Wendy Potts

Use of the internet and other media for health information among clinic outpatients with serious mental illness

OBJECTIVE This study examined how people with serious mental illness access and use media to receive health information. METHODS One hundred people with serious mental illness were interviewed regarding their media use, with a focus on how they get their health information. RESULTS Among these participants, 91% had a television (M+/-SD=5.7+/-4.6 hours per day), and 74% indicated it was a primary health information source. One third of the sample had used the Internet. Of these participants, about half (53%) had gone online for health information. Younger participants and those with more education were significantly more likely to use the Internet. Among Internet nonusers, there was still interest in finding health information online; however, expense, lack of computer skills or knowledge, and difficulties with typing and reading prevented doing so. CONCLUSIONS Although this sample used television more often than the Internet as a resource, there appears to be interest among persons with serious mental illness in using the Internet as a source of health information and support.

A comparison of adherence to hypoglycemic medications between Type 2 diabetes patients with and without serious mental illness

Inadequate self-management of chronic medical conditions like Type 2 diabetes may play a role in the poor health status of individuals with serious mental illnesses. We compared adherence to hypoglycemic medications and blood glucose control between 44 diabetes patients with a serious mental illness and 30 patients without a psychiatric illness. The two groups did not differ in their ability to manage a complex medication regimen as assessed by a performance-based measure of medication management capacity. However, significantly fewer patients with a mental illness self-reported nonadherence to their hypoglycemic regimens compared to those without a mental illness. Although individuals with mental illnesses also had better control of blood glucose, this metabolic parameter was not correlated with adherence to hypoglycemic medications in either patient group. The experience of managing a chronic mental illness may confer advantages to individuals with serious mental illnesses in the self-care of co-occurring medical conditions like Type 2 diabetes.

Predictors of mortality in patients with serious mental illness and co-occurring type 2 diabetes

Persons with serious mental illness (SMI) have higher rates of chronic medical conditions such as type 2 diabetes and mortality than the general population. We assessed demographic and health related factors in the prediction of all-cause mortality among SMI patients with diabetes and a comparison group of diabetic patients without SMI. From 1999 to 2002, 201 patients with type 2 diabetes and SMI were recruited from community mental health centers and 99 persons with type 2 diabetes and no identified mental illness were recruited from nearby primary clinics. Deaths over an average seven-year period after baseline assessment were identified using the Social Security Administrations Death Master File. Twenty-one percent in each group died over follow-up. Age, smoking status, duration of diabetes, and diabetes-related hospitalization in the 6months prior to baseline assessment predicted mortality in all patients. Among the non-SMI patients, those who were prescribed insulin had over a four-fold greater odds of mortality whereas this association was not found in the SMI patients. Diabetes likely contributes to mortality in persons with SMI. Providers need to be especially vigilant regarding mortality risk when patients require hospitalization for diabetes and as their patients age. Smoking cessation should also be aggressively promoted.

Media and internet ownership and use among mental health outpatients with serious mental illness.

Objective: To determine whether people with serious mental illness (SMI) and substance use disorder (SUD) use the Internet to receive health information. Methods: One hundred people with SMI were surveyed in community mental health clinics. Results: Participants with SUD were significantly less likely to use the Internet compared to those who without SUD (.34 [.12–.95] p = .04). Internet users with SUD were significantly more likely to report accessing sites topically related to substance abuse (p = .01). Conclusion: Few participants with SMI and SUD used the Internet. Attention to educating patients about quality health information on the Internet may be warranted.

Evaluation of brief screens for gambling disorder in the substance use treatment setting

BACKGROUND AND OBJECTIVES The goal of this study was to determine the diagnostic accuracy of brief screens for Gambling Disorder within a sample of people receiving outpatient treatment for substance use disorders. METHODS Individuals (n = 300) recruited from intensive outpatient substance use treatment (23.67%) or methadone maintenance programs (76.34%) participated in the study. Four brief screens for Gambling Disorder were administered and compared to DSM-5 criteria. Receiver operator curves were created and an Area Under the Curve (AUC) analysis (an overall summary of the utility of the scale to correctly identify Gambling Disorder) was assessed for each. RESULTS On average participants were aged 46.4 years (SD = 10.2), African American/Black (70.7%), with an income less than

Pilot feasibility study of Heart2HAART: a smartphone application to assist with adherence among substance users living with HIV

20,000/year (89.5%). Half the participants were female. Approximately 40% of participants (40.5%; n = 121) met DSM-5 criteria for Gambling Disorder. Accuracy of the brief screens as measured by hit rate were .88 for the BBGS, .77 for the Lie/Bet, .75 for NODS-PERC, and .73 for the NODS-CLiP. AUC analysis revealed that the NODS-PERC (AUC: .93 (95% CI: .91-.96)) and NODS-CLiP (AUC: .90 (95% CI: .86-.93)) had excellent accuracy. DISCUSSION AND CONCLUSIONS The NODS-PERC and NODS-CLiP had excellent accuracy at all cut-off points. However, the BBGS appeared to have the best accuracy at its specified cut-off point. SCIENTIFIC SIGNIFICANCE Commonly used brief screens for Gambling Disorder appear to be associated with good diagnostic accuracy when used in substance use treatment settings. The choice of which brief screen to use may best be decided by the needs of the clinical setting.

Prevalence and potential predictors of gambling disorder among people living with HIV

ABSTRACT Background: Smartphones with programmable apps may offer innovative interactive interventions for improving adherence among people living with HIV with substance use problems. Methods: This pilot randomized controlled trial sought to primarily determine the usability and feasibility of using a smartphone-based intervention called Heart2HAART as an adjunct to directly observed treatment with adherence counseling compared to directly observed treatment with adherence counseling alone among those with HIV and a history of substance use over a three-month time frame. Participants in the Heart2HAART condition completed an additional survey on usability and acceptability. Adherence was measured using unannounced pill counts assessed via a phone call. Results: Twenty-eight participants were randomized to receive Heart2HAART (n = 19) or control (n = 9). All were receiving either weekly (n = 9) or daily (n = 19) observed treatment. Among those randomized to Heart2HAART, 63.2% reported no difficulty using the Heart2HAART smartphone application and 94.7% responded that the medication reminders did not interfere negatively with their activities. On average participants used Heart2HAART application 56.8 times over the three-month trial. In analyses adjusting for age, there was no difference in adherence to HAART medication between the Heart2HAART and control group as evaluated by the random pill count assessment (P = .29). Conclusions: Heart2HAART was feasible to use during a three-month pilot trial. Future studies may evaluate a more tailored approach, with more robust contingency management.

Telephone Based Cognitive Behavioral Therapy Targeting Major Depression Among Urban Dwelling, Low Income People Living with HIV/AIDS: Results of a Randomized Controlled Trial

ABSTRACT Specific subsets of the adult population are at an increased risk of problem gambling behaviors. Previous research among these subsets has found increased rates of disordered gambling among those with drug use, alcohol use, mood, anxiety, and personality disorders. To what extent this may apply to the HIV population, known to have a high burden of co-occurring substance use and mental disorders, is not known The current study also examined the effectiveness of The Brief Biosocial Gambling Screen (BBGS) for the diagnosis of gambling disorder. This study examined the prevalence of gambling behaviors and disordered gambling in patients enrolled in an urban HIV clinic. 100 people living with HIV (PLWH) were assessed on gambling behaviors, impulsivity, and criterion on disordered gambling. Screening for gambling disorder using the BBGS was compared to the American Psychiatric Association DSM-5 criterion. The mean age was 53, 44% were female, 60% completed high school or above, and 80% self-identified as unemployed/disabled. 13% met four or more criteria for gambling disorder according to DSM-5 criteria. Participants that met criteria were more likely to report marijuana (p = .044) and heroin (p = .002) use, and greater impulsivity (p < 0.00001) when compared to participants who did not meet criteria. The BBGS was able to effectively screen individuals for disordered gambling with a sensitivity of 100%, specificity of 90.8%, positive predictive value of 56.2%, and a negative predictive value of 100%. These results suggest that urban HIV clinics may need to consider actively screening for gambling disorders, and referring to appropriate counseling and treatment for those who screen positive.