A longitudinal analysis of PTSD and other mental health symptoms among people sentenced to drug treatment court.

OBJECTIVE: Drug treatment courts offer an alternative to incarceration for people who are facing criminal charges related to addiction. Because addiction commonly co-occurs with trauma exposure and associated mental illnesses, drug treatment courts likely serve people with these difficulties. Yet whether or how mental health symptoms change over drug treatment court participation has not been studied. METHOD: We sought to (1) describe the mental health symptom profiles, including PTSD, of recent drug court enrollees, (2) examine the course of these symptom profiles at baseline, 6-month follow-up, and 12-month follow-up, and (3) test posttraumatic stress symptoms (PTSS) and gender as potential moderators of any identified time effects. Participants were 983 adults sentenced to drug treatment court between 2009 and 2017. RESULTS: Generalized linear mixed models revealed a significant effect of time on PTSS as measured by the PTSD Checklist and on summary indices of mental health measured by the Brief Symptom Inventory (p < .05 for all the outcomes). Gender did not moderate the effect of time on either outcome. However, those with PTSS above the clinical cut-off at baseline experienced less improvement in mental health over time. CONCLUSION: Our findings suggest that drug treatment court participants' mental health, including PTSS, improved over time. However, the presence of elevated PTSS interfered with improvements in other facets of mental health. Additional work is needed to identify specific program components that may exert causal effects and to examine interventions for PTSS that can be readily integrated in drug treatment courts. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Evaluating the Use of Mobile Health Technology in Older Adults With Heart Failure: Mixed-Methods Study.

BACKGROUND: Heart failure (HF) is associated with high rates of hospitalizations, morbidity, mortality, and costs. Remote patient monitoring (mobile health, mHealth) shows promise in improving self-care and HF management, thus increasing quality of care while reducing hospitalizations and costs; however, limited information exists regarding perceptions of older adults with HF about mHealth use. OBJECTIVE: This study aimed to compare perspectives of older adults with HF who were randomized to either (1) mHealth equipment connected to a 24-hour call center, (2) digital home equipment, or (3) standard care, with regard to ease and satisfaction with equipment, provider communication and engagement, and ability to self-monitor and manage their disease. METHODS: We performed a pilot study using a mixed-methods descriptive design with pre- and postsurveys, following participants for 12 weeks. We augmented these data with semistructured qualitative interviews to learn more about feasibility, satisfaction, communication, and self-management. RESULTS: We enrolled 28 patients with HF aged 55 years and above, with 57% (16/28) male, 79% (22/28) non-Hispanic white, and with multiple comorbid conditions. At baseline, 50% (14/28) rated their health fair or poor and 36% (10/28) and 25% (7/28) were very often/always frustrated and discouraged by their health. At baseline, 46% (13/28) did not monitor their weight, 29% (8/28) did not monitor their blood pressure, and 68% (19/28) did not monitor for symptoms. Post intervention, 100% of the equipment groups home monitored daily. For technology anxiety, 36% (10/28) indicated technology made them nervous, and 32% (9/28) reported fear of technology, without significant changes post intervention. Technology usability post intervention scored high (91/100), reflecting ease of use. A majority indicated that a health care provider should be managing their health, and 71% reported that one should trust and not question the provider. Moreover, 57% (16/28) believed it was better to seek professional help than caring for oneself. Post intervention, mHealth users relied more on themselves, which was not mirrored in the home equipment or standard care groups. Participants were satisfied with communication and engagement with providers, yet many described access problems. Distressing symptoms were unpredictable and prevailed over the 12 weeks with 79 provider visits and 7 visits to emergency departments. The nurse call center received 872 readings, and we completed 289 telephone calls with participants. Narrative data revealed the following main themes: (1) traditional communication and engagement with providers prevailed, delaying access to care; (2) home monitoring with technology was described as useful, and mHealth users felt secure knowing that someone was observing them; (3) equipment groups felt more confident in self-monitoring and managing; and finally, (4) uncertainty and frustration with persistent health problems. CONCLUSIONS: mHealth equipment is feasible with potential to improve patient-centered outcomes and increase self-management in older adults with HF.