A Clinician-Supported Mobile App to Reduce Mental Health Symptoms Among World Trade Center Responders in Florida:
Mark J Macgowan1, Kyle Possemato2, Eric Kuhn3
1School of Social Work, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th Street, AHC5-513, Miami, FL, 33199, United States, 1 3053480427.
Background:
World Trade Center (WTC) general responders (GRs) continue to experience long-term mental health conditions, including posttraumatic stress disorder (PTSD), depression, anxiety, and sleep disturbance. A growing number of GRs reside in Florida, where barriers such as stigma, limited access to specialty care, and age-related limitations contribute to persistent unmet mental health needs. PTSD Coach, a mobile app originally developed for trauma-exposed veterans, has shown promise but has not been evaluated with WTC GRs or adapted for Spanish-speaking responders.
Objective:
This study aims to evaluate the feasibility, acceptability, and efficacy of Clinician-Supported (CS) PTSD Coach for reducing PTSD symptoms among English-speaking and Spanish-speaking WTC GRs living in Florida. Secondary objectives include evaluating effects on depression, anxiety, and sleep disturbance; comparing CS PTSD Coach with Self-Managed (SM) PTSD Coach and a waitlist control; and adapting and delivering a Spanish-language version of the intervention.
Methods:
This study is a 3-arm randomized controlled trial comparing CS PTSD Coach, SM PTSD Coach, and a waitlist control for reducing PTSD, depression, anxiety, and sleep disturbance among English-speaking and Spanish-speaking WTC GRs living in Florida. A total of 120 participants are randomized and assessed at baseline, 8 weeks, and a 12-week follow-up. CS PTSD Coach includes 4 clinician-guided sessions integrated with app-based activities, whereas SM PTSD Coach includes a single orientation session. Outcomes include PTSD symptoms (PTSD Checklist for DSM-5), depression (Patient Health Questionnaire-9), anxiety (Generalized Anxiety Disorder-7), and sleep disturbance (Insomnia Severity Index). Feasibility and acceptability are assessed using app use data, satisfaction ratings, and usability measures. Primary analyses focus on between-group differences after the intervention (8 weeks), with secondary longitudinal analyses incorporating all assessment time points.
Results:
The notice of award was received in September 2024, and institutional review board approval, including amendments, was granted in January 2025. Recruitment began in February 2025, with data collection initiated in March 2025. As of April 2026, 63 participants have been enrolled, and outcome data collection is ongoing. Data analysis will commence following completion of follow-up assessments, with dissemination of results anticipated in 2027.
Conclusions:
This trial will provide the first randomized controlled evaluation of a clinician-supported mobile PTSD intervention for WTC responders, including Spanish-speaking GRs. Findings will inform the feasibility, acceptability, and potential scalability of supported digital mental health interventions for aging, geographically dispersed disaster-exposed populations.