Abstract
Mobile health applications (apps) are increasingly used to reduce mental health problems. However, few effective apps are available for bereaved adults. Recently, a randomized controlled trial demonstrated the short-term beneficial effects of access to the My Grief app in mitigating symptoms of prolonged grief and posttraumatic stress in bereaved parents. The present study examined the long-term outcomes of app access and their predictors in a longitudinal survey of participants who had access to the My Grief app. We assessed symptoms of prolonged grief (PG-13), posttraumatic stress (PCL-5), and depressive symptoms (PHQ-9) at 3-, 6-, and 12-month follow-up assessments. Potential predictors of symptom change included baseline symptom levels, sociodemographic and loss-related variables, rumination (UGRS), negative grief-related cognitions (GCQ-SF), avoidance processes (DAAPGQ), and self-reported app use reported at each follow-up. Significant small-to-moderate reductions in prolonged grief, posttraumatic stress, and depressive symptoms were observed in people with app access at most follow-ups, ds = 0.26-0.66. For each symptom type, more severe baseline symptoms significantly predicted larger symptom reductions, Bs = 0.37-0.55. Lower baseline negative grief-related cognitions significantly predicted larger 3-month prolonged grief, B = -0.15, and posttraumatic stress symptom reductions, B = -0.23. Lower baseline anxious avoidance significantly predicted larger 3-month depressive symptom reductions, B = -0.23. Self-reported app use did not significantly predict symptom changes. Participants with access to the My Grief app experienced decreased symptom levels over a 1-year period. Specific cognitive behavioral processes (avoidance, negative cognitions) appear to be implicated in the short-term effects of app access.