Use and Interest in Virtual Reality for Mental and Physical Health in a U.S. Population-Based Sample of Low-Income Veterans

Abstract

Virtual reality (VR) represents a new way to deliver health interventions, but research is needed on experience and interest in using VR for health among important subgroups in the United States. This descriptive study examined these issues among low-income veterans in the United States. Data were analyzed from a nationally representative sample of 1,028 low-income veterans surveyed in late 2022-early 2023. The results showed that while only 10 percent of the sample had ever used a VR headset, 35 percent of veterans reported they would be “somewhat/very willing” to use VR for mental health or substance use problems. Veterans with higher levels of education (adjusted odds ratio [aOR] = 1.25, 95% confidence interval [CI] = 1.07–1.47), lower mental health functioning (aOR = 0.96, 95% CI = 0.94–0.98), and previous VR experience (aOR = 5.30, 95% CI = 2.96–9.48) were significantly more willing to use VR to treat their mental health or substance use problems. These findings suggest many veterans are willing to use VR to improve their mental health, and they could benefit from greater exposure and education about VR-based interventions.

Introduction

Virtual reality (VR) holds great potential to enhance various aspects of life, from work life to entertainment. With technological advancements and mass production of VR headsets, VR has become more affordable and common in various settings for the general population. VR also represents an exciting new modality to deliver interventions for physical and mental health. While there is a large body of literature on positive effects of using video games and mobile apps to deliver health interventions,^1,2 VR may present new opportunities as a more immersive and interactive experience for users.

While VR has existed for over three decades, it is only recently that VR headsets have become widely used and purchased as personal devices. As VR has become more popular, there is growing research in the mental health field.³ However, the literature is nascent, and there is little understanding of use and interest in VR among various subgroups in the United States. Veterans represent an important subgroup in the United States who are vulnerable to mental health, substance use, and other social problems.^4–6 Several small-scale studies have explored using VR in veterans for various applications, such as treating posttraumatic stress disorder, providing job interview training, and addressing phantom limb pain.^7–9 However, more data are needed to inform how scalable these applications are and how interested veterans are to use them.

Thus, the current study used a population-based sample of low-income U.S. veterans to (a) examine experience with VR headsets; (b) assess interest in using VR for mental health and substance use issues; and (c) identify individual characteristics associated with prior VR use and interest in using VR to treat mental health and substance use.

Methods

Data were from a combined nationally representative survey of low-income U.S. veterans conducted as part of the National Veteran Homeless and Other Poverty Experiences (NV-HOPE) study. The NV-HOPE study was designed to examine psychosocial outcomes of low-income veterans.^10,11 Surveys were conducted through a contract with Ipsos using KnowledgePanel^®. KnowledgePanel is the first and largest online research panel that is representative of the U.S. population. Panel members were randomly recruited through probability-based sampling, and households were provided with access to the Internet and hardware if needed. Ipsos uses address-based sampling, selects samples by weighting the pool of active members using the most recent U.S. Census Bureau's Current Population Survey and uses a probability-proportional-to-size procedure to select study specific samples.

Design weights are adjusted to account for any differential nonresponse. All respondents provided informed consent; the study protocol followed institutional security and human subject procedures at Ipsos; and a de-identified dataset was provided to the research team which was deemed exempt from institutional review board review.

Eligibility criteria for the study were adults who were 18 years or older, had served on active duty in the U.S. Armed Forces (across all military branches) and were now discharged from the military, and lived in a household under 300 percent of the U.S. federal poverty level in 2021. This study combined data from two nationally representative surveys of low-income veterans (n = 783 and n = 245) that were conducted using the same methodology and during the same time period (December 2022–January 2023). Using the combined dataset (n = 1,028), poststratification weights were computed based on geodemographic benchmarks (age, gender, race/ethnicity, education, Census region, household income, and metropolitan area) of veterans living in households at less than 300 percent of the federal poverty level in the 2019 American Community Survey. An iterative proportional fitting (raking) procedure was used to produce the final weights. Data are available upon reasonable request and proper authorization by the author.

Measures

Sociodemographic characteristics of participants were collected by a self-report questionnaire. Clinical characteristics were assessed with several widely used, validated measures including Short Form-8 item Health Survey (SF-8)¹² which assesses general physical and mental health functioning and generates Physical and Mental Component Summary scores; Alcohol Use Disorder Identification Test Consumption¹³ used to assess any past-year probable alcohol use disorder, with a score of 8 or greater as indicative of a positive screen¹⁴; Drug Use Disorder Checklist¹⁵ based on diagnostic criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5)¹⁶ with endorsement of symptoms that met DSM-5 criteria for drug use disorder indicative of a positive screen.

Generalized Anxiety Disorder-2 scale¹⁷ and the Patient Health Questionnaire-2 (PHQ-2) scale¹⁸ with scores of 3 or greater on each scale were treated as indicative of a positive screen for generalized anxiety disorder and major depression, respectively. Any past 2-week passive suicidal ideation was assessed with item 9 of the PHQ-9 that asked about “thoughts that you would be better off dead or hurting yourself.”¹⁹

A number of different questions designed for this study were used to collect information about participants' experiences with VR. First, participants were instructed that they would be asked some questions about using “virtual reality headsets (e.g., Oculus, Metra Quest Pro, HTC Vive, and Playstation VR) and then asked: “Have you ever used a virtual reality headset?” with yes/no response options. Participants who answered in the affirmative were then asked if they own a VR headset and whether they ever used a VR headset for the following: work/meetings, games/recreation, viewing pornography, meditation/relaxation, physical fitness/physical health, and mental health/substance abuse treatment. Lastly, all participants were asked to respond to the following question on a 5-point Likert scale from 1 (Not willing at all) to 5 (Very willing): “How willing would you be to use a virtual reality headset to help you with mental health or substance use problems? If you don't have problems, how open would you be if you did?”

Data analyses

First, descriptive statistics were conducted to examine VR experiences of the sample. Second, correlation analyses were conducted using Pearson's r and chi-square tests to examine associations between sociodemographic and clinical characteristics, and ever using VR and willingness to use VR for mental health or substance use problems. Third, two sets of logistic regression analyses were conducted to examine characteristics independently associated with ever using VR and being “somewhat/very willing” to use VR for mental health or substance use problems. In the logistic regression analyses, only characteristics found to be significantly associated at the p < 0.01 level were included as independent variables. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were calculated for effect sizes. Given the number of statistical tests, significance for bivariate and multivariable analyses was set at the p < 0.01 level.

Results

Table 1 shows the sociodemographic and clinical characteristics of the total sample along with a summary of their experiences with VR. With the sample weighted to be representative of the low-income U.S. veteran population, the majority of the sample was middle-age white men, with a high school education or higher, living in a metropolitan area (i.e., metropolitan statistical area, having personal annual income below $60,000, and 11–19 percent screening positive for alcohol use, drug use, depression, or anxiety problems).

Table 1.

Individual Characteristics, Experiences with Virtual Reality, and Correlations with Willingness to Use Virtual Reality for Mental Health or Substance Use Problems Among Low-Income Veterans (n = 1,028)

	Weighted mean/raw count	Weighted SD/percent	Correlation with willingness to use VR for mental health or substance use problems ^a
Sociodemographic characteristics
Age, mean, SD	63.8	15.8	−0.18^***
Male	905	89.7	0.01
Race^b			−0.01
White non-Hispanic	792	70.3
Black non-Hispanic	106	14.0
Hispanic	14	2.0
Other	81	8.7
Education level		5.0	0.09^**
Below high school	19	3.4
High school graduate/GED	235	40.6
Some college/associates degree	516	38.3
Bachelor's degree	170	11.1
Master's/doctoral degree	88	6.6
Married	562	53.8	−0.04
Living in a metropolitan area	817	79.0	−0.01
Personal annual income			−0.01
<$10,000	53	7.8
$10,000–$19,999	135	14.1
$20,000–$39,999	423	38.4
$40,000–$59,999	302	30.8
$60,000–$84,999	75	7.2
$85,000–$99,999	17	1.2
$100,000–$124,999	6	0.4
Clinical characteristics
SF-8 Physical Component Summary score, mean, SD	45.3	10.1	−0.06
SF-8 Mental Component Summary score, mean, SD	53.7	9.6	−0.18^***
Positive screen for alcohol use problems	100	11.4	0.06
Positive screen for drug use problems	26	3.9	0.08^*
Positive screen on major depression	115	13.5	0.13^***
Positive screen for generalized anxiety disorder	137	18.5	0.08^*
Any passive suicidal ideation in past 2 weeks	117	14.0	0.11^***
VR experience
Ever used a VR headset	91	9.9	0.20^***
Own a VR headset	26	2.5	0.11^***
Have used VR for:
Work/meetings	0	0.0
Games/recreation	23	2.2	0.10^**
Viewing pornography	0	0.0
Meditation/relaxation	5	0.4	0.05
Physical fitness/physical health	6	0.5	0.06
Mental health/substance abuse treatment	0	0.0
Would be “somewhat/very willing” to use VR for mental health or substance use problems	343	34.7

p < 0.05, ^**p < 0.01, ^***p < 0.001.

Willingness to use virtual reality for mental health or substance use problems was rated from 1 (Not willing at all) to 5 (Very willing).

In correlational analyses, race was dichotomized as white or racial minorities.

GED, General Education Diploma; SD, standard deviation; SF-8, 8 item Short-Form Health Survey; VR, virtual reality.

In terms of VR experience, only 10 percent of the sample had ever used a VR headset before and less than 3 percent owned a VR headset. Of the veterans who had used VR before, it was almost entirely for games and recreation, with a proportion reporting having used VR for physical fitness or physical health. But ∼35 percent of veterans reported they would be “somewhat/very willing” to use VR for their mental health or substance use problems (mean 2.95 on a 5-point scale, standard deviation = 1.32).

Correlation analyses revealed younger age, racial minority status, higher education level, poorer general physical and mental health, and positive screen for major depression were significantly associated with ever using a VR headset (all p < 0.01; Table 2). Further, correlation analyses also revealed younger age, higher education, lower SF-8 Mental Health Component Summary scores, positive screens for major depression, any past 2-week passive suicidal ideation, prior experience with VR, and owning a VR headset were significantly associated with willingness to use VR for mental health or substance use problems (all p < 0.01; Table 1).

Table 2.

Association between Individual Characteristics Any Experience with Virtual Reality Among Low-Income Veterans (n = 1,028)

	Association between characteristics and having ever used a VR headset, Pearson r or Chi-square
	Sociodemographic characteristics
Age	r = −0.19^***
Male or female	χ² = 1.63
White or racial/ethnic minorities	χ² = 11.85^***
Education level	r = 0.13^***
Married	χ² = 3.51
Living in a metropolitan area	χ² = 0.49
Personal annual income	r = −0.05
Clinical characteristics
SF-8 Physical Component Summary score	r = −0.09^**
SF-8 Mental Component Summary score	r = −0.09^**
Positive screen for alcohol use problems	χ² = 0.21
Positive screen for drug use problems	χ² = 1.75
Positive screen on major depression	χ² = 8.21^**
Positive screen for generalized anxiety disorder	χ² = 3.35
Any passive suicidal ideation in past 2 weeks	χ² = 4.44^*

p < 0.05, ^**p < 0.01, ^***p < 0.001.

When these correlations were examined in logistic regression analyses, the results showed that veterans who were racial minorities (aOR = 0.49, 95% CI = 0.31–0.77, β = 0.10, p = 0.002) and had higher levels of education (aOR = 1.51, 95% CI = 1.20–1.90, β = 0.411, p = 0.001) were significantly more likely to have ever used a VR headset. Similarly, veterans with higher levels of education (aOR = 1.25, 95% CI = 1.07–1.47, β = 0.23, p = 0.006), lower SF-8 Mental Component Summary scores (aOR = 0.96, 95% CI = 0.94–0.98, β = −0.04, p < 0.001), and had used a VR headset before (aOR = 5.30, 95% CI = 2.96–9.48, β = 1.67, p < 0.001) were significantly more likely to be “somewhat/very willing” to use VR for their mental health or substance use problems.

Discussion

In a nationally representative U.S. sample, only 1 in 10 low-income veterans has ever used a VR headset and only about 3 percent of the population own a VR headset. While there have been limited estimates from the general population, one survey by the Harris Poll of a nationally representative group of 2,010 U.S. adults found that 23 percent of Americans have used a VR headset before and 7.1 percent own a VR headset.²⁰ Compared to these numbers, low-income U.S. veterans may have had less access and experience to VR headsets. This may be especially true for low-income veterans who were white and/or had lower levels of education since they were found to be significantly less likely to have ever used VR. Greater exposure and opportunities to try VR among low-income veterans may be needed.

Despite their limited exposure to VR, over one-third of low-income veterans reported they would be willing to use VR to treat mental health or substance use problems. This finding was encouraging and indicates there is at least moderate interest among veterans to use VR for health. This interest is particularly notable for veterans who had more mental health problems since we found they were significantly more willing to use VR for treatment. Some studies have found VR is more effective in treating comorbid mental health disorders among military personnel than traditional therapies.²¹ We found that veterans who had previous experience with VR were 5 times more likely to be willing to use VR for treatment than those who had no prior experience with VR, again suggesting the importance of providing greater exposure to VR in the veteran population.

This study provides some of the first data on experiences with VR in the veteran population and the level of interest in using VR to treat mental health. These findings indicate there is great interest in VR and more opportunities should be provided to veterans to use VR in general and specifically to treat mental health and substance use problems. These data also provide justification and pave the way for more pilot studies and education about VR-based interventions for veterans.

Limitations of this study include use of self-report data on VR, generalizability of results limited to low-income veterans, and the cross-sectional study design. These limitations are outweighed by the strengths of the study including a nationally representative sample, use of comprehensive sociodemographic and clinical data as correlates, and results on VR that have not been reported before and contribute to the literature.

Footnotes

Acknowledgments

Thanks to the veterans who served and participated in the study.

Authors' Contributions

The author conceptualized the study, analyzed the data, and wrote the article.

Author Disclosure Statement

The author reports no conflicts of interest with this work.

Funding Information

There was no specific funding for this work. Data collection was funded internally by the VA National Center on Homelessness among Veterans.

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