Depression Focus on MoodFx Raymond W Lam MD FRCPC Professor and Associate Head for Research Department of Psychiatry University of British Columbia Director Mood Disorders Centre ID: 487602
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Slide1
Mobile Health Apps for
Depression
Focus
on
MoodFx
Raymond W. Lam, MD, FRCPC
Professor and Associate Head for Research,
Department of Psychiatry, University of British Columbia; Director, Mood Disorders Centre, Djavad Mowafaghian Centre for Brain Health, Vancouver, BC;Executive Chair, Canadian Network for Mood and Anxiety Treatments (CANMAT).r.lam@ubc.caSlide2
Disclosure Statement 2012-2014
Dr. Raymond Lam, MD, FRCPC
Ad hoc Consulting/Advisory
AstraZeneca, Bristol Myers Squibb, CANMAT, Eli Lilly, Lundbeck,
Mochida, Pfizer, Takeda
Ad hoc Speaking honoraria
AstraZeneca, Bristol Myers Squibb, CANMAT, Canadian Psychiatric Association, Lundbeck, Lundbeck Institute, Medscape, Mochida, Otsuka,
Servier
.
Clinical trials/research
(through UBC)
Bristol Myers Squibb, Canadian Institutes of Health Research, Canadian Psychiatric Association Foundation, CANMAT, Lundbeck,
Merck, Ontario Brain Institute,
Pfizer, St. Jude Medical, UBC Institute of Mental Health/Coast Capital Savings,
University Health Network, VGH Foundation
Stocks
None.
Patents/Copyrights
Lam Employment Absence and Productivity
Scale (LEAPS)
Book Royalties
American
Psychiatric Press, Cambridge University Press,
Informa
Press, Oxford University Press.Slide3
Objectives
www.WorkingWithDepression.ca
Describe the nature of occupational impairment in MDD.
Discuss challenges in application of measurement-based care.
Describe the clinical use of a free mobile web app for tracking symptoms and work functioning.
At the end of this presentation, participants will be able toSlide4
Comparing the burden of mental and physical illness
* Health-adjusted life years (HALYs)
A combination of years lived with less than full function and years lost to early death.
Ratnasingham
S, et al.
Ontario Burden of Mental Illness and Addictions Report
Institute for Clinical Evaluative Science, 2012.Lung, Colorectal, Breast & Prostate Cancers Combined
Health Adjusted Life Years* Lost (in thousands)Depression ALONE carries a burden that is more than the COMBINED burden of lung, colorectal, breast, and prostate cancers.
Years of Reduced Function
Years of Life LostSlide5
Impact of depression on employment
Health Report. Statistics Canada Health Statistics Division. 2006; 17:1-88.
Alonso et al. Acta Psychiatr Scand 2004; Suppl (420):38-46. Kessler et al, Health Aff
1999; 18:163-71.
Depressed workers have:
32 days unable to work in the past year
(Statistics Canada report)
3-4 times more work loss days per month, compared to non-depressed workers (ESEMed study)2-3 times more short-term disability, compared to non-depressed workers
(United States survey of corporations)
Presenteeism
is a greater
problem than
absenteeism.
Presenteeism
= reduced productivity when people are still at work.Slide6
Depression is associated with huge economic costs
Work-related economic losses are estimated to cost, per year:
In Canada: C$6 billion.
In the UK: £8.6 billion.
In Europe: €118 billion.
In the US: US$83 billion.
Health Report. Statistics Canada 2006; Stephens &
Joubert, Chron Dis Canada 2001.UK House of Commons Library report, 2009; Sobocki et al, J Ment Health Policy Econ 2006;Greenberg et al, J Clin
Psychiatry 2003.Slide7
Love and work
are the
cornerstones
of our
Humanness.
~ Sigmund Freud ~Slide8
Why is work important to patients?
Source of income
Sense of accomplishmentIntellectual stimulation
Regular activity scheduleSocial interactionsSlide9
Clinical consequences of cognitive deficits
Problems with planning
Difficulties with memory
Impaired
ability to
concentrate
Slowness in responding
Hammar Å, Årdal G.
Front Hum Neurosci 2009;3:26
Cognitive dysfunction in depression is common, broad-based and often debilitating, leading to difficulties includingSlide10Slide11
Measurement-based care for depression?
Can you treat hypertension without measuring blood pressure?Can you treat diabetes without measuring HbA1c?What makes us think we can treat depression without measuring it?Slide12
Over the last 2 weeks, how often have you been bothered by any of the following problems?
Not at all (0)
Several days (1)
More than half the days (2)Nearly every day (3)
1.
Little interest or pleasure in doing things.
☐☐☐
☐2. Feeling down, depressed, or hopeless.☐☐
☐
☐3. Trouble
falling/staying asleep, sleeping too much.
☐
☐
☐
☐
4.
Feeling
tired or having little energy.
☐
☐
☐
☐
5.
Poor
appetite or overeating.
☐
☐
☐
☐
6.
Feeling
bad about yourself, or that you are a failure, or have let yourself or your family down.
☐
☐
☐
☐
7.
Trouble
concentrating on things, such as reading the newspaper or watching TV.
☐
☐
☐
☐
8.
Moving
or speaking so slowly that other people could have
noticed.
Or
the opposite; being
so
fidgety
or restless that you have been moving around more than usual.
☐
☐
☐
☐
9.
Thoughts
that you would be better off dead or of hurting yourself in some way.
☐
☐
☐
☐
Patient Health Questionnaire-9 (PHQ-9)
A score of 10 or higher indicates significant depression.Slide13
Measurement-based care for depression
Routine assessment with scales integrated into clinical care.Symptoms
, side effects, functioning, quality of life.
Timely adjustments of medication and counsellingTimely changes in treatments depending on outcomes.
Measurement-based care improves outcomes
in people treated for depression
Trivedi
MH, et al. Am J Psychiatry. 2006;163:28-40.Slide14
Doctors understand
the importance of scales – but many don’t use them
Type of scaleCurrently Use
Would like to use
Symptom
questionnaire
50%40%Quality of life
23%54%Overall functioning37%54%
Work functioning
23%
59%
Survey of 115 family physicians
2/3 of psychiatrists don’t use a scale. Reasons why?
Do not believe it would be clinically helpful.
28%
Do not
know what scale to use.
21%
Takes too much time.
34%
Too disruptive to practice.
19%
Wasn’t trained to use them.
34%
Survey of
314
psychiatrists
CANMAT Needs Assessment, September
2010;
Zimmerman &
McGlinchey
, J
Clin
Psychiatry 2006.Slide15
Think Global
Act LocalSlide16
Enlist the power of the internet!
83% of adult Canadians have internet access (2012 data)90% have high speed connection; >70% use the internet daily59% of households used wireless handheld devices to connect to the web at home
Canadian Internet Use Survey 2012.
Desktop computer
Laptop computer
Wireless handheld device
Games consoleSlide17
Name
Target audienceMain purpose/ description
Depression – screening, diagnostic
STAT Depression Screening PHQ-9
Clinicians;
patients possible
Guides physicians in selecting and monitoring depression treatment.Doctor Depression
CliniciansAssessment scales to measure depressive symptoms in patients.Depression Screening/ ProPatientsScreens depression with PHQ-9, with additional questions on suicide, psychosis, and mania.
Geriatric Depression Screening
PatientsScreens for geriatric depression with a 15-item geriatric depression scale.
Depression check
Patients
Screens, assesses risk for depression, bipolar, anxiety disorders
iCrazy
- Psychology Tests
Gen. pop.
General interest, education; screening for various mental disorders
Mood Tracking – depression, bipolar, etc.
Depression Monitor
Patients
Screens depression with PHQ-9 and tracks (graphs) scores over time.
T2 Mood Tracker
Patients
Mood tracking
MoodyMe
– Mood Diary
Gen.
pop., patients
Monitor moods and emotions (including depression, mania),
medications,
etc.
MoodPanda
Patients, Gen. pop
Monitor moods: “interactive mood diary”
iMind
& Mood
Patients
Assessment & recommendations
Moodtrack.com
Gen.
pop.
Mood tracking
Treatment/Programs
Depression
Cure – 12 week course
Patients
Treatment
iBiomed
Patients, caregivers, clinicians
Synchronize with caregivers; social network; health records
Anti-Depression
Patients
info and strategies
HappyApp
Patients/Gen.
pop.
“brainwave” synchronization, audio frequencies
Social/Community Support
Depression Connect
Patients *teenagers
Connection/community/ discussion/social networking
Bipolar Disorder Connect
Patients
Social networking, community
Happiness, General Well-Being
Happiness Tips
Gen. pop.
Inspire, motivate
happiness+
Gen.
pop.
Inspire: quotes; Social: chat
Optimism
Gen.
pop.
Depression apps in iTunes storeSlide18
MoodFx
mobile web app
www.MoodFx.ca
Partners in Measurement-based mHealth
eHealth
Strategy OfficeSlide19
MoodFx
mobile web appOptimized for computers, tablets, smartphonesPatient-centred focus on work functioning and depression
Assess and track outcomes using validated scalesInteractive text and email appointment reminders
Subscribe to text/email tipsSimple and easy to use
www.MoodFx.caSlide20
Validated scales used in MoodFxFor work functioning =
LEAPSLam Employment Absence and Productivity ScaleFor depression = PHQ-9Sensitivity and specificity for diagnosis of Major Depressive Disorder (MDD) = 83% and 83%For anxiety = GAD-7Sensitivity and specificity for diagnosis of anxiety disorder =For GAD: 89% and 82%
For Others: 66-74% and 80-81%For cognition = PDQ-D-5Perceived Deficits Questionnaire for DepressionSlide21
The Lam Employment Absence and
Productivity Scale (LEAPS) 10-item, self-rated scale assessing symptoms and function at work.Designed specifically for depressed patients in primary care and specialty clinic settings.Takes only 3–5 minutes to complete.
Used to track progress and to help in work/off work decisions.
©
Lam RW, University of British Columbia, 2009Slide22
Perceived Deficits Questionnaire – Depression5-item version
The following questions describe problems people may have with their memory, attention or concentration. Please select the best response based on your experiences during the past 7 days
During the
past 7 days, how often did you…
Never in the
past 7 days
Rarely (once or twice) Sometimes (3 to 5 times)
Often
(about once a day)
Very often
(more than
once a day)
Have trouble getting things organised?
0
1
2
3
4
Have trouble concentrating on what you
were reading?
0
1
2
3
4
Forget the date unless you looked it up?
0
1
2
3
4
Forget what you talked about after a telephone conversation?
0
1
2
3
4
Feel like your mind went totally blank?
0
1
2
3
4
Add up score in each column:
TOTAL SCORE:
_________
Copyright: Professor Sullivan, McGill UniversitySlide23
MoodFx mobile web app
www.MoodFx.caSlide24
Summary
Depressive symptoms cause significant interference in work functioning.Measurement-based care can involve patients in tracking outcomes to improve collaboration with their clinicians
New mobile web apps like MoodFx can utilize technology to support measurement-based care
www.MoodFx.caSlide25
Thanks to our collaborators and funders
Collaborators in workplace mental health
:
Melady
Preece
Paula CayleyAnne WalkerDebra
WolinskyErin MichalakEllen AndersonFunding partners:Canadian Institutes of Health ResearchMichael Smith Foundation for Health Research
Mathematics of InformationTechnology and AdvancedComputing
Canadian Psychiatric Association Foundation
Sagar
Parikh
Andrew Clarke
Dorothy
Shaw
Erica Frank
Cindy
Woo
Marie-
Josee
Filteau
Canadian
Network for Mood and Anxiety Treatments
UBC Institute of Mental
Health /
Coast Capital Savings
Lundbeck
Canada
AstraZeneca Canada
Pfizer Canada
Optum
CV
Manjunath
Trish Nolan
David Bond
Lakshmi
Yatham
Auby
Axler
Kendall Ho
www.WorkingWithDepression.caSlide26Slide27Slide28
Depressive symptoms and impairment in
work functioningPercentage of depressed patients (n=164) reporting that depressive symptom interfered with work functioning “Very much” or “So much that I had to stop working”
Adapted from
Lam RW et al. Depress Res Treat 2012;2012:630206
Patients (%)
Anergia
= lack of motivation, low energy, physically slowed down, sleepy during day;
Tension = anxious / tense / nervous, irritability / anger;
Cognitive difficulty = trouble concentrating, trouble with memory
52%
52% of depressed patients report that cognitive difficulty
severely interferes with their occupational functioning
Cognitive DifficultySlide29
Employee and Family Assistance Programs (EAPs) are the “first line of defence” for workers with depression
Ongoing collaboration with
Optum
(previously PPC Canada), an a
ccredited
EAP provider to over 350 organizations across CanadaRandomized controlled trial of MoodFx vs. standard care in clients attending EAP services
N=50 Optum clinicians and 750 clientsOutcomes to include symptoms and work functioning
Evaluation of MoodFx in anEmployee Assistance Program (EAP)Slide30
Knowledge translation and dissemination for MoodFxContinuing Professional Development activities
Webinars for cliniciansLunch and learn sessionsCME conferences and eventsAids for users – fridge magnets, online videos, whiteboards, social mediaEvaluation using RE-AIM principles, including users and clinicians