和使用情况。目标：本研究的目的是描述美国退伍军人的智能手机拥有率，确定与下载和使用 COVID Coach 相关的退伍军人特征，并描述应用程序中的关键内容使用情况。方法：数据分析来自 2019-2020 年国家退伍军人健康和复原力研究 (NHRVS)，该研究在大流行之前和大流行后 1 年调查了具有全国代表性的前瞻性队列 3078 名美国退伍军人。NHRVS 样本来自 KnowledgePanel，这是一个由 Ipsos, Inc 维护的由 50,000 多个家庭组成的研究小组。完成调查的中位时间接近 32 分钟。COVID Coach 的研究版本提供给所有在移动设备上完成大流行后续评估的退伍军人（n=814；占总样本的加权 34.2%）。在 2020 年 11 月 14 日至 2021 年 11 月 7 日期间收集了所有下载该应用程序的受访者（n=34；加权 3.3% 的移动完成者样本）的应用程序使用数据。结果：我们发现，大多数美国退伍军人 (81.5%) 拥有智能手机，并且受过高等教育、更多不良童年经历、外向性更高以及与流行病相关的创伤后应激障碍症状更严重的退伍军人更有可能下​​载 COVID Coach。尽管 COVID Coach 的使用率和使用率相对较低（符合条件的参与者的 3.3%，n=34），但 50% 的参与者在使用超过 1 天后返回应用程序。管理压力的交互式工具使用频率最高。结论：COVID-19 大流行增加了对数字心理健康工具的需求和创造。然而，这些资源可能需要针对老年退伍军人群体进行调整。未来的研究需要更好地了解如何优化应用程序等数字心理健康工具，以确保老年人，特别是那些在整个生命周期中经历过​​创伤的人的接受和使用。