{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T20:18:36Z","timestamp":1790194716195,"version":"4.1.0"},"reference-count":48,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,11,24]],"date-time":"2021-11-24T00:00:00Z","timestamp":1637712000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Psychol."],"abstract":"<jats:p><jats:bold>Background:<\/jats:bold> Veterans who did not seek and complete treatment as intended have been shown to have an elevated risk of experiencing and being exposed to post-traumatic stress disorder (PTSD). Internet-based interventions (IBIs) provide more confidentiality and fewer treatment barriers, and they are regarded as potential treatments to reduce PTSD in veterans. However, the effects of IBI for veterans with PTSD are inconclusive.<\/jats:p><jats:p><jats:bold>Objectives:<\/jats:bold> IBI is defined as any internet-based series of psychosocial interventions, of which the internet works as a way of delivery. Psychosocial content and reduction of PTSD symptoms in veterans have been recognized as two core elements of this intervention. This study aimed to (1) examine the effects of IBI on veterans\u2019 PTSD outcomes and (2) distinguish between the elements of IBI that play an important role for veterans with PTSD.<\/jats:p><jats:p><jats:bold>Methods:<\/jats:bold> Web of Science, PubMed, EMBASE, PsycINFO, Cochrane, Wanfang Data, CNKI, and CQVIP databases were searched for randomized controlled trials (RCT) in IBI programs for veterans with PTSD, covering all studies in English and Chinese published from January 1990 to November 2020. Also, related studies tracking citations were identified. Studies met the following inclusion criteria of (1) being RCTs; (2) containing IBI in the full text; (3) having IBI conducted on veterans as participants; and (4) being on PTSD. All processes followed PRISMA. The risk of bias of the studies was assessed by the Cochrane Systematic Review Handbook. The confidence of outcomes of this review was valued according to the GRADE (Grading of Recommendations Assessment, Development, and Evaluation). The meta-analysis was done by RevMan 5.13. Two teams of reviewers independently searched the literature, made the assessment, and extracted the data.<\/jats:p><jats:p><jats:bold>Results:<\/jats:bold> A total of 1,493 citations were identified after initial searching, of which the full texts of 66 studies were screened. Eventually, six RCT studies met the inclusion criteria. Beneficial effects of IBI were found on the overall PTSD outcome (\u22120.29; 95% CI\u20130.48 to \u22120.11, <jats:italic>p<\/jats:italic>&amp;lt;0.01). Particularly, IBI based on cognitive behavioral therapy (CBT) with peer support was found to be effective for PTSD outcomes (\u22120.36; 95% CI\u20130.61 to \u22120.11, <jats:italic>p<\/jats:italic>&amp;lt;0.01). The subgroup analysis demonstrated that scores of PTSD outcome measured by a PCL (PTSD Checklist) decreased to an average score of 0.38 (95% CI \u20130.60 to \u22120.15, <jats:italic>p<\/jats:italic>=0.001). The intervention had a positive effect on the PTSD outcome on veterans with comorbid psychological disorders (\u22120.30; 95% CI \u20130.61 to \u22120.11, <jats:italic>p<\/jats:italic>&amp;lt;0.01). Overall, the six studies included were evaluated with a low risk of bias, and the outcomes of the meta-analysis were proven with high confidence.<\/jats:p><jats:p><jats:bold>Conclusion:<\/jats:bold> On the whole, IBIs have a positive effect on the overall PTSD outcome of veterans. The results encouraged us to focus on IBI with CBT with peer support for veterans, on specific instruments for veterans with PTSD, and on veterans with comorbid psychological disorders. This study, however, has limits. Only six studies with a Western population were included, which might result in cultural bias on IBI effects. In future, more high-qualified research and diverse cultural background of RCTs is needed to prove the effectiveness of IBI on veterans with PTSD.<\/jats:p>","DOI":"10.3389\/fpsyg.2021.711652","type":"journal-article","created":{"date-parts":[[2021,11,30]],"date-time":"2021-11-30T22:27:07Z","timestamp":1638311227000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":14,"title":["Impacts of Internet-Based Interventions for Veterans With PTSD: A Systematic Review and Meta-Analysis"],"prefix":"10.3389","volume":"12","author":[{"given":"Yang","family":"Zhou","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhenggang","family":"Bai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei","family":"Wu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zijia","family":"Fan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cuiying","family":"Wu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Longyi","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Siyu","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2021,11,24]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"111","DOI":"10.1037\/a0027924","article-title":"Videoconferencing psychotherapy: a systematic review","volume":"9","author":"Backhaus","year":"2012","journal-title":"Psychol. Serv."},{"key":"ref2","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1007\/s12160-009-9130-7","article-title":"Defining internet-supported therapeutic interventions","volume":"38","author":"Barak","year":"2009","journal-title":"Ann. Behav. Med."},{"key":"ref3","doi-asserted-by":"publisher","first-page":"793","DOI":"10.1093\/geront\/45.6.793","article-title":"Worksite-based internet multimedia program for family caregivers of persons with dementia","volume":"45","author":"Beauchamp","year":"2005","journal-title":"The Gerontologist"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"153","DOI":"10.1002\/jts.21994","article-title":"A preliminary study of an internet-based intervention for OEF\/OIF veterans presenting for VA specialty PTSD care","volume":"28","author":"Belsher","year":"2015","journal-title":"J. Trauma. Stress."},{"key":"ref5","doi-asserted-by":"publisher","first-page":"527","DOI":"10.1093\/her\/15.5.527","article-title":"Health education and the digital divide: building bridges and filling chasms","volume":"15","author":"Bernhardt","year":"2000","journal-title":"Health Educ. Res."},{"key":"ref6","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1177\/1357633X010070S103","article-title":"The use of telepsychiatry in the brief counselling of non-psychotic patients from an inner-London general practice","volume":"7","author":"Bose","year":"2001","journal-title":"J. Telemed. Telecare"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"455","DOI":"10.1037\/a0025038","article-title":"afterdeployment.org: A web-based multimedia wellness resource for the postdeployment military community","volume":"42","author":"Bush","year":"2011","journal-title":"Prof. Psychol. Res. Pr."},{"key":"ref8","doi-asserted-by":"publisher","first-page":"80","DOI":"10.1016\/j.jpsychires.2016.09.021","article-title":"Peer-based health interventions for people with serious mental illness: A systematic literature review","volume":"84","author":"Cabassa","year":"2017","journal-title":"J. Psychiatr. Res."},{"key":"ref9","doi-asserted-by":"publisher","first-page":"e3","DOI":"10.2196\/jmir.4.1.e3","article-title":"Web-based cognitive behavior therapy: analysis of site usage and changes in depression and anxiety scores","volume":"4","author":"Christensen","year":"2002","journal-title":"J. Med. Internet Res."},{"key":"ref10","doi-asserted-by":"publisher","first-page":"372","DOI":"10.1007\/s12671-015-0453-0","article-title":"The body scan and mindful breathing among veterans with PTSD: type of intervention moderates the relationship between changes in mindfulness and post-treatment depression","volume":"7","author":"Colgan","year":"2016","journal-title":"Mindfulness"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"323","DOI":"10.1016\/j.genhosppsych.2015.04.007","article-title":"Delivery of self training and education for stressful situations (DESTRESS-PC): a randomized trial of nurse assisted online self-management for PTSD in primary care","volume":"37","author":"Engel","year":"2015","journal-title":"Gen. Hosp. Psychiatry"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"1490","DOI":"10.1136\/bmj.328.7454.1490","article-title":"Grading quality of evidence and strength of recommendations","volume":"328","year":"2004","journal-title":"Br. Med. J."},{"key":"ref13","doi-asserted-by":"publisher","first-page":"e313","DOI":"10.2196\/jmir.7896","article-title":"Components and outcomes of internet-based interventions for caregivers of older adults: systematic review","volume":"19","author":"Guay","year":"2017","journal-title":"J. Med. Internet Res."},{"key":"ref14","doi-asserted-by":"publisher","first-page":"184","DOI":"10.1016\/j.cpr.2015.06.008","article-title":"The efficacy of recommended treatments for veterans with PTSD: A metaregression analysis","volume":"40","author":"Haagen","year":"2015","journal-title":"Clin. Psychol. Rev."},{"key":"ref15","doi-asserted-by":"publisher","first-page":"41","DOI":"10.1089\/tmj.2017.0305","article-title":"An online peer educational campaign to reduce stigma and improve help seeking in veterans with posttraumatic stress disorder","volume":"25","author":"Hamblen","year":"2019","journal-title":"Telemed. J. E Health"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"425","DOI":"10.1002\/jclp.20777","article-title":"The effectiveness of a trauma focused spiritually integrated intervention for veterans exposed to trauma","volume":"67","author":"Harris","year":"2011","journal-title":"J. Clin. Psychol."},{"key":"ref17","doi-asserted-by":"publisher","first-page":"d5928","DOI":"10.1136\/bmj.d5928","article-title":"The Cochrane collaboration's tool for assessing risk of bias in randomised trials","volume":"343","author":"Higgins","year":"2011","journal-title":"Br. Med. J."},{"key":"ref18","doi-asserted-by":"publisher","first-page":"557","DOI":"10.1136\/bmj.327.7414.557","article-title":"Measuring inconsistency in meta-analysis","volume":"327","author":"Higgins","year":"2003","journal-title":"Br. Med. J."},{"key":"ref19","doi-asserted-by":"publisher","first-page":"e216","DOI":"10.2196\/jmir.9548","article-title":"Internet-based interventions aimed at supporting family caregivers of people with dementia: systematic review","volume":"20","author":"Hopwood","year":"2018","journal-title":"J. Med. Internet Res."},{"key":"ref20","doi-asserted-by":"publisher","first-page":"101","DOI":"10.1002\/jclp.20853","article-title":"Association of participation in a mindfulness program with measures of PTSD, depression and quality of life in a veteran sample","volume":"68","author":"Kearney","year":"2012","journal-title":"J. Clin. Psychol."},{"key":"ref21","doi-asserted-by":"publisher","first-page":"638","DOI":"10.1002\/da.22104","article-title":"A pilot study of group mindfulness-based cognitive therapy (MBCT) for combat veterans with posttraumatic stress disorder (PTSD)","volume":"30","author":"King","year":"2013","journal-title":"Depress. Anxiety"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"94","DOI":"10.3390\/healthcare6030094","article-title":"Veteran treatments: PTSD interventions","volume":"6","author":"Koven","year":"2018","journal-title":"Healthcare"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"461","DOI":"10.1037\/tra0000176","article-title":"An Internet-based writing intervention for PTSD in veterans: a feasibility and pilot effectiveness trial","volume":"9","author":"Krupnick","year":"2017","journal-title":"Psychol. Trauma"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"230","DOI":"10.1080\/21635781.2015.1055866","article-title":"Help-seeking stigma and mental health treatment seeking among young adult veterans","volume":"3","author":"Kulesza","year":"2015","journal-title":"Mil. Behav. Health"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"1676","DOI":"10.1176\/appi.ajp.2007.06122057","article-title":"A randomized, controlled proof-of-concept trial of an internet-based, therapist-assisted self-management treatment for posttraumatic stress disorder","volume":"164","author":"Litz","year":"2007","journal-title":"Am. J. Psychiatr."},{"key":"ref26","doi-asserted-by":"publisher","first-page":"788","DOI":"10.1016\/j.janxdis.2013.03.004","article-title":"Dissemination and implementation of prolonged exposure therapy for posttraumatic stress disorder","volume":"27","author":"McLean","year":"2013","journal-title":"J. Anxiety Disord."},{"key":"ref27","doi-asserted-by":"publisher","first-page":"455","DOI":"10.1348\/014466509X472138","article-title":"Dropout from internet-based treatment for psychological disorders","volume":"49","author":"Melville","year":"2011","journal-title":"Br. J. Clin. Psychol."},{"key":"ref28","doi-asserted-by":"publisher","first-page":"658","DOI":"10.1016\/j.ijsu.2010.07.299","article-title":"Corrigendum to: preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement","volume":"8","author":"Moher","year":"2010","journal-title":"Int. J. Surg."},{"key":"ref29","doi-asserted-by":"publisher","first-page":"e30","DOI":"10.2196\/jmir.1602","article-title":"Supportive accountability: A model for providing human support to enhance adherence to ehealth interventions","volume":"13","author":"Mohr","year":"2011","journal-title":"J. Med. Internet Res."},{"key":"ref30","doi-asserted-by":"publisher","first-page":"707","DOI":"10.1016\/j.cpr.2009.09.002","article-title":"Military-related PTSD and intimate relationships: from description to theory-driven research and intervention development","volume":"29","author":"Monson","year":"2009","journal-title":"Clin. Psychol. Rev."},{"key":"ref31","doi-asserted-by":"publisher","first-page":"811","DOI":"10.1002\/da.22397","article-title":"Telemedicine versus in-person delivery of cognitive processing therapy for women with posttraumatic stress disorder: A randomized noninferiority trial","volume":"32","author":"Morland","year":"2015","journal-title":"Depress. Anxiety"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"843","DOI":"10.1016\/j.amepre.2016.06.008","article-title":"Evaluating digital health interventions: key questions and approaches","volume":"51","author":"Murray","year":"2016","journal-title":"Am. J. Prev. Med."},{"key":"ref33","doi-asserted-by":"publisher","first-page":"205","DOI":"10.1186\/s12888-020-02595-z","article-title":"Evaluation of an internet-based intervention for service members of the German armed forces with deployment-related posttraumatic stress symptoms","volume":"20","author":"Niemeyer","year":"2020","journal-title":"BMC Psychiatry"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"697","DOI":"10.1176\/appi.ps.650501","article-title":"Engaging U.S. veterans with PTSD in online therapy","volume":"65","author":"Parish","year":"2014","journal-title":"Psychiatric Services"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"305","DOI":"10.1037\/prj0000334","article-title":"A pilot study comparing peer supported web-based CBT to self-managed web CBT for primary care veterans with PTSD and hazardous alcohol use","volume":"42","author":"Possemato","year":"2019","journal-title":"Psychiatr. Rehabil. J."},{"key":"ref36","doi-asserted-by":"publisher","first-page":"245","DOI":"10.1258\/jtt.2011.100909","article-title":"A brief self-guided telehealth intervention for post-traumatic stress disorder in combat veterans: a pilot study","volume":"17","author":"Possemato","year":"2011","journal-title":"J. Telemed. Telecare"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"750","DOI":"10.1089\/acm.2014.0014","article-title":"The effect of a yoga intervention on alcohol and drug abuse risk in veteran and civilian women with posttraumatic stress disorder","volume":"20","author":"Reddy","year":"2014","journal-title":"J. Altern. Complement. Med."},{"key":"ref38","doi-asserted-by":"publisher","first-page":"1638","DOI":"10.3389\/fpsyg.2020.01638","article-title":"Defining the PTSD service dog intervention: perceived importance, usage, and symptom specificity of psychiatric service dogs for military veterans","volume":"11","author":"Rodriguez","year":"2020","journal-title":"Front. Psychol."},{"key":"ref39","doi-asserted-by":"publisher","first-page":"199","DOI":"10.1037\/ser0000032","article-title":"Efficacy of structured approach therapy in reducing PTSD in returning veterans: A randomized clinical trial","volume":"12","author":"Sautter","year":"2015","journal-title":"Psychol. Serv."},{"key":"ref40","doi-asserted-by":"publisher","first-page":"e47","DOI":"10.2196\/resprot.4354","article-title":"Usefulness of a tailored ehealth service for informal caregivers and professionals in the dementia treatment and care setting: The ehealth monitor dementia portal","volume":"5","author":"Schaller","year":"2016","journal-title":"JMIR Res. Protoc."},{"key":"ref41","doi-asserted-by":"publisher","first-page":"e10668","DOI":"10.2196\/10668","article-title":"Impact of internet-based interventions on caregiver mental health: systematic review and meta-analysis","volume":"20","author":"Sherifali","year":"2018","journal-title":"J. Med. Internet Res."},{"key":"ref42","doi-asserted-by":"publisher","first-page":"e14","DOI":"10.2196\/mental.5558","article-title":"A systematic review and meta-analysis of e-mental health interventions to treat symptoms of posttraumatic stress","volume":"4","author":"Simblett","year":"2017","journal-title":"JMIR Ment. Health"},{"key":"ref43","doi-asserted-by":"publisher","first-page":"42","DOI":"10.1037\/tra0000184","article-title":"Web-based trauma intervention for veterans has physical health payoff in randomized trial","volume":"9","author":"Stevens","year":"2016","journal-title":"Psychol. Trauma Theory Res. Pract. Policy"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"195","DOI":"10.3138\/jmvfh.2018-0035","article-title":"A systematic review of interventions for supporting partners of military veterans with PTSD","volume":"5","author":"Turgoose","year":"2019","journal-title":"J. Mil. Veteran Fam. Health"},{"key":"ref45","doi-asserted-by":"publisher","first-page":"85","DOI":"10.1016\/j.psychres.2011.07.026","article-title":"Efficacy of an internet-based intervention for posttraumatic stress disorder in Iraq: A pilot study","volume":"195","author":"Wagner","year":"2011","journal-title":"Psychiatry Res."},{"key":"ref46","doi-asserted-by":"publisher","first-page":"725","DOI":"10.1682\/JRRD.2014.04.0113","article-title":"E-mental health preferences of veterans with and without probable posttraumatic stress disorder","volume":"52","author":"Whealin","year":"2015","journal-title":"J. Rehabil. Res. Dev."},{"key":"ref47","doi-asserted-by":"publisher","first-page":"534","DOI":"10.1016\/j.jagp.2017.11.001","article-title":"Prevalence of mental health disorders in elderly U.S. military veterans: A meta-analysis and systematic review","volume":"26","author":"Williamson","year":"2018","journal-title":"Am. J. Geriatr. Psychiatr."},{"key":"ref48","doi-asserted-by":"publisher","first-page":"e13415","DOI":"10.2196\/13415","article-title":"Web-based interventions to improve mental health in home caregivers of people with dementia: meta-analysis","volume":"21","author":"Zhao","year":"2019","journal-title":"J. Med. Internet Res."}],"container-title":["Frontiers in Psychology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyg.2021.711652\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,11,30]],"date-time":"2021-11-30T22:27:09Z","timestamp":1638311229000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyg.2021.711652\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,11,24]]},"references-count":48,"alternative-id":["10.3389\/fpsyg.2021.711652"],"URL":"https:\/\/doi.org\/10.3389\/fpsyg.2021.711652","relation":{},"ISSN":["1664-1078"],"issn-type":[{"value":"1664-1078","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,11,24]]},"article-number":"711652"}}