Further Development and Initial Testing of RESTORE in Frontline Workers

The PTSD Checklist-5 (PCL-5); Weathers, Litz, Keane, Palemeri, Marx, & Schnurr, 2013) weekly version will provide a measure of change in self-reported PTSD symptoms over the course of intervention. Items are rated from 0 (not at all) to 4 (extremely). Items are summed to create a total score ranging from 0 to 80. A cutoff score of ≥ 33 can be used for screening for PTSD diagnosis (Weathers et al, 2013).

A brief clinical measure to assess anxiety severity. Each item is rated on a 4-point scale from 0 (not at all) to 3 (nearly every day). A symptom severity score is calculated based on the sum of the 7 items, with scores ranging from 0 to 21. GAD-7 scores of 10 and 15 are the cut-off points for moderate and severe anxiety, respectively (Spitzer et., 2006).

A self-report measure of depression symptoms. Each of the 9 items is rated on a 4-point scale, ranging from 0 (not at all) to 3 (nearly every day). Items are summed to produce a total severity score ranging from 0 to 27, with higher scores indicating greater symptom severity. PHQ-9 scores ≥ 10 are considered indicative of moderate levels of depression (Manea et al., 2011).

Single items will be used to measure perceived health, work functioning, and quality of life over the past month. Each item is rated on a 5-point scale, ranging from 1 (not at all satisfied/poor) to 5 (extremely satisfied/excellent).

The TRGI is a 32-item self-report questionnaire designed to measure guilt experienced as a result of surviving a traumatic event. The inventory includes three scales: guilt cognitions, distress, and global guilt scales.

The Adapted Brief Grief Questionnaire is a 5-item self-report measure for screening for complicated grief (Shear et al., 2006). The items deal with difficulty accepting the death, interference in current life, troubling thoughts related to the death, avoidance of reminders of the loss, and feeling distant from others. Each item is scored from 0 to 2 (0 = not at all, 1 = somewhat, 2 = a lot).

Perceived Emotional Social Support is a single item measure of emotional of social support received in the past week from family and friends (Stappenbeck et al., 2015). The item is rated on a 5-point Likert scale, with responses ranging from 1 (strongly disagree) to 5 (strongly agree).

The Adapted Expressions of Moral Injury Scale is an investigator-adapted version of the Expressions of Moral Injury Scale (EMES). The EMES is a brief measure assessing emotions, beliefs, and behaviours associated with moral injury (Koenig, Mantri, Wang, & Lawson, 2020). Each of the 11 items is rated on a 5-point scale, ranging from 1 (strongly disagree) to 5 (strongly agree).

The Mental Health Seeking Attitudes/Intention Scale is an adapted 3-item measure to assess attitudes toward seeking help from a mental health professional (Hammer, Parent, & Spiker, 2018). Each of the items is rated on a 7-point scale, ranging from 1 (definitely false) to 7 (definitely true).

Qualitative interviews will be conducted post-intervention to further assess acceptability and to improve RESTORE content and presentation.

Feasibility of recruitment measured by percentage of screened individuals who are eligible and percentage of those who screen eligible who are subsequently enrolled.

Adherence to the intervention measured by mean number of completed modules and drop out rate.

Engagement will be measured by mean number of platform log-ins, mean number of module entries and mean number of practice assignment entries.

At the end of the intervention, participants will complete the Client Satisfaction Questionnaire (Attkisson & Zwick, 1982), which measures client satisfaction with the intervention they received. This short questionnaire consists of 6 items, and each item is rated on a 4-point scale with varying response alternatives (1=poor/no, definitely not/quite dissatisfied to 4=excellent/yes, definitely/very satisfied).